Technological advances in modern medicine have had a great impact on the care of critically ill patients, saving many children’s lives, but also leaving others with chronic diseases and disabilities. The increased ability to sustain life with intensive care may lead, unfortunately, sometimes only to prolonging suffering when treatment is unsuccessful, and prolonging the dying process, attached to technology, instead of dying with dignity in the company of loved ones. Thus, with these new technologies also comes the responsibility to understand how, when, and why these technologies are applied, and when technology should not be used or withdrawn. Professionals have a duty to act in their patients’ best interests, to sustain life and restore health to an acceptable standard (Chantler & Doyal, 2000, Level 9). However, it is important both from an ethical as well as an economic viewpoint, for these professionals to recognise the limits of unnecessary prolongation of life. Furthermore, recognition that resources are finite, limit the provision of care that is deemed futile. The decision by a doctor to withhold or withdraw treatment, but not care, (please see Appendix 1 for definition of terms) from a patient may result in a serious conflict with a parent who insists otherwise. However, this may be ethically justifiable and legally defensible under certain circumstances, since doctors are morally obliged to question if providing treatment is inconsistent with his professional ethics. The decision to withhold or withdraw treatment can be made on the basis that treatment is contrary to the child’s best interests, disproportionately burdensome, futile, or even harmful (Larcher & Hird 2002, Level 9; Schneiderman et al, 1996, Level 9).
A systematic search of the literature using PubMed, Proquest, Ovid, and Ebsco was carried out. The key words used included withdrawal, withholding, limitation, lifesustaining therapy, life support, treatment, children, neonate, intensive care, paediatric intensive care, ethical, cost, and financial implication, used singly or in combination. The Cochrane Database of Systematic Reviews and Evidence Based Medicine Database of Abstracts of Reviews (DARE) were also searched. Additional literature search was carried out using the words nutrition and hydration.