End-of-life care in Brazilian pediatric intensive care units: challenges and opportunities

End-of-life care in Brazilian pediatric intensive care units: challenges and opportunities

Rotta AT; Alibrahim O

The Journal of Pediatrics

2023

Brazil; end-of life care; Intensive Care Units; pediatric; Terminal Care

Pediatric Critical Care Medicine has evolved drastically as a specialty since its inception more than five decades ago.1 Advances in technology and medical interventions have led to a substantial reduction in mortality rates, which are now in the single digits; an achievement once unfathomable in the early days of our specialty.1,2 However, with the high survival rates currently seen in pediatric intensive care units (PICUs), the focus of care has shifted from life preservation “at all cost” to greater consideration given towards end-of-life care (EOLC), when appropriate. In fact, over 50% of deaths in the PICU represent the endpoint of a predetermined EOLC strategy within the scope of palliative care.3,4 This shift has created a dilemma for pediatric intensivists, who must balance the benefits of technological interventions (what can be done) with the ethical and moral quandaries of providing quality care (what should be done) to terminally ill children. The use of technological equipment has become increasingly ordinary in patients with irreversible and chronic illnesses, leading to a reliance on artificial life-sustaining methods that can adversely affect the patient's quality of life, their loved ones, and the healthcare team. As counterpart to these contemporary care strategies, it is morally and ethically permissible – and most would reason that it is in fact one's responsibility – to recommend and facilitate discontinuation of life-sustaining measures when the distress brought about by treatment outweighs its benefit to the child.5 ...

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