Ethical Considerations in Chronic Invasive Mechanical Ventilation in Pediatrics

Abstract

Placement of a tracheotomy and chronic ventilation of a child is a common enough decision in pediatric intensive care, but the decision echoes through the rest of the child’s and the family’s life. This chapter will address the ethical issues surrounding chronic ventilation by means of tracheostomy, including the initial decision to place the tracheostomy, informed consent of parents, assessment of quality of life and its role in making the decision to institute mechanical ventilation, and future decisions on end-of-life care. In addition, special considerations of ethics in two populations, teenagers with intact cognition and infants with severe cognitive deficits, will be examined.