End of life issues in pediatric patients.

Dealing with end-of-life issues in pediatric patients is difficult due to their young age, the complexities of situations leading to illness, and the multiple decision makers that exist in addition to parents and guardians. Pediatric patients do not have living wills addressing specific instructions for how long to continue life support systems such as a ventilator or a G-tube (gastrostomy tube for feeding). The dying pediatric patient also has typically not consented to organ donation either. The burden of decision making lies with the parents, guardians, and health-care providers of the dying child. This paper deals with these complexities and reflects the author's own experiences over nearly four decades of dealing with pediatric patients in her practice.