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Paediatric long term ventilation; the right or wrong move? A critical analysis based on case studies in picu, exploring the controversial issues surrounding the initiation of long term ventilation in children with chronic disease
  1. H S Baird
  1. Medical School, University of Manchester, Manchester, UK


Aim The number of children in the UK that are supported by long term ventilation (LTV) has increased over the last decade, creating questions about its viability. This analysis does not aspire to provide answers, but explore the difficult dilemma's arising from paediatric LTV.

Method and results Three cases involving LTV are presented here, from which questions have arisen regarding this practice and its ethical, social and resource implications. Views were gathered from the parents, doctors and specialist teams involved with the cases. Questions were asked about the sustainability of LTV alongside the many difficult ethical implications of initiating LTV, as well as not initiating LTV. The results of this analysis failed to give a definitive answer as to legitimacy of LTV. Instead it highlights the immense ethical dilemma in making these decisions around initiation of LTV, and the difficulty in determining who has the responsibility for making that decision.

Conclusion The high cost, poor prognosis and limited resources at times make it difficult to justify the ongoing support required for LTV. However, this alone cannot supersede the basic human right to life. Controversy arises when it is perceived that this practice is merely prolonging death rather than supporting life. The child's best interests are paramount, although it is important to try to comprehend the child's quality of life; this is inevitably subjective, especially when a child is unable to communicate. Ultimately the situation must be evaluated in terms of its level of futility. The Royal College of Paediatrics and Child Health outline situations that can be regarded as futile, namely the ‘unbearable situation’. The difficulty that arises with LTV is determining if and when this situation is reached. First instincts may suggest that the parents are best placed to determine what is best for their child as the surrogate decision maker, although it is recognised that parents and child's interests are inseparable. Responsibility falls to the doctor to guide parents with their knowledge and experience to the best course of action. This discussion does not aspire to provide answers, but explore the difficult dilemma's arising from paediatric LTV.

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