Background Intensive care is high risk care and patients are susceptible to iatrogenic injury due to the placement of multiple invasive devices used for monitoring clinical status. These injuries have financial and medical implications as patients may later seek legal recourse and compensation. There are also issues about loss of confidence in medical carers when injuries occur and this can complicate ethical decision making within the ICU.
Objectives To explore the practical application of ethical principles in decision making around withdrawal of intensive care given a background of iatrogenic injury.
Methodology Retrospective analysis of case records and case discussions between the neonatal team and parents.
Case A 26+5 week gestation infant with treatable congenital heart disease who developed many of the complications of prematurity including respiratory distress syndrome, necrotising enterocolitis and cystic periventricular leukomalacia and attendant risks of long term respiratory, gastrointestinal and neurological morbidity. Placement of an arterial line led to ischaemic necrosis of the hand. The ethical dilemma faced related to conflict between the parents and carers as to continued provision of ICU. Did the presence of the hand injury sway physicians from acting in the best interests of the child?
Discussion In this case decisions about continued provision of care were complicated by the presence of a non-life threatening iatrogenic injury. Parental confidence in physician motivation was a major issue in clinical decision making. This highlights the need for a clinical ethics service to provide more impartial decision making in the best interests of the infant.