Witholding resuscitation from seriously ill children shocks parents
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Questions on the conditions under which resuscitation should be witheld from seriously ill young children has sparked an intense ethical debate between doctors and parents in the Helsinki area.
The debate at the Hospital for Children and Young People at of the Helsinki and Uusimaa Hospital District was sparked when the medical journal Duodecim published a special issue on developmental disability. The issue included an article by the hospital’s child neurologist, Tuula Lönnqvist on care for the most severely disabled children.
"When a definitive diagnosis of a severe disability or a severe advancing disease has been made, the specialist responsible for the treatment should, in my opinion, tell the parents that the child should not be given intensive care, and should not be resuscitated or connected to a respirator".
The article shocked a number of parents of severely disabled children. The parents were left asking if a group decision was involved, or possibly a ban on resuscitating children with a certain diagnosis.
"We have been told that we have misunderstood and misinterpreted the matter. If this is the case, the matter must be clarified and rectified", says Miina Weckroth, executive director of a centre for families with disabled children.
Tuula Lönnqvist emphasises that witholding treatment is always an individual decision, aimed at avoiding suffering by the patient, because intensive care is very strenuous. "The child’s illness and overall situation are the most important basis for selecting treatment", Lönnqvist says.
"The reason that I wrote about the matter in the article is that it was an issue on developmental disability. The main idea was that a doctor should be able to discuss treatment with the parents in a calm situation", she added.
A few children being cared for in the hospital have "do not resuscitate" (DNR) orders in force.
"Our possibilities to discuss these decisions and their backgrounds thoroughly in public are limited by doctor-patient confidentiality, which means that details of a patient’s condition cannot be aired in public", says Helena Pihko, head of children’s neurology at the Helsinki University Central Hospital. She adds that if a child’s condition improves, decisions on treatment can also be changed.
However, some parents feel that the hospital has ignored their feelings in deciding on treatment. Others have felt insulted by doctors’ comments on a disabled child and the child’s prognosis.
Miina Weckroth feels that an outside expert on human interaction is needed to unlock the stalemate.
"If doctors would only understand that feedback is not an annoyance, and that it needs to be taken seriously", Weckroth says.
The State Provincial Office of Southern Finland is currently dealing with the DNR issue, and asked the Helsinki University Central Hospital to submit a report in early December.
Helsingin Sanomat
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| 11.12.2006 - TODAY |
 Witholding resuscitation from seriously ill children shocks parents
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