Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Introduction
- Part I Therapeutic misalliances
- Part II Medical futility
- 4.1 Letting go: a study in pediatric life-and-death decision making
- 4.2 Near-drowning, futility, and the limits of shared decision making
- 4.3 Topical discussion
- 5.1 Long-term ventilation in a child with severe central nervous system impairment
- 5.2 Autonomy, community, and futility: moral paradigms for the long-term ventilation of a severely impaired child
- 5.3 Topical discussion
- 6.1 Complexities in the management of a brain-dead child
- 6.2 The moral arena in the management of a brain-dead child
- 6.3 Topical discussion
- Part III Life by any means
- Part IV Institutional impediments to ethical action
- References
- Index
6.1 - Complexities in the management of a brain-dead child
Published online by Cambridge University Press: 18 August 2009
- Frontmatter
- Contents
- List of contributors
- Preface
- Introduction
- Part I Therapeutic misalliances
- Part II Medical futility
- 4.1 Letting go: a study in pediatric life-and-death decision making
- 4.2 Near-drowning, futility, and the limits of shared decision making
- 4.3 Topical discussion
- 5.1 Long-term ventilation in a child with severe central nervous system impairment
- 5.2 Autonomy, community, and futility: moral paradigms for the long-term ventilation of a severely impaired child
- 5.3 Topical discussion
- 6.1 Complexities in the management of a brain-dead child
- 6.2 The moral arena in the management of a brain-dead child
- 6.3 Topical discussion
- Part III Life by any means
- Part IV Institutional impediments to ethical action
- References
- Index
Summary
First of all I would define medicine as the complete removal of the distress of the sick, the alleviation of the more violent diseases and the refusal to undertake to cure cases in which the disease has already won the mastery, knowing that everything is not possible to medicine.
Hippocratic corpus (Lloyd 1978: 140)Introduction
The management of the brain-dead individual moves physicians beyond the traditional boundaries of medicine. The physicians are confronted with an assortment of moral, professional, and psychological problems whose effects are deeply felt by both family members and healthcare providers. To vividly illustrate how such cases can play out in practice, despite all preparations of protocols and policies, we present a case which focuses upon the problems encountered once a four-year-old child is diagnosed as fulfilling brain-death criteria. We focus upon the medical interventions and the psychosocial support that were required in the care of this patient, and in addition we address the ethical dilemma caregivers faced while caring for this patient in a critical care unit.
The case
The patient was a four-year-old female who was transferred to a tertiary pediatric intensive care unit following a cardiorespiratory arrest. Prior to this event she was bed-ridden with Pierre-Robin syndrome (an autosomal recessive disorder characterized by a small jaw [micrognathia], retracted tongue [glossoptosis], and upper airway obstruction) and severe developmental delay. Because of poor airway control and gastroesophageal reflux, she was fed via a surgically placed gastric tube.
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- Information
- Ethical Dilemmas in PediatricsCases and Commentaries, pp. 135 - 139Publisher: Cambridge University PressPrint publication year: 2005
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