Haematological symptoms

The management of symptomatic anaemia, minor bleeding, and other rarer haematological symptoms in the palliative phase illustrates very well the challenging decisions that face professionals who are working with dying children. On the one hand, modern medical interventions have the capacity to relieve some of the symptoms that haematological abnormalities can cause. On the other hand, the interventions themselves carry morbidity and can cause not only symptoms related to physical reactions, but also often emotional and psychological issues related to otherwise avoidable hospital attendance. The ethical issues involved in subjecting a child—whose voice is often unheard—to treatments just because they are available should also be carefully considered. The best clinical decision can only be made by considering the needs of the individual child and their family, giving appropriate weight to the risks and potential benefits of giving an intervention, both physical and otherwise, and the risks and potential benefits of withholding it. In this respect, management of haematological symptoms is typical of thoughtful and skilled childhood palliative care in general.