TY - JOUR T1 - Ethics and law and palliative medicine joint session JF - Archives of Disease in Childhood JO - Arch Dis Child SP - A77 LP - A81 VL - 90 IS - suppl 2 A2 - , Y1 - 2005/04/01 UR - http://adc.bmj.com/content/90/suppl_2/A77.abstract N2 - G. Minnaar1, N. Dumphy2, J. Beedaysee2, A. D. Cowley1, R. J. Mildner1.1Diana, Princess of Wale Children’s Hospital, Birmingham, UK; 2University of Leeds Medical School, Leeds, UK Background: Children commonly die through withholding or withdrawing of life sustaining measures and the RCPCH first produced a framework for practice in 1997. Little is known about its effect on clinical practice. Aims: To establish the attitudes of paediatricians towards end of life management issues including four key areas: communication, dealing with conflict, active v palliative care, and withdrawal of treatment. Methods: A questionnaire based on four real life cases of children with incurable disease was sent to all consultant paediatricians in the West Midlands. Twenty four statements encompassing the four key areas were included. Responses were rated on an itemised rating scale from strongly disagree to strongly agree. Results: The response rate was 52% (113 completed questionnaires). Forty five per cent of consultants had more than five patients with incurable disease, but only 22% had received formal training in end-of-life management. Most agreed that early information and understanding about prognosis and management is important for families and their children. Quality of life and intractable symptoms were the most common reasons for stopping active treatment. In dealing with conflict most agreed to maintain dialogue but not to give families the final decision. The majority (57%) would delay seeking a second opinion and most disagreed with using the courts to resolve conflict. Opinions were divided on when care should be switched from active to palliative. Most advocated use of sedation and analgesia during withdrawal and would discontinue or avoid muscle relaxants. Conclusion: Although clear communication was important for consultants at the end-of-life, there was disagreement on the timing of withdrawal of life … ER -