1
40
25
-
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Title
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April 2024 List
Text
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April List 2024
URL Address
<a href="http://doi.org/10.3389/fped.2024.1272648" target="_blank" rel="noreferrer noopener"> http://doi.org/10.3389/fped.2024.1272648</a>
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Title
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Perceived potentially inappropriate treatment in the PICU: frequency, contributing factors and the distress it triggers
Publisher
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Frontiers in Pediatrics
Date
A point or period of time associated with an event in the lifecycle of the resource
2024
Subject
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distress; medical futility; death & dying; end-of-life (EOL); ethical conflict; potentially inappropriate treatment
Creator
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Sarpal A; Miller MR; Martin CM; Sibbald RW; Speechley KN
Description
An account of the resource
BACKGROUND: Potentially inappropriate treatment in critically ill adults is associated with healthcare provider distress and burnout. Knowledge regarding perceived potentially inappropriate treatment amongst pediatric healthcare providers is limited. OBJECTIVES: Determine the frequency and factors associated with potentially inappropriate treatment in critically ill children as perceived by providers, and describe the factors that providers report contribute to the distress they experience when providing treatment perceived as potentially inappropriate. METHODS: Prospective observational mixed-methods study in a single tertiary level PICU conducted between March 2 and September 14, 2018. Patients 0-17 years inclusive with: (1) ≥1 organ system dysfunction (2) moderate to severe mental and physical disabilities, or (3) baseline dependence on medical technology were enrolled if they remained admitted to the PICU for ≥48 h, and were not medically fit for transfer/discharge. The frequency of perceived potentially inappropriate treatment was stratified into three groups based on degree of consensus (1, 2 or 3 providers) regarding the appropriateness of ongoing active treatment per enrolled patient. Distress was self-reported using a 100-point scale. RESULTS: Of 374 patients admitted during the study, 133 satisfied the inclusion-exclusion criteria. Eighteen patients (unanimous - 3 patients, 2 providers - 7 patients; single provider - 8 patients) were perceived as receiving potentially inappropriate treatment; unanimous consensus was associated with 100% mortality on 3-month follow up post PICU discharge. Fifty-three percent of providers experienced distress secondary to providing treatment perceived as potentially inappropriate. Qualitative thematic analysis revealed five themes regarding factors associated with provider distress: (1) suffering including a sense of causing harm, (2) conflict, (3) quality of life, (4) resource utilization, and (5) uncertainty. CONCLUSIONS: While treatment perceived as potentially inappropriate was infrequent, provider distress was commonly observed. By identifying specific factor(s) contributing to perceived potentially inappropriate treatment and any associated provider distress, organizations can design, implement and assess targeted interventions.
Identifier
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<a href="http://doi.org/10.3389/fped.2024.1272648" target="_blank" rel="noreferrer noopener">10.3389/fped.2024.1272648</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2024
April List 2024
Death & Dying
Distress
end-of-life (EOL)
ethical conflict
Frontiers in Pediatrics
Martin CM
Medical Futility
Miller MR
potentially inappropriate treatment
Sarpal A
Sibbald RW
Speechley KN
-
Dublin Core
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Title
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August 2023 List
Text
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Citation List Month
August List 2023
URL Address
<a href="http://doi.org/10.5546/aap.2022-02872.eng" target="_blank" rel="noreferrer noopener"> http://doi.org/10.5546/aap.2022-02872.eng</a>
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Title
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Decisions concerning resuscitation and end-of-life care in neonates. Bioethical aspects (Part II)
Publisher
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Archivos Argentinos de Pediatria
Date
A point or period of time associated with an event in the lifecycle of the resource
2023
Subject
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Humans; Infant, Newborn; Infant; Decision Making; Terminal Care; Withholding Treatment; Medical Futility; Bioethics; Terminal Care; Death; Resuscitation
Creator
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Mariani G; Arimany M
Description
An account of the resource
Coping with the death of a newborn infant requires training and reflection regarding the end-of-life decision-making process, communication with the family, and the care to be provided. The objective of this article is to analyze in depth the salient aspects of neonatal bioethics applied to end-of-life situations in newborn infants. Part I describes notions of therapeutic futility, redirection of care criteria, patient and family rights, and concepts about the value of life. Part II analyzes situations that deserve considering the redirection of care and delves into aspects of communication and the complex process of end-of-life decision-making in newborn infants.
Identifier
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<a href="http://doi.org/10.5546/aap.2022-02872.eng" target="_blank" rel="noreferrer noopener">10.5546/aap.2022-02872.eng</a>
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2023
Archivos Argentinos De Pediatria
Arimany M
August List 2039
Bioethics
Death
Decision Making
Humans
Infant
Infant, Newborn
Mariani G
Medical Futility
Resuscitation
Terminal Care
Withholding Treatment
-
Dublin Core
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Title
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March 2023 List
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Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
March List 2023
URL Address
<a href="http://doi.org/10.3390/ijerph192416975" target="_blank" rel="noreferrer noopener"> http://doi.org/10.3390/ijerph192416975</a>
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Title
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Limitation of Futile Therapy in the Opinion of Nursing Staff Employed in Polish Hospitals-Results of a Cross-Sectional Study
Publisher
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International Journal of Environmental Research and Public Health
Date
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2022
Subject
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Attitude of Health Personnel; Nursing Staff; Adult; Cesarean Section; Child; Cross-Sectional Studies; Human; Medical Futility; Poland; Quality of Life; Surveys and Questionnaires
Creator
An entity primarily responsible for making the resource
Damps M; Gajda M; Kowalska M; Kucewicz-Czech E
Description
An account of the resource
The debate on limiting futile therapy in the aspect of End of Life (EoL) care has been going on in Poland over the last decade. The growing demand for EoL care resulting from the aging of societies corresponds to the expectation of a satisfactory quality of life and self-determination. The authors designed a cross-sectional study using a newly designed questionnaire to assess the opinions of 190 nurses employed in intensive care units (ICUs) on futile therapy, practices, and the respondents' approach to the issue. The problem of futile therapy and its clinical implications are known to the nursing community. Among the most common reasons for undertaking futile therapy in adult patients, the respondents declared fear of legal liability for not taking such actions (71.58%), as well as fear of being accused of unethical conduct (56.32%), and fear of talking to the patient/patient's family and their reaction (43.16%). In the case of adult patients, the respondents believed that discontinuation of futile therapy should be decided by the patient (84.21%), followed by a doctor (64.21%). As for paediatric patients, two-thirds of the respondents mentioned a doctor and a court (64.74% and 64.21%, respectively). Overall, 65.26% of the respondents believe and agree that the comfort of the patient's last days is more important than the persistent continuation of therapy and prolonging life at all costs. The presented results clearly show the attitude of the respondents who defend the patient's dignity and autonomy.
Identifier
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<a href="http://doi.org/10.3390/ijerph192416975" target="_blank" rel="noreferrer noopener">10.3390/ijerph192416975</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2022
Adult
Attitude Of Health Personnel
Cesarean Section
Child
Cross-sectional Studies
Damps M
Gajda M
Human
International Journal of Environmental Research and Public Health
Kowalska M
Kucewicz-Czech E
March List 2023
Medical Futility
Nursing Staff
Poland
Quality Of Life
Surveys And Questionnaires
-
Dublin Core
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Title
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November 2020 List
Text
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Citation List Month
February List 2023
URL Address
<a href="http://doi.org/10.3389/fped.2020.00581" target="_blank" rel="noreferrer noopener"> http://doi.org/10.3389/fped.2020.00581</a>
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Title
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Moral Distress in the Neonatal Intensive Care Unit: What Is It, Why It Happens, and How We Can Address It
Publisher
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Frontiers in Pediatrics
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
Subject
The topic of the resource
decision-making; decision-making; end-of-life care; ethical confrontation; medical futility; moral distress; neonatal; intensive care; periviability; end-of-life care; ethical confrontation; medical futility; moral distress; neonatal intensive care; periviability
Creator
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Mills M; Cortezzo DE
Description
An account of the resource
Moral distress is prevalent in the neonatal intensive care unit (NICU), where decisions regarding end-of-life care, periviable resuscitation, and medical futility are common. Due to its origins in the nursing literature, moral distress has primarily been reported among bedside nurses in relation to the hierarchy of the medical team. However, it is increasingly recognized that moral distress may exist in different forms than initially described and that healthcare professions outside of nursing experience it. Advances in medical technology have allowed the smallest, sickest neonates to survive. The treatment for critically ill infants is no longer simply limited by the capability of medical technology but also by moral and ethical boundaries of what is right for a given child and family. Shared decision-making and the zone of parental discretion can inform and challenge the medical team to balance the complexities of patient autonomy against harm and suffering. Limited ability to prognosticate and uncertainty in outcomes add to the challenges faced with ethical dilemmas. While this does not necessarily equate to moral distress, subjective views of quality of life and personal values in these situations can lead to moral distress if the plans of care and the validity of each path are not fully explored. Differences in opinions and approaches between members of the medical team can strain relationships and affect each individual differently. It is unclear how the various types of moral distress uniquely impact each profession and their role in the distinctively challenging decisions made in the NICU environment. The purpose of this review is to describe moral distress and the situations that give rise to it in the NICU, ways in which various members of the medical team experience it, how it impacts care delivery, and approaches to address it. © Copyright © 2020 Mills and Cortezzo.
Identifier
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<a href="http://doi.org/10.3389/fped.2020.00581" target="_blank" rel="noreferrer noopener">10.3389/fped.2020.00581</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2020
Cortezzo DE
Decision-making
End-of-life Care
ethical confrontation
February List 2023
Frontiers in Pediatrics
Intensive Care
Medical Futility
Mills M
Moral Distress
Neonatal
neonatal intensive care
periviability
-
Dublin Core
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Title
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August 2018 List
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Text
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Citation List Month
August 2018 List
URL Address
<a href="http://doi.org/10.1017/s0963180117000767" target="_blank" rel="noreferrer noopener">http://doi.org/10.1017/s0963180117000767</a>
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Title
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Quality of Living and Dying: Pediatric Palliative Care and End-of-Life Decisions in the Netherlands
Publisher
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Cambridge Quarterly of Healthcare Ethics
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Subject
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Decision Making; Child; Netherlands; Medical Futility; Suicide; United Kingdom; Palliative Care In Infancy and Childhood Netherlands; Practice Guidelines United Kingdom; Terminal Care In Infancy and Childhood Netherlands; Assisted Legislation and Jurisprudence Netherlands; Clinical In Infancy and Childhood Netherlands
Creator
An entity primarily responsible for making the resource
Brouwer M; Maeckelberghe ELS; De Weerd W; Verhagen E
Description
An account of the resource
In 2002, The Netherlands continued its leadership in developing rules and jurisdiction regarding euthanasia and end-of-life decisions by implementing the Euthanasia Act, which allows euthanasia for patients 12 years of age and older. Subsequently, in 2005, the regulation on active ending of life for newborns was issued. However, more and more physicians and parents have stated that the age gap between these two regulations-children between 1 and 12 years old-is undesirable. These children should have the same right to end their suffering as adults and newborn infants. An extended debate on pediatric euthanasia ensued, and currently the debate is ongoing as to whether legislation should be altered in order to allow pediatric euthanasia. An emerging major question regards the active ending of life in the context of palliative care: How does a request for active ending of life relate to the care that is given to children in the palliative phase? Until now, the distinction between palliative care and end-of-life decisions continues to remain unclear, making any discussion about their mutual in- and exclusiveness hazardous at best. In this report, therefore, we aim to provide insight into the relationship between pediatric palliative care and end-of-life decisions, as understood in the Netherlands. We do so by first providing an overview of the (legal) rules and regulations regarding euthanasia and active ending of life, followed by an analysis of the relationship between these two, using the Dutch National Guidelines for Palliative Care for Children. The results of this analysis revealed two major and related features of palliative care and end-of-life decisions for children: (1) palliative care and end-of-life decisions are part of the same process, one that focuses both on quality of living and quality of dying, and (2) although physicians are seen as ultimately responsible for making end-of-life decisions, the involvement of parents and children in this decision is of the utmost importance and should be regarded as such.
Identifier
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<a href="http://doi.org/10.1017/s0963180117000767" target="_blank" rel="noreferrer noopener">10.1017/s0963180117000767</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2018
Assisted Legislation and Jurisprudence Netherlands
August 2018 List
Brouwer M
Cambridge Quarterly of Healthcare Ethics
Child
Clinical In Infancy and Childhood Netherlands
De Weerd W
Decision Making
Maeckelberghe ELS
Medical Futility
Netherlands
Palliative Care In Infancy and Childhood Netherlands
Practice Guidelines United Kingdom
Suicide
Terminal Care In Infancy and Childhood Netherlands
United Kingdom
Verhagen E
-
Dublin Core
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Title
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April 2018 List
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
April 2018 List
URL Address
<a href="http://doi.org/10.1016/j.jpeds.2017.12.050" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.jpeds.2017.12.050</a>
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Title
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Worth a Try? Describing the Experiences of Families during the Course of Care in the Neonatal Intensive Care Unit When the Prognosis is Poor
Publisher
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Journal of Pediatrics
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Subject
The topic of the resource
prognosis; Infant; Intensive Care Units; Medical Futility; Neonatal; Newborn; Parents; Prognosis; ethics; moral distress; prematurity; gray zone; Nicu; parent experiences; poor prognosis
Creator
An entity primarily responsible for making the resource
Arnolds M; Xu L; Hughes P; McCoy J; Meadow W
Description
An account of the resource
OBJECTIVE: To determine how parents of infants in the neonatal intensive care unit with a poor or uncertain prognosis view their experience, and whether they view their choices as "worth it," regardless of outcome. STUDY DESIGN: Parents of eligible neonates at 2 institutions underwent audiotaped, semistructured interviews while their infants were still in the hospital and then again 6 months to 1 year after discharge or death. Interviews were transcribed and data were analyzed using thematic analysis. Two authors independently reviewed and coded each interview and discrepancies were resolved by consensus. RESULTS: Twenty-six families were interviewed in the initial group and 17 families were interviewed in the follow-up group. The most common themes identified included realism about death (24 families), appreciation for the infant's care team (23 families), and optimism and hope (22 families). Overall themes were very similar across both centers, and among parents of infants who died and those who survived. Themes of regret, futility, distrust of care team, and infant pain were brought up infrequently or not at all. CONCLUSIONS: No family believed that the care being provided to their infant was futile; rather, parents were grateful for the care provided to their infant, regardless of outcome. Even in the case of a poor prognosis or the death of an infant, families in our study viewed their infant's stay in the neonatal intensive care unit favorably.
Identifier
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<a href="http://doi.org/10.1016/j.jpeds.2017.12.050" target="_blank" rel="noreferrer noopener">10.1016/j.jpeds.2017.12.050</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2018
April 2018 List
Arnolds M
Ethics
gray zone
Hughes P
Infant
Intensive Care Units
Journal of Pediatrics
McCoy J
Meadow W
Medical Futility
Moral Distress
Neonatal
Newborn
Nicu
Parent Experiences
Parents
poor prognosis
Prematurity
Prognosis
Xu L
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1136/medethics-2011-100104" target="_blank" rel="noreferrer">http://doi.org/10.1136/medethics-2011-100104</a>
Dublin Core
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Title
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Should religious beliefs be allowed to stonewall a secular approach to withdrawing and withholding treatment in children?
Publisher
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Journal Of Medical Ethics
Date
A point or period of time associated with an event in the lifecycle of the resource
2013
Subject
The topic of the resource
Child; Humans; retrospective studies; Intensive Care Units; Terminal Care; Medical Futility; Withholding Treatment; Professional-Family Relations; Culture; Conflict (Psychology); Religion and Psychology; Pediatric
Creator
An entity primarily responsible for making the resource
Brierley J; Linthicum J; Petros A
Description
An account of the resource
Religion is an important element of end-of-life care on the paediatric intensive care unit with religious belief providing support for many families and for some staff. However, religious claims used by families to challenge cessation of aggressive therapies considered futile and burdensome by a wide range of medical and lay people can cause considerable problems and be very difficult to resolve. While it is vital to support families in such difficult times, we are increasingly concerned that deeply held belief in religion can lead to children being potentially subjected to burdensome care in expectation of 'miraculous' intervention. We reviewed cases involving end-of-life decisions over a 3-year period. In 186 of 203 cases in which withdrawal or limitation of invasive therapy was recommended, agreement was achieved. However, in the 17 remaining cases extended discussions with medical teams and local support mechanisms did not lead to resolution. Of these cases, 11 (65%) involved explicit religious claims that intensive care should not be stopped due to expectation of divine intervention and complete cure together with conviction that overly pessimistic medical predictions were wrong. The distribution of the religions included Protestant, Muslim, Jewish and Roman Catholic groups. Five of the 11 cases were resolved after meeting religious community leaders; one child had intensive care withdrawn following a High Court order, and in the remaining five, all Christian, no resolution was possible due to expressed expectations that a 'miracle' would happen.
2013-09
Identifier
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<a href="http://doi.org/10.1136/medethics-2011-100104" target="_blank" rel="noreferrer">10.1136/medethics-2011-100104</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2013
Backlog
Brierley J
Child
Conflict (Psychology)
Culture
Humans
Intensive Care Units
Journal Article
Journal of Medical Ethics
Linthicum J
Medical Futility
Pediatric
Petros A
Professional-family Relations
Religion and Psychology
Retrospective Studies
Terminal Care
Withholding Treatment
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1111/j.1440-1754.2008.01353.x" target="_blank" rel="noreferrer">http://doi.org/10.1111/j.1440-1754.2008.01353.x</a>
Dublin Core
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Title
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Withdrawal and limitation of life-sustaining treatments in a paediatric intensive care unit and review of the literature.
Publisher
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Journal Of Paediatrics And Child Health
Date
A point or period of time associated with an event in the lifecycle of the resource
2008
Subject
The topic of the resource
Child; Humans; Intensive Care Units; New South Wales; Hospital Mortality; Hospitals; adolescent; Preschool; infant; retrospective studies; Withholding Treatment/statistics & numerical data; Terminal Care; Pediatric/statistics & numerical data; Medical Audit; Medical Futility; Physician's Practice Patterns/statistics & numerical data
Creator
An entity primarily responsible for making the resource
Moore P; Kerridge I; Gillis J; Jacobe S; Isaacs D
Description
An account of the resource
OBJECTIVES: To examine withdrawal and limitation of life-sustaining treatment (WLST) in an Australian paediatric intensive care unit (PICU) and to compare this experience with published data from other countries. DESIGN: Retrospective chart review and literature review. SOURCE OF DATA: Review of 12 months of patient records from a tertiary Australian children's teaching hospital. Medline search using relevant key words focusing on death and PICU. RESULTS: Twenty of 27 deaths (74%) followed either WLST (n = 16) or Do Not Resuscitate (DNR) orders (n = 4); five children failed cardiopulmonary resuscitation (CPR); and two children were brain-dead. Meetings between the medical team and family were documented for 15 of 16 children (93.8%) before treatment was withdrawn. The average time between withdrawal of life support and death was 13 min. A review of the English-language literature revealed that 18-65% occurring in PICUs worldwide follow WLST and/or institution of DNR orders. Rates were higher (30-65%) in North America and Europe than elsewhere. Most PICU deaths occurred within 3 days of admission. North American and British parents appear to be involved in decisions regarding withdrawal and limitation of treatment more often than parents in other countries. CONCLUSIONS: Withdrawal and limitation of life-sustaining treatment was more common in an Australian children's hospital ICU than has been reported from other countries. Details of discussion with parents, including the basis for any decision to WLST, were almost always documented in the patient's medical record.
2008-08
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1111/j.1440-1754.2008.01353.x" target="_blank" rel="noreferrer">10.1111/j.1440-1754.2008.01353.x</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2008
Adolescent
Backlog
Child
Gillis J
Hospital Mortality
Hospitals
Humans
Infant
Intensive Care Units
Isaacs D
Jacobe S
Journal Article
Journal of Paediatrics and Child Health
Kerridge I
Medical Audit
Medical Futility
Moore P
New South Wales
Pediatric/statistics & Numerical Data
Physician's Practice Patterns/statistics & numerical data
Preschool
Retrospective Studies
Terminal Care
Withholding Treatment/statistics & Numerical Data
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1016/j.ygyno.2005.07.102" target="_blank" rel="noreferrer">http://doi.org/10.1016/j.ygyno.2005.07.102</a>
Dublin Core
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Title
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Resource utilization for ovarian cancer patients at the end of life: how much is too much?
Publisher
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Gynecologic Oncology
Date
A point or period of time associated with an event in the lifecycle of the resource
2005
Subject
The topic of the resource
Female; Humans; Adult; Medical Futility; Aged; Middle Aged; 80 and over; Comparative Study; retrospective studies; Hospice Care/economics; Health Services/economics/utilization; Hospitalization/economics; Ovarian Neoplasms/economics/therapy; Palliative Care/economics; Terminal Care/economics/methods
Creator
An entity primarily responsible for making the resource
Lewin SN; Buttin BM; Powell MA; Gibb RK; Rader JS; Mutch DG; Herzog TJ
Description
An account of the resource
OBJECTIVE: End-of-life (EOL) medical care consumes 10-12% of national health care expenditures and 27% of Medicare dollars annually. Studies suggest that hospice services decrease EOL expenditures by 25-40%. The goal of this study was to compare the total cost of hospital-based resources utilized in ovarian cancer patients during their last 60 days of life for those enrolled in hospice versus those not on hospice. METHODS: Study eligibility included patients who expired from ovarian cancer from 1999 to 2003. Medical records were reviewed for demographic data as well as treatment, response and recurrence rates, histologic type, grade and stage. Billing records were analyzed for costs of inpatient and outpatients visits, including radiologic, laboratory and pharmacy charges. Total cost of hospital resources was compared between patients managed on hospice for >10 days (hospice group) versus <10 days (non-hospice group) using the following methods: Mann-Whitney U, Kruskal-Wallis and Student's t tests. Overall survival was compared using Kaplan-Meier statistics. RESULTS: Of the 84 patients analyzed, 67 (79.8%) were in the non-hospice group and 17 (20.2%) were in the hospice group. Demographic, histologic and staging characteristics as well as platinum sensitivity were similar between the two groups before the last 60 days of life. Mean number of chemotherapy cycles before the study period was also similar (20.4 and 21.0, respectively). However, during the study period, the mean total cost per patient in the non-hospice group was dollar 59,319 versus dollar 15,164 in the hospice group (P = 0.0001). A significant difference in cost was noted for mean inpatient days (dollar 6584 vs. dollar 1629, P = 0.0007), radiology (dollar 6063 vs. dollar 2343, P = 0.003), laboratory (dollar 12,281 vs. dollar 2026, P = 0.0004) and pharmacy charges (dollar 13,650 vs. dollar 4465, P = 0.0017) as well as for treating physician per patient (dollar 112,707 vs. dollar 34,677, P = 0.04). Overall survival for the two groups was the same. CONCLUSIONS: Our findings demonstrate that there is a significant cost difference with no appreciable improvement in survival between ovarian cancer patients treated aggressively versus those enrolled in hospice at the EOL. These data suggest that earlier hospice enrollment is beneficial. Furthermore, cost variations between physicians and patients imply that education may be an important variable.
2005
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1016/j.ygyno.2005.07.102" target="_blank" rel="noreferrer">10.1016/j.ygyno.2005.07.102</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2005
80 And Over
Adult
Aged
Backlog
Buttin BM
Comparative Study
Female
Gibb RK
Gynecologic Oncology
Health Services/economics/utilization
Herzog TJ
Hospice Care/economics
Hospitalization/economics
Humans
Journal Article
Lewin SN
Medical Futility
Middle Aged
Mutch DG
Ovarian Neoplasms/economics/therapy
Palliative Care/economics
Powell MA
Rader JS
Retrospective Studies
Terminal Care/economics/methods
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1377/hlthaff.24.4.961" target="_blank" rel="noreferrer">http://doi.org/10.1377/hlthaff.24.4.961</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
The costs of nonbeneficial treatment in the intensive care setting
Publisher
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Health Affairs
Date
A point or period of time associated with an event in the lifecycle of the resource
2005
Subject
The topic of the resource
Female; Humans; Male; United States; Patient Discharge; Adult; Medical Futility; Middle Aged; Length of Stay; Dissent and Disputes; Survival Analysis; Empirical Approach; Death and Euthanasia; decision making; ICU Decision Making; Health Care and Public Health; Hospital Costs/statistics & numerical data; Ethics Consultation/utilization; Intensive Care Units/economics/ethics; Intensive Care/economics/ethics/utilization; Life Support Care/economics/ethics/utilization
Creator
An entity primarily responsible for making the resource
Gilmer T; Schneiderman LJ; Teetzel H; Blustein J; Briggs K; Cohn F; Cranford R; Dugan D; Kamatsu G; Young E
Description
An account of the resource
Ethics consultations have been shown to reduce the use of "nonbeneficial treatments," defined as life-sustaining treatments delivered to patients who ultimately did not survive to hospital discharge, when treatment conflicts occurred in the adult intensive care unit (ICU). In this paper we estimated the costs of nonbeneficial treatment using the results from a randomized trial of ethics consultations. We found that ethics consultations were associated with reductions in hospital days and treatment costs among patients who did not survive to hospital discharge. We conclude that consultations resolved conflicts that would have inappropriately prolonged nonbeneficial or unwanted treatments in the ICU instead of focusing on more appropriate comfort care.
2005
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1377/hlthaff.24.4.961" target="_blank" rel="noreferrer">10.1377/hlthaff.24.4.961</a>
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Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2005
Adult
Backlog
Blustein J
Briggs K
Cohn F
Cranford R
Death and Euthanasia
Decision Making
Dissent And Disputes
Dugan D
Empirical Approach
Ethics Consultation/utilization
Female
Gilmer T
Health Affairs
Health Care and Public Health
Hospital Costs/statistics & numerical data
Humans
ICU Decision Making
Intensive Care Units/economics/ethics
Intensive Care/economics/ethics/utilization
Journal Article
Kamatsu G
Length Of Stay
Life Support Care/economics/ethics/utilization
Male
Medical Futility
Middle Aged
Patient Discharge
Schneiderman LJ
Survival Analysis
Teetzel H
United States
Young E
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1542/peds.2004-0905" target="_blank" rel="noreferrer">http://doi.org/10.1542/peds.2004-0905</a>
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
New and lingering controversies in pediatric end-of-life care
Publisher
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Pediatrics
Date
A point or period of time associated with an event in the lifecycle of the resource
2005
Subject
The topic of the resource
Child; Humans; Analgesics; Data Collection; Attitude of Health Personnel; Medical Futility; Medical Staff; Withholding Treatment; Life Support Care; Medical; Practice Guidelines; ICU Decision Making; Pain/drug therapy; Opioid/therapeutic use; Specialties; Terminal Care/psychology; Nurses/psychology; Hospital/psychology
Creator
An entity primarily responsible for making the resource
Solomon MZ; Sellers DE; Heller KS; Dokken DL; Levetown M; Rushton C; Truog RD; Fleischman AR
Description
An account of the resource
OBJECTIVES: Professional societies, ethics institutes, and the courts have recommended principles to guide the care of children with life-threatening conditions; however, little is known about the degree to which pediatric care providers are aware of or in agreement with these guidelines. The study's objectives were to determine the extent to which physicians and nurses in critical care, hematology/oncology, and other subspecialties are in agreement with one another and with widely published ethical recommendations regarding the withholding and withdrawing of life support, the provision of adequate analgesia, and the role of parents in end-of-life decision-making. METHODS: Three children's hospitals and 4 general hospitals with PICUs in eastern, southwestern, and southern parts of the United States were surveyed. This population-based sample was composed of attending physicians, house officers, and nurses who cared for children (age: 1 month to 18 years) with life-threatening conditions in PICUs or in medical, surgical, or hematology/oncology units, floors, or departments. Main outcome measures included concerns of conscience, knowledge and beliefs, awareness of published guidelines, and agreement or disagreement with guidelines. RESULTS: A total of 781 clinicians were sampled, including 209 attending physicians, 116 house officers, and 456 nurses. The overall response rate was 64%. Fifty-four percent of house officers and substantial proportions of attending physicians and nurses reported, "At times, I have acted against my conscience in providing treatment to children in my care." For example, 38% of critical care attending physicians and 25% of hematology/oncology attending physicians expressed these concerns, whereas 48% of critical care nurses and 38% of hematology/oncology nurses did so. Across specialties, approximately 20 times as many nurses, 15 times as many house officers, and 10 times as many attending physicians agreed with the statement, "Sometimes I feel we are saving children who should not be saved," as agreed with the statement, "Sometimes I feel we give up on children too soon." However, hematology/oncology attending physicians (31%) were less likely than critical care (56%) and other subspecialty (66%) attending physicians to report, "Sometimes I feel the treatments I offer children are overly burdensome." Many respondents held views that diverged widely from published recommendations. Despite a lack of awareness of key guidelines, across subspecialties the vast majority of attending physicians (range: 92-98%, depending on specialty) and nurses (range: 83-85%) rated themselves as somewhat to very knowledgeable regarding ethical issues. CONCLUSIONS: There is a need for more hospital-based ethics education and more interdisciplinary and cross-subspecialty discussion of inherently complex and stressful pediatric end-of-life cases. Education should focus on establishing appropriate goals of care, as well as on pain management, medically supplied nutrition and hydration, and the appropriate use of paralytic agents. More research is needed on clinicians' regard for the dead-donor rule.
2005
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1542/peds.2004-0905" target="_blank" rel="noreferrer">10.1542/peds.2004-0905</a>
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Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2005
Analgesics
Attitude Of Health Personnel
Backlog
Child
Data Collection
Dokken DL
Fleischman AR
Heller KS
Hospital/psychology
Humans
ICU Decision Making
Journal Article
Levetown M
Life Support Care
Medical
Medical Futility
Medical Staff
Nurses/psychology
Opioid/therapeutic use
Pain/drug Therapy
Pediatrics
Practice Guidelines
Rushton C
Sellers DE
Solomon MZ
Specialties
Terminal Care/psychology
Truog RD
Withholding Treatment
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1016/j.spen.2004.03.012" target="_blank" rel="noreferrer">http://doi.org/10.1016/j.spen.2004.03.012</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ethical issues in pediatric critical care neurology
Publisher
An entity responsible for making the resource available
Seminars In Pediatric Neurology
Date
A point or period of time associated with an event in the lifecycle of the resource
2004
Subject
The topic of the resource
Child; Humans; Pediatrics; Medical Futility; Research; Informed Consent; Ethics; Medical; Professional Patient Relationship; Death and Euthanasia; ICU Decision Making; Biomedical and Behavioral Research; Critical Care/ethics; Health Care and Public Health; Intensive Care Units/ethics; Jurisprudence; Neurology/ethics
Creator
An entity primarily responsible for making the resource
Shevell M
Description
An account of the resource
Ethical issues in the critical care unit frequently arise in children with neurological problems. These ethical issues frequently challenge our medical management of such cases and can be quite problematic. This article reviews key ethical issues that may arise including informed consent, futility, justice/rationing, clinical research conduct and the severely compromised patient who is in either a permanent vegetative or minimally conscious state.
2004
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1016/j.spen.2004.03.012" target="_blank" rel="noreferrer">10.1016/j.spen.2004.03.012</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2004
Backlog
Biomedical and Behavioral Research
Child
Critical Care/ethics
Death and Euthanasia
Ethics
Health Care and Public Health
Humans
ICU Decision Making
Informed Consent
Intensive Care Units/ethics
Journal Article
Jurisprudence
Medical
Medical Futility
Neurology/ethics
Pediatrics
Professional Patient Relationship
Research
Seminars In Pediatric Neurology
Shevell M
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12133247" target="_blank" rel="noreferrer">http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12133247</a>
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discussing do-not-resuscitate orders in the hospital setting: Part 2
Publisher
An entity responsible for making the resource available
Journal Of Palliative Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2002
Subject
The topic of the resource
Medical Futility; Human; Resuscitation Orders; Emotions
Creator
An entity primarily responsible for making the resource
von Gunten CF; Weissman DE
Rights
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
Description
An account of the resource
2002
2002
Backlog
Emotions
Human
Journal Article
Journal of Palliative Medicine
Medical Futility
Resuscitation Orders
von Gunten CF
Weissman DE
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1016/s0002-9343(00)00609-4" target="_blank" rel="noreferrer">http://doi.org/10.1016/s0002-9343(00)00609-4</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Terminal nutrition: framing the debate for the withdrawal of nutritional support in terminally ill patients
Publisher
An entity responsible for making the resource available
The American Journal Of Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2000
Subject
The topic of the resource
Humans; United States; Medical Futility; Ethics; Medical; Death and Euthanasia; Enteral Nutrition/adverse effects; Fasting/physiology/psychology; Parenteral Nutrition/adverse effects; Terminal Care/methods/standards
Creator
An entity primarily responsible for making the resource
Winter SM
Description
An account of the resource
Nutrition and hydration have long been considered to be life-sustaining therapies that are associated with comfort and relief of suffering. This belief is largely based on our own experiences with the sensations of thirst and hunger, which have led physicians to question whether withdrawing or withholding nutritional support from a dying patient can be morally or ethically justified. When considered in light of the available evidence, the underlying premise of this question must be reevaluated. The evidence suggests an alternative formulation, namely, that unrequested nutritional support provided by either the enteral or parenteral route to a terminally ill patient may be both medically and ethically indefensible because it may increase suffering without improving outcome.
2000
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1016/s0002-9343(00)00609-4" target="_blank" rel="noreferrer">10.1016/s0002-9343(00)00609-4</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2000
Backlog
Death and Euthanasia
Enteral Nutrition/adverse effects
Ethics
Fasting/physiology/psychology
Humans
Journal Article
Medical
Medical Futility
Parenteral Nutrition/adverse effects
Terminal Care/methods/standards
The American Journal Of Medicine
United States
Winter SM
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1016/s0738-3991(98)00125-6" target="_blank" rel="noreferrer">http://doi.org/10.1016/s0738-3991(98)00125-6</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
The attitude of young adults with chronic disease or handicaps towards enforced treatment and euthanasia
Publisher
An entity responsible for making the resource available
Patient Education And Counseling
Date
A point or period of time associated with an event in the lifecycle of the resource
1999
Subject
The topic of the resource
Female; Humans; Male; Adolescent Psychology; Attitude to Health; Medical Futility; Prognosis; Questionnaires; Attitude to Death; Physician's Role; Informed Consent; Israel; Case-Control Studies; quality of life; adolescent; decision making; Family/psychology; Treatment Refusal/psychology; Chronic Disease/psychology; Disabled Persons/psychology; Euthanasia/psychology; Terminal Care/psychology
Creator
An entity primarily responsible for making the resource
Brook U
Description
An account of the resource
One hundred fifty-nine young adults in the 17-18 year old age group suffering from chronic disease or handicap participated in this study which examined their attitudes towards enforced treatment and euthanasia in terminal patients. The comparison group included 120 healthy high school pupils of the same age group. A total of 42.6% of the chronic patients thought that enforced treatment was justified even if the patient didn't understand its importance and didn't want treatment (in comparison with 23.3% of the healthy pupils who felt the same way). Of the chronic patients, 54.4% thought that euthanasia was justified in consenting terminal patients (in comparison with 74.2% of the healthy pupils who felt the same way; P < 0.01). This may be explained by the feeling of total dependency of chronic patients upon medication and treatment. On the other hand, they may be opposed to euthanasia because of their own personal hope that a cure would be found for their severe and chronic condition. Both groups studied believed that physicians should always consider the subjective suffering of the patient and his family, as well as the short and long term prognosis when deciding about therapy.
1999
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1016/s0738-3991(98)00125-6" target="_blank" rel="noreferrer">10.1016/s0738-3991(98)00125-6</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
1999
Adolescent
Adolescent Psychology
Attitude To Death
Attitude To Health
Backlog
Brook U
Case-Control Studies
Chronic Disease/psychology
Decision Making
Disabled Persons/psychology
Euthanasia/psychology
Family/psychology
Female
Humans
Informed Consent
Israel
Journal Article
Male
Medical Futility
Patient Education and Counseling
Physician's Role
Prognosis
Quality Of Life
Questionnaires
Terminal Care/psychology
Treatment Refusal/psychology
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1056/nejm200001203420312" target="_blank" rel="noreferrer">http://doi.org/10.1056/nejm200001203420312</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Rethinking the role of tube feeding in patients with advanced dementia
Publisher
An entity responsible for making the resource available
The New England Journal Of Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2000
Subject
The topic of the resource
Humans; United States; Medical Futility; Withholding Treatment; Euthanasia; Religion and Medicine; Risk Assessment; Medical; Mental Health Therapies; Professional Patient Relationship; Death and Euthanasia; decision making; Pneumonia; Psychological; Stress; Legislation; Passive; Empirical Research; Alzheimer Disease/therapy; Aspiration/prevention & control; Dementia/therapy; Enteral Nutrition/adverse effects/standards; 'Physical'; Restraint
Creator
An entity primarily responsible for making the resource
Gillick MR
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1056/nejm200001203420312" target="_blank" rel="noreferrer">10.1056/nejm200001203420312</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
Description
An account of the resource
2000
'Physical'
2000
Alzheimer Disease/therapy
Aspiration/prevention & control
Backlog
Death and Euthanasia
Decision Making
Dementia/therapy
Empirical Research
Enteral Nutrition/adverse effects/standards
Euthanasia
Gillick MR
Humans
Journal Article
Legislation
Medical
Medical Futility
Mental Health Therapies
Passive
Pneumonia
Professional Patient Relationship
Psychological
Religion and Medicine
Restraint
Risk Assessment
Stress
The New England Journal Of Medicine
United States
Withholding Treatment
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1097/00003246-200005000-00055" target="_blank" rel="noreferrer">http://doi.org/10.1097/00003246-200005000-00055</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Attitudes toward limitation of support in a pediatric intensive care unit
Publisher
An entity responsible for making the resource available
Critical Care Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2000
Subject
The topic of the resource
Child; Female; Humans; Male; Intensive Care Units; Medical Futility; Prospective Studies; Euthanasia; Ethics; Medical; quality of life; Pediatric; patient care team; Caregivers/psychology; ICU Decision Making; Resuscitation Orders/psychology; Passive/psychology; Life Support Care/psychology
Creator
An entity primarily responsible for making the resource
Keenan HT; Diekema DS; O'Rourke PP; Cummings P; Woodrum DE
Description
An account of the resource
OBJECTIVE: To prospectively determine opinions of members of a pediatric intensive care unit (PICU) team regarding the appropriateness of aggressive care. The types of support that caregivers sought to limit and their reasons for wanting these limits were collected over time. DESIGN: Prospective survey of caregiver opinions. SETTING: PICU in an academic tertiary care children's hospital. SUBJECTS: A total of 68 intensive care nurses, 11 physicians attending in the PICU, 10 critical care and anesthesia fellows, and 24 anesthesia and pediatric residents. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: During a 6-month period, 503 patients were admitted to the PICU. Within this time period, 52.4% of all deaths were preceded by limitation of support, with 100% of noncardiac surgical deaths preceded by limitation of medical interventions. At least one caregiver wished to limit care for 63 of these patients (12.5%). When caregivers wished to limit support they most frequently wished to limit invasive modes of support such as cardiopulmonary resuscitation (94%) and hemodialysis (83%). The ethical rationales identified most often for wishing to limit support were burden vs. benefit (88%) and qualitative futility (83%). Preadmission quality of life was cited less frequently (50%). Caregivers were less likely to limit care on the basis of quality of life. Nurses and physicians in the PICU were very similar to each other in the types of support they thought should be limited and their ethical rationales. CONCLUSIONS: When making decisions about whether or not to limit care for a patient, caregivers were more likely to rely on the perceived benefit to the patient than preadmission quality of life.
2000
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1097/00003246-200005000-00055" target="_blank" rel="noreferrer">10.1097/00003246-200005000-00055</a>
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Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2000
Backlog
Caregivers/psychology
Child
Critical Care Medicine
Cummings P
Diekema DS
Ethics
Euthanasia
Female
Humans
ICU Decision Making
Intensive Care Units
Journal Article
Keenan HT
Life Support Care/psychology
Male
Medical
Medical Futility
O'Rourke PP
Passive/psychology
Patient Care Team
Pediatric
Prospective Studies
Quality Of Life
Resuscitation Orders/psychology
Woodrum DE
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1097/00006254-199706000-00009" target="_blank" rel="noreferrer">http://doi.org/10.1097/00006254-199706000-00009</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Death in the intensive care nursery: physician practice of withdrawing and withholding life support
Publisher
An entity responsible for making the resource available
Pediatrics
Date
A point or period of time associated with an event in the lifecycle of the resource
1997
Subject
The topic of the resource
Humans; infant; Intensive Care Units; Medical Futility; Euthanasia; Life Support Care; quality of life; Pediatric; Empirical Approach; Death and Euthanasia; decision making; Newborn; ICU Decision Making; Very Low Birth Weight; Passive; San Francisco; Life Support Systems; University of California
Creator
An entity primarily responsible for making the resource
Wall SN; Partridge JC
Description
An account of the resource
OBJECTIVE: To determine the frequency of selective nontreatment of extremely premature, critically ill, or malformed infants among all infant deaths in a level III intensive care nursery (ICN) and to determine the reasons documented by neonatologists for their decisions to withdraw or withhold life support. METHODS: This was a descriptive study based on review of the medical records of all 165 infants who died at a university-based level III ICN during 3 years. We determined whether each death had occurred despite the use of all available technologies to keep the infant alive or whether these were withheld or withdrawn, thereby leading to the infant's death. We also determined whether neonatologists documented either "futility" or "quality of life" as a reason to limit medical interventions. RESULTS: One hundred sixty-five infants died among the 1609 infants admitted during the study period. One hundred eight infant deaths followed the withdrawal of life support, 13 deaths followed the withholding of treatment, and 44 deaths occurred while infants continued to receive maximal life-sustaining treatment. For 90 (74%) of the 121 deaths attributable to withholding of withdrawal of treatment, physicians cited that death was imminent and treatment was futile. Quality-of-life concerns were cited by the neonatologists as reasons to limit treatment in 62 (51%). Quality of life was the only reason cited for limiting treatment for 28 (23%) of the 121 deaths attributable to withholding or withdrawal of treatment. CONCLUSIONS: The majority of deaths in the ICN occurred as a result of selective nontreatment by neonatologists, with few infants receiving maximal support until the actual time of death. Neonatologists often documented that quality-of-life concerns were considered in decisions to limit treatment; however, the majority of these decisions were based on their belief that treatment was futile. Prospective studies are needed to elucidate the determinants of neonatologists' practice decisions of selective nontreatment for marginally viable or damaged infants.
1997
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1097/00006254-199706000-00009" target="_blank" rel="noreferrer">10.1097/00006254-199706000-00009</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
1997
Backlog
Death and Euthanasia
Decision Making
Empirical Approach
Euthanasia
Humans
ICU Decision Making
Infant
Intensive Care Units
Journal Article
Life Support Care
Life Support Systems
Medical Futility
Newborn
Partridge JC
Passive
Pediatric
Pediatrics
Quality Of Life
San Francisco
University of California
Very Low Birth Weight
Wall SN
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1136/adc.84.3.265" target="_blank" rel="noreferrer">http://doi.org/10.1136/adc.84.3.265</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Identifying futility in a paediatric critical care setting: a prospective observational study
Publisher
An entity responsible for making the resource available
Archives Of Disease In Childhood
Date
A point or period of time associated with an event in the lifecycle of the resource
2001
Subject
The topic of the resource
Child; Female; Humans; Male; Intensive Care Units; Medical Futility; Prognosis; Prospective Studies; Euthanasia; Severity of Illness Index; Hospitals; Teaching; quality of life; Preschool; Empirical Approach; Death and Euthanasia; infant; ICU Decision Making; Pediatric/organization & administration; Patient Admission/statistics & numerical data; London; Health Care and Public Health; Critical Illness/classification; Cost Control; Passive/statistics & numerical data
Creator
An entity primarily responsible for making the resource
Goh AY; Mok Q
Description
An account of the resource
AIMS: To determine the extent of futile care provided to critically ill children admitted to a paediatric intensive care setting. METHODS: Prospective evaluation of consecutive admissions to a 20 bedded multidisciplinary paediatric intensive care unit of a North London teaching hospital over a nine month period. Three previously defined criteria for futility were used: (1) imminent demise futility (those with a mortality risk greater than 90% using the Paediatric Risk of Mortality (PRISM II) score); (2) lethal condition futility (those with conditions incompatible with long term survival); and (3) qualitative futility (those with unacceptable quality of life and high morbidity). RESULTS: A total of 662 children accounting for 3409 patient bed days were studied. Thirty four patients fulfilled at least one of the criteria for futility, and used a total of 104 bed days (3%). Only 33 (0.9%) bed days were used by patients with mortality risk greater than 90%, 60 (1.8%) by patients with poor long term prognosis, and 16 (0.5%) by those with poor quality of life. Nineteen of 34 patients died; withdrawal of treatment was the mode of death in 15 (79%). CONCLUSIONS: Cost containment initiatives focusing on futility in the paediatric intensive care unit setting are unlikely to be successful as only relatively small amounts of resources were used in providing futile care. Paediatricians are recognising futility early and may have taken ethically appropriate measures to limit care that is futile.
2001
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1136/adc.84.3.265" target="_blank" rel="noreferrer">10.1136/adc.84.3.265</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2001
Archives of Disease in Childhood
Backlog
Child
Cost Control
Critical Illness/classification
Death and Euthanasia
Empirical Approach
Euthanasia
Female
Goh AY
Health Care and Public Health
Hospitals
Humans
ICU Decision Making
Infant
Intensive Care Units
Journal Article
London
Male
Medical Futility
Mok Q
Passive/statistics & numerical data
Patient Admission/statistics & numerical data
Pediatric/organization & Administration
Preschool
Prognosis
Prospective Studies
Quality Of Life
Severity Of Illness Index
Teaching
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1016/j.jpeds.2011.01.022" target="_blank" rel="noreferrer">http://doi.org/10.1016/j.jpeds.2011.01.022</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Whom are we comforting? An analysis of comfort medications delivered to dying neonates
Publisher
An entity responsible for making the resource available
The Journal Of Pediatrics
Date
A point or period of time associated with an event in the lifecycle of the resource
2011
Subject
The topic of the resource
Humans; infant; Intensive Care Units; Attitude of Health Personnel; Medical Futility; Prognosis; Neonatal; Stress; Newborn; retrospective studies; ICU Decision Making; Palliative Care/methods; Pain/drug therapy; Physician Assisted Dying PAD; Analgesics/administration & dosage; Cardiopulmonary Resuscitation/methods; Decision Making/ethics; Hypnotics and Sedatives/administration & dosage; Neuromuscular Blocking Agents/administration & dosage; NICU; Psychological/drug therapy
Creator
An entity primarily responsible for making the resource
Janvier A; Meadow W; Leuthner SR; Andrews B; Lagatta J; Bos Arend; Lane L; Verhagen AAE
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1016/j.jpeds.2011.01.022" target="_blank" rel="noreferrer">10.1016/j.jpeds.2011.01.022</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2011
Analgesics/administration & dosage
Andrews B
Attitude Of Health Personnel
Backlog
Bos Arend
Cardiopulmonary Resuscitation/methods
Decision Making/ethics
Humans
Hypnotics and Sedatives/administration & dosage
ICU Decision Making
Infant
Intensive Care Units
Janvier A
Journal Article
Lagatta J
Lane L
Leuthner SR
Meadow W
Medical Futility
Neonatal
Neuromuscular Blocking Agents/administration & dosage
Newborn
Nicu
Pain/drug Therapy
Palliative Care/methods
Physician Assisted Dying PAD
Prognosis
Psychological/drug therapy
Retrospective Studies
Stress
The Journal Of Pediatrics
Verhagen AAE
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1017/s1478951511000423" target="_blank" rel="noreferrer">http://doi.org/10.1017/s1478951511000423</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Palliative medicine consultation impacts DNR designation and length of stay for terminal medical MICU patients.
Publisher
An entity responsible for making the resource available
Palliative & Supportive Care
Date
A point or period of time associated with an event in the lifecycle of the resource
2011
Subject
The topic of the resource
Female; Humans; Male; Medical Futility; Aged; referral and consultation; Costs and Cost Analysis; retrospective studies; DNAR; Resuscitation Orders; Palliative Care; DNAR Outcomes; APACHE; Hospital Mortality/td [Trends]; Intensive Care Units/statistics & numerical data; Length of Stay/sn [Statistics & Numerical Data]; Acute physiology and chronic health evaluation; Do not resuscitate; Length of Stay/td [Trends]; Medical intensive care; Palliative medicine consultation
Creator
An entity primarily responsible for making the resource
Lustbader DR; Pekmezaris R; Frankenthaler M; Walia R; Smith F; Hussain E; Napolitano B; Lesser M
Description
An account of the resource
OBJECTIVE: The purpose of this study was to assess the impact of a palliative medicine consultation on medical intensive care unit (MICU) and hospital length of stay, Do Not Resuscitate (DNR) designation, and location of death for MICU patients who died during hospitalization., METHOD: A comparison of two retrospective cohorts in a 17-bed MICU in a tertiary care university-affiliated hospital was conducted. Patients admitted to the MICU between January 1, 2003 and June 30, 2004 (N = 515) were compared to MICU patients who had had a palliative medicine consultation between January 1, 2005 and June 1, 2009 (N = 693). To control for disease severity, only patients in both cohorts who died during their hospitalization were considered for this study., RESULTS: Palliative medicine consultation reduced time until death during the entire hospitalization (log-rank test, p < 0.01). Time from MICU admission until death was also reduced (log-rank test, p < 0.01), further demonstrating the impact of the palliative care consultation on the duration of dying for hospitalized patients. The intervention group contained a significantly higher percentage of patients with a DNR designation at death than did the control group (86% vs. 68%, chi2 test, p < 0.0001)., SIGNIFICANCE OF RESULTS: Palliative medicine consultation is associated with an increased rate of DNR designation and reduced time until death. Patients in the intervention group were also more likely to die outside the MICU as compared to controls in the usual care group.
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1017/s1478951511000423" target="_blank" rel="noreferrer">10.1017/s1478951511000423</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2011
Acute physiology and chronic health evaluation
Aged
APACHE
Backlog
Costs And Cost Analysis
DNAR
DNAR Outcomes
Do Not Resuscitate
Female
Frankenthaler M
Hospital Mortality/td [Trends]
Humans
Hussain E
Intensive Care Units/statistics & numerical data
Journal Article
Length of Stay/sn [Statistics & Numerical Data]
Length of Stay/td [Trends]
Lesser M
Lustbader DR
Male
Medical Futility
Medical intensive care
Napolitano B
Palliative & Supportive Care
Palliative Care
Palliative medicine consultation
Pekmezaris R
Referral And Consultation
Resuscitation Orders
Retrospective Studies
Smith F
Walia R
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1001/virtualmentor.2012.14.10.ecas3-1210" target="_blank" rel="noreferrer">http://doi.org/10.1001/virtualmentor.2012.14.10.ecas3-1210</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Pediatric end-of-life decisions when abuse is suspected
Publisher
An entity responsible for making the resource available
The Virtual Mentor: Vm
Date
A point or period of time associated with an event in the lifecycle of the resource
2012
Subject
The topic of the resource
Female; Humans; infant; United States; Terminal Care; Parental Consent; referral and consultation; Medical Futility; Withholding Treatment; Life Support Care; Emergency Medical Services; Brain Injuries; Child Abuse; Skull Fractures
Creator
An entity primarily responsible for making the resource
Arias JJ; Weise KL
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1001/virtualmentor.2012.14.10.ecas3-1210" target="_blank" rel="noreferrer">10.1001/virtualmentor.2012.14.10.ecas3-1210</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2012
Arias JJ
Backlog
Brain Injuries
Child Abuse
Emergency Medical Services
Female
Humans
Infant
Journal Article
Life Support Care
Medical Futility
Parental Consent
Referral And Consultation
Skull Fractures
Terminal Care
The Virtual Mentor: Vm
United States
Weise KL
Withholding Treatment
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
January 2018 List
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
January 2018 List
URL Address
<a href="https://www.ncbi.nlm.nih.gov/pubmed/11547505" target="_blank" rel="noreferrer">https://www.ncbi.nlm.nih.gov/pubmed/11547505</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ethical decision making in neonatal units--the normative significance of vitality
Publisher
An entity responsible for making the resource available
Medicine, Health Care & Philosophy
Date
A point or period of time associated with an event in the lifecycle of the resource
2001
Subject
The topic of the resource
Decision Making; Ethics Medical; Euthanasia/px [Psychology]; Infant Premature; Intensive Care Neonatal/st [Standards]; Female; Humans; Infant Mortality; Infant Newborn; Infant Premature Diseases; Male; Medical Futility; Norway; Parents/px [Psychology]; Physician's Role; Qualitative Research
Creator
An entity primarily responsible for making the resource
Brinchmann BS; Nortvedt P
Description
An account of the resource
This article will be concerned with the phenomenon of vitality, which emerged as one of the main findings in a larger grounded theory study about life and death decisions in hospitals' neonatal units. Definite signs showing the new-born infant's energy and vigour contributed to the clinician's judgements about life expectancy and the continuation or termination of medical treatment. In this paper we will discuss the normative importance of vitality as a diagnostic cue and will argue that vitality, as a sign perceived by doctors and nurses, has moral significance and represents a legitimate contribution to clinical decision-making in difficult cases where the child's life is at stake. We will argue that these clinical intuitions can be justified on a moral basis but only with certain qualifications that accounts for a certain objectivity and intersubjective reliability in the therapeutic judgements.
Identifier
An unambiguous reference to the resource within a given context
<a href="https://www.ncbi.nlm.nih.gov/pubmed/11547505" target="_blank" rel="noreferrer">11547505</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2001
Brinchmann BS
Decision Making
Ethics Medical
Euthanasia/px [Psychology]
Female
Humans
Infant Mortality
Infant Newborn
Infant Premature
Infant Premature Diseases
Intensive Care Neonatal/st [standards]
January 2018 List
Male
Medical Futility
Medicine, Health Care & Philosophy
Nortvedt P
Norway
Parents/px [psychology]
Physician's Role
Qualitative Research
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
May 2017 List
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
The Needs Of Children With Life-limiting Conditions: A Healthcare-provider-based Model
Publisher
An entity responsible for making the resource available
The American Journal Of Hospice & Palliative Care
Date
A point or period of time associated with an event in the lifecycle of the resource
2005
Subject
The topic of the resource
Attitude Of Health Personnel; Child; Child Advocacy; Cluster Analysis; Decision Making; Family/psychology; Feasibility Studies; Health Services Accessibility/organization & Administration; Health Services Needs And Demand/organization & Administration; Humans; Medical Futility; Models Organizational; New York; Pain/prevention & Control; Patient Care Team/organization & Administration; Patient-centered Care/organization & Administration; Pediatrics/organization & Administration; Psychology Child; Qualitative Research; Quality Assurance Health Care; Quality Of Life; Right To Die; Spirituality; Terminal Care/organization & Administration
Creator
An entity primarily responsible for making the resource
Donnelly James P; Huff Susan M; Lindsey Michael L; McMahon Kathy A; Schumacher JDonald
Description
An account of the resource
Pediatric hospice and palliative care has progressed in recent years with the development of new programs and models of care. Missing from the empirical literature, however is a model of the needs of children. The purpose of the present study was to develop an empirically based conceptual model of the needs of children with life-limiting conditions. Recognizing the value of both qualitative and quantitative data, concept mapping methodology was selected as an effective way to obtain data that reflected both the "big picture" and subtleties of pediatric end-of-life needs. The seven-cluster concept map appeared best in terms of both interpretability and parsimony. This model includes the following clusters of needs: 1) pain, 2) decision making, 3) medical system access and quality, 4) dignity and respect, 5) family-oriented care, 6) spirituality, and 7) psychosocial issues. We believe that the development of a comprehensive model of the needs of such children is a step toward concrete, measurable, and effective support for children and their families.
Identifier
An unambiguous reference to the resource within a given context
10.1177/104990910502200406
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2005
Attitude Of Health Personnel
Child
Child Advocacy
Cluster Analysis
Decision Making
Donnelly James P
Family/psychology
Feasibility Studies
Health Services Accessibility/organization & administration
Health Services Needs And Demand/organization & Administration
Huff Susan M
Humans
Lindsey Michael L
May 2017 List
McMahon Kathy A
Medical Futility
Models Organizational
New York
Pain/prevention & control
Patient Care Team/organization & administration
Patient-Centered Care/organization & administration
Pediatrics/organization & Administration
Psychology Child
Qualitative Research
Quality Assurance Health Care
Quality Of Life
Right to Die
Schumacher JDonald
Spirituality
Terminal Care/organization & Administration
The American Journal of Hospice & Palliative Care
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
May 2016 List
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ethical Dilemmas In Postnatal Treatment Of Severe Congenital Hydrocephalus.
Publisher
An entity responsible for making the resource available
Cambridge Quarterly Of Healthcare Ethics
Date
A point or period of time associated with an event in the lifecycle of the resource
2016
Subject
The topic of the resource
Decision Making/ethics; Ethics Medical; Female; Humans; Hydrocephalus/diagnosis; Hydrocephalus/therapy; Infant; Infant Premature; Intensive Care Neonatal/ethics; Male; Medical Futility/ethics; Postnatal Care/ethics; Quality Of Life; Severity Of Illness Index; Ventriculoperitoneal Shunt/ethics; Withholding Treatment/ethics
Children; Hydrocephalus; Medical Ethics; Medical Futility; Neonatal Intensive Care Unit; Withdrawing Treatment
Creator
An entity primarily responsible for making the resource
Wilkinson D
Description
An account of the resource
Severe congenital hydrocephalus manifests as accumulation of a large amount of excess fluid in the brain. It is a paradigmatic example of a condition in which diagnosis is relatively straightforward and long-term survival is usually associated with severe disability. It might be thought that, should parents agree, palliative care and limitation of treatment would be clearly permissible on the basis of the best interests of the infant. However, severe congenital hydrocephalus illustrates some of the neuroethical challenges in pediatrics. The permissibility of withholding or withdrawing treatment is limited by uncertainty in prognosis and the possibility of "palliative harm." Conversely, although there are some situations in which treatment is contrary to the interests of the child, or unreasonable on the grounds of limited resources, acute surgical treatment of hydrocephalus rarely falls into that category.
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2016
Cambridge Quarterly of Healthcare Ethics
Children
Decision Making/ethics
Ethics Medical
Female
Humans
Hydrocephalus
Hydrocephalus/diagnosis
Hydrocephalus/therapy
Infant
Infant Premature
Intensive Care Neonatal/ethics
Male
May 2016 List
Medical Ethics
Medical Futility
Medical Futility/ethics
Neonatal Intensive Care Unit
Postnatal Care/ethics
Quality Of Life
Severity Of Illness Index
Ventriculoperitoneal Shunt/ethics
Wilkinson D
Withdrawing Treatment
Withholding Treatment/ethics