Catholic Medical Quarterly Volume 69(1) February 2019

Correspondence

Care of Dying Children. Withdrawal of Treatment in Children.

Dr Anthony Cole JP, FRCP(EDIN). FRCPCH,

I write as a paediatrician with forty years experience in general paediatrics and neonatology in the NHS. Here are two m points that I think important

  1. The insights of parents
    It is not uncommon for disagreements to arise between parents and healthcare professionals over small signs of consciousness or other responses in very sick children. Parents have a natural empathy with their child and are often in nearly continuous contact . Professional, on the other hand, may attach great importance to relatively small X-ray findings or other investigations which parents may not appreciate. Communication is of the essence to maintain confidence with the clinical team. Images as such, may not be synonymous with a diagnosis. The observations of parents should be treated with the utmost seriousness and documented. The comment that is sometimes made that "the response is just reflex " may be unhelpful or even mistaken.
  2. The withdrawal of life supporting treatment
     This is a very sensitive matter and a good relationship between clinical decision makers and the parents is of paramount importance. This will take time and the issue is not only the survival of the child, but the long term emotional and spiritual well being of the parents and the wider family. As Dame Cicely Saunders reminds us, the manner of death lives on with the survivors. I have been humbled and great full to parents that I have known and, in particular, a willingness to accept the inevitable, but clinicians must be prepared to wait for the right moment.
Dr Anthony Cole. Chairman of the Medical Ethics Alliance