Continuation of Potentially Inappropriate Life-Sustaining Therapies: Provider Perspectives.

Background: Prior work examines provider perspectives on withholding potentially inappropriate life-sustaining treatments over family objections; however, data are limited regarding how physicians approach situations in which they are considering withholding or withdrawing life-sustaining therapies against the wishes of the patient's family.

Measures: This study sought to better understand the way in which pediatric critical care clinicians navigate situations in which families request life-sustaining therapies that the team feels may be inappropriate.

Outcomes: We conducted a series of semi-structured group interviews with pediatric critical care faculty and used these data to create a case-based, ten-question ethical dilemma survey, which was disseminated nationally to pediatric intensivists. This paper explores participant responses to survey question three, which presented a case in which family requests continuation of ventilatory/nutritional support after severe traumatic brain injury with minimal recovery potential.

Outcomes: Most participants reported that they would offer the requested interventions; however, there was substantial variation among participants regarding the best next steps. Participants who chose to submit free-text responses described thoughtfully attempting to balance avoiding prolongation of suffering and respecting parents' roles as decision-makers for their child.

Conclusions/lessons learned: The variation between participants in their approach to this ethical dilemma underscores its difficulty, as well as the importance of institutional support structures (e.g. ethics, legal, risk management, palliative care). In a healthcare system with limited resources to support families taking care of critically ill and technology-dependent children, our study underscores a need for training, practice, and institutional support for physicians assisting families in navigating these decisions.