Thanks for the post worldwatcher, and no doubt it may get a bit heated in this discussion as it involves little ones.

Those of you who do not know, I am a Pediatric Critical Care Transport Specialist (RNTS) I have spent my entire nursing life in tranport or the Peds ICU. What I may say will no doubt bother some people. So please lets try to keep the discussion civil as befitting ATS.

This occurs in the US as well. No it is not sanctioned and no it is not reported as such. Parents in hospitals are ALWAYS given the options they have on a termanly ill child and sometimes that option can involve doing nothing, or removing treatment. As the article points out, it is not a team of doctors playing god, it is a decision that is reached by the care team as well as the parents.

Examples include extremely premature births, where children suffer brain damage from bleeding and convulsions; and diseases where a child could only survive on life support for the rest of its life, such as severe cases of spina bifida and epidermosis bullosa, a rare blistering illness.

All of the above cases quoted from the article (link above) involve the child undergoing agressive treatment and usually it is quite hard to controll thier pain for a variety of reasons. We would not hesatae to put down a beloved pet, yet we insist to subjecting our loved ones to a futile regime that at best may by them a few hours, a few days, or a few months. The price of this beyond our own grief and angush is that the one we are subjecting this to is flogged, is subject to painfull procedures and by and large suffers greatly. Im not saying that a dog or a cat is more important than a human, I just pointing out that we do not subject them to this.

Let me leave you with this story: most details will be ommited to comply with HIPPA laws. Emily was a 7 year old. Mental retardation made her the equivilent of about a 3 year old according to her mom. Around Thanksgiving she developed a cold. Several trips to the ED and finaly on the night of the 29th she presented to the local hospital in respiratory distress. The ICU at the community hospital realizing that they were in trouble made arrangements to transport her to the nearest childrens hospital. The team via lifeflight chopter arrived and judging her condition to be critical immedialy loaded and took off for home. Halfway home and with communications with the hospital blocked by a coastal range Emily suffered respiratory arrest. The nurse intubated (put in a breathing tube) however, even with a ventalator Emily was in trouble. Her heart went into a dysrythmia known as Ventricular Tachycardia (caused by the global lack of oxygen) she was shocked several times before landing and a heart rate was returned after 3 minutes of shocking and CPR in the chopter On landing she was taken to the PICU. The team worked on her for hours. We got to the point where the parents were presented with thier options. Continue flogging her with drug and CPR, Place her on heart lung bypass, or do nothing. The parents chose the latter. Quoting the mom "shes suffered enough" We stopped, the life support was removed, and the breating tube taken out. a dose of morphine was given to help with any pain and ease her out so she did not have to suffer. She died a few minutes later free of any pain being held by her mother and father and surrounded by family. This event was real, and I was the nurse that intubated her and stayed with her till the end. I will always remember one thing. Before we sedated her to intubate, she mouthed what could only be "mommy" and she looked scared.

This family made a choice. The chose the best option for thier daughter not FOR them. As noted in the article, the religious groups are already up in arms and no doubt the pope will have negative things to say. But taken in context and with the consent of the parents What is the real issue here?

What happens in the case of divorced parents with one parent wanting to end their child's supposed suffering and the other disagreeing? Is it then in the hands of the courts? The legal ramifications here are endless. This could turn ugly.

Peace

Originally posted by Dr Love
What happens in the case of divorced parents with one parent wanting to end their child's supposed suffering and the other disagreeing?

Usually most parents will pull it together and decide what best for thier child. I will tell you that if it comes down to a court decison, they usually go with the full treatment cource.

Originally posted by FredT
Continue flogging her with drug and CPR, Place her on heart lung bypass, or do nothing. The parents chose the latter

I'm not understanding something here. This patient was brought in with a respitory infection, things went bad and what happens now, what are the choices? The heart lung bypass is permanent and no matter what this persno would have to be on all sorts of life support and never really be 'cured', and on top of they they're mentally handicapped? Because when i first read it it seemed like she was handicapped, got sick, and then things went bad, and in order to return the kid to normal they'd have to do some crazy stuff but in the end she'd be like she was before the respitory infection.

Originally posted by Nygdan
[I'm not understanding something here. This patient was brought in with a respitory infection, things went bad and what happens now, what are the choices? The heart lung bypass is permanent and no matter what

Couple of things. The heart lung bypass also called ECMO or Extra Copreal Memberane Oxygenation is used as temporary measure. it allows the body to recive the blood flow and oxygen to sustain itslef and allows time for the lungs to heal. If they do, then the patient is weaned back to conventional ventalation. Longest run we have had was a kid that wnet 30+ days waiting for a heart transplant. The other option was continued use of high vent pressures, drugs, CPR and the like that was not working and would have failed eventually.

FredT thank you for sharing your perspective on this issue, I found your responses to be quite informative

This is a touchy subject, but I understand, totally, why the parents would choose to let their child die a peaceful death without more intervention. It occurs at the other end of the age spectrum as well. I will use a hypothetical case: Patient A has dementia and can no longer make decisions for himself. He is well into his 90s. He presents, at the ER, with pneumonia and is admitted to the hospital. After 3 days of intravenous antibiotics, Patient A's pneumonia has worsened. Lasix is given to try to drain fluids. The prognosis for patient A is grim: the family is informed that the patient cannot recover from this illness. The family is given several options: to use aggressive treatment, to remove the patient to a Hospice, or to stop all treatment except pallative care. The family chooses to stop all treatment except pallative care. Patient A lives another 12 hours and dies a peaceful death. In this case, the Patient's family were asked if they wanted to give morphine for paiin. The family replied "if, in your judgement, the patient is feeling pain, give pain relief."
In my opinion, whether at the beginning, middle or end of life (in terms of years) there are some situations where, medically there is no hope. I do not believe in active euthanasia (although I can understand those who do) but I do strongly believe that it's a person's right and a family's right to stop aggressive, painful treatments when there is no hope of a good outcome.
joey

There is a world of difference between witholding aggressive measures to allow someone to die (happens every day, even in America) and doing something that actually will cause death (overdoses of pain meds...etc.)

IMO there is nothing wrong with allowing them to die, but by causing the death as discussed in the article is , for lack of a better word, wrong.

I see the mercy side of this but folks it starts to scare the hell out of me when you talk about killing people because others decide that it is best for them. I mean there is a slippery slope going on here, and an inch can make a lot of difference as far as who a government considers to be able to comminicate their wishes. I just pray now that we've gone this far that it doesn't continue into say the severely handicapped. Not trying to overreact, but when a government starts making guidelines as to when its ok to kill a person for medical reasons, I think you have to. I'm all for not making terminally ill children suffer and I understand the letting them die naturally and not extending their pain thing, but when you start prematurely bringing on the death and setting standards......

SkiBum, I feel the same way. Active euthansia, through the use of overdoses, is, in my opinion, wrong. What gets sticky is this: when a patient is in acute pain AND undergoing respiratory distress of some level. Administering the pain meds will aggravate the respiratory distress and, possibly, cause death. The question is:where do you draw that line between alleviating pain and stopping aggressive treatment and euthansia? I am sure ethnicists have a problem with this one too. I would go with alleviating pain and suffering...especially if there is no hope of survival.
joey

First, sorry about the extra thread, did not see it.


First abortion , now this. When you do not value the innocent it starts one down a path. That path leads to getting rid of the sick, the mentally Ill, any life that is not respected....it is what Hitler tried in his perfect race.

This is absolutely heartbreaking!

Originally posted by FredT
Let me leave you with this story: most details will be ommited to comply with HIPPA laws. Emily was a 7 year old. Mental retardation made her the equivilent of about a 3 year old according to her mom. Around Thanksgiving she developed a cold. Several trips to the ED and finaly on the night of the 29th she presented to the local hospital in respiratory distress. The ICU at the community hospital realizing that they were in trouble made arrangements to transport her to the nearest childrens hospital. The team via lifeflight chopter arrived and judging her condition to be critical immedialy loaded and took off for home. Halfway home and with communications with the hospital blocked by a coastal range Emily suffered respiratory arrest. The nurse intubated (put in a breathing tube) however, even with a ventalator Emily was in trouble. Her heart went into a dysrythmia known as Ventricular Tachycardia (caused by the global lack of oxygen) she was shocked several times before landing and a heart rate was returned after 3 minutes of shocking and CPR in the chopter On landing she was taken to the PICU. The team worked on her for hours. We got to the point where the parents were presented with thier options. Continue flogging her with drug and CPR, Place her on heart lung bypass, or do nothing. The parents chose the latter. Quoting the mom "shes suffered enough" We stopped, the life support was removed, and the breating tube taken out. a dose of morphine was given to help with any pain and ease her out so she did not have to suffer. She died a few minutes later free of any pain being held by her mother and father and surrounded by family. This event was real, and I was the nurse that intubated her and stayed with her till the end. I will always remember one thing. Before we sedated her to intubate, she mouthed what could only be "mommy" and she looked scared.

This family made a choice. The chose the best option for thier daughter not FOR them. As noted in the article, the religious groups are already up in arms and no doubt the pope will have negative things to say. But taken in context and with the consent of the parents What is the real issue here?

That is so sad and I can not say it was wrong of the parents to remove care. You hit a nerve though, not that you do not know your job, but was there ANY possibility of recovery? Could she be stabilized?

Euthanasia was NOT done in this case, the Lord called her home when life support was taken away. No parent should ever have to go through this and I can not say what I would have done as I was not there.

Euthanasia though can be seen in the Netherlands for what it is is some cases, old people that no longer want to burden their children. Some children even encourage it....

Life- When its value is degraded in any way, it just becomes easier...

Originally posted by edsinger
First, sorry about the extra thread, did not see it.


First abortion , now this. When you do not value the innocent it starts one down a path. That path leads to getting rid of the sick, the mentally Ill, any life that is not respected....it is what Hitler tried in his perfect race.

This is absolutely heartbreaking!

Would you rather these babies suffer? Would you rather people with no hope for recovery suffer in pain couting down the days until they will die anyways? Who are you to let them suffer more? We do value the innocent, value them enough to know when to let them pass on because of immense pain with no hope of recovering. Your Hitler comment is ridiculous, were only trying to alleviate suffering, not create some perfect race, or just do away with anyone we deem undesirable... We DO respect life, respect it enough to not let it drag on in miserable pain. Where is the line between life and death? Would you consider a people with a terminally ill disease suffering in their beds day in and day out, as "living"? Its not like they just go around killing anyone they wish.

I understand the desire of family and parents of terminally ill family members to alleviate the suffering of their family. Given the same circumstances, I hope that my family allows me to go if even in that situation. But will it stop here or continue on.

Who is to say that a couple of years from now that doctors decide to euthansize children who are mentally retarded, have MS, or have Cerebral Palsy? The doctors might say that they have no hope of living a normal, productive life. Where does it stop?

I feel the pain of the family, but I believe that this goes too far. By the way, why isn't anything being done to the hospital for euthanizing before the law? Wouldn't that be against the law?

I don't have a problem with it unless it is kept in check. This is how the holocaust started in Germany.

Remeber Hitler preached compassion in the mercy killing of Baby Lois ( I think that was the name). Hitler then followed suit to include the disabled, mentally ill, elderly, so on and so forth. So if it is kept in check and on a very tight leash, (meaning only applying to terminally ill children, who are in terrible pain and cannot recover) I can tolerate it.

On the other hand this does open up a can of worms. What about AIDS babies? They are terminally ill, there is no cure for their disease, do we euthanize them as well? What about Downs Syndrome babies?

Mark my words the next step will be to allow parents to make the choice of whether or not to euthanize their children if they are born with any birth defect.

Therein lies the problem, who decides who is "beyond hope?" Remember, the path to hell is paved with good intentions.

I agree that it is a slippery slope. In the case I cited previously, the determination to stop treatment was based on brain death. It seems to me, that if someone is brain dead, that they are, by any medical, ethical, or religious criteria, "dead". However, I still remain conflicted on this subject. I guess I'm conflicted because what can be seen as humane and moral (and is humane, moral, and legal) might well be abused or misused, at some point.
I think the Hospice model is the best one. It's not proactive, but allows people, who are clearly terminal, to refuse aggressive treatment and to die as painfree as possible. When we reach beyond the Hospice model, I think things get a bit stickier. Just my 2 cents.
joey

Originally posted by jukyu
Therein lies the problem, who decides who is "beyond hope?" Remember, the path to hell is paved with good intentions.

I just hope that the politicians stay out of making a decision and let the family and the doctors make all decisions period.

Originally posted by knights5629I just hope that the politicians stay out of making a decision and let the family and the doctors make all decisions period.

But there in lies another question, which DOC gives the information needed by the parents? Don't give me that Hippocratic oath either.