‘Good’ Medicine: Ethics and Pediatric Critical Care

  • F. A. Carnevale
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 25)


In a recent study of 16 pediatric intensive care units (PICU), in the United States, Levetown and her associates reported that every unit systematically restricted medical intervention for particular groups of patients [1]. In their examination of 5415 consecutive PICU admissions, the care of 119 patients was restricted; 79% of these patients subsequently died in the PICU. This group of ’restriction’ patients that died represented 38% of all deaths in the study settings.


Pediatric Intensive Care Unit Brain Death Moral Ideal American Hospital Association Medical Futility 
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  1. 1.
    Levetown M, Pollack MM, Cuerdon TT, Ruttiman UE, Glover J J (1994) Limitations and withdrawals of medical intervention in pediatric critical care. Journal of the American Medical Association 272:1271–1275.PubMedCrossRefGoogle Scholar
  2. 2.
    Fox RC (1994) The entry of U.S. bioethics into the 1990s: A sociological analysis. In: Du- Bose ER, Hamel RP, O’Connell LJ (eds) A matter of principles? Ferment in US bioethics. Trinity Press International, Valley Forge, Pennsylvania, pp.21–71.Google Scholar
  3. 3.
    Fox RC (1990) The evolution of American bioethics: A sociological perspective. In: Weisz G (ed), Social science perspectives on Medical Ethics. Kluwer Academic, Boston, pp. 201–217.CrossRefGoogle Scholar
  4. 4.
    Engelhardt HT (1986) The foundations of bioethics. Oxford University Press, New York.Google Scholar
  5. 5.
    Beauchamp TL, Childress JF (1994) Principles of biomedical ethics, 4th edn. Oxford University Press, New York.Google Scholar
  6. 6.
    DuBose ER, Hamel RP, O’Connell LJ (eds) (1994) A matter of principles? Ferment in US bioethics. Trinity Press International, Valley Forge, Pennsylvania.Google Scholar
  7. 7.
    Kennedy Institute of Ethics Journal: Special issue (1995) Theories and methods in bioethics: Principlism and its critics. Kennedy Institute of Ethics Journal 5:181–286.Google Scholar
  8. 8.
    Schneider CE (1994) Bioethics and the language of the law. Hastings Center Report 24:16-22.PubMedGoogle Scholar
  9. 9.
    American Academy of Pediatrics - Committee on Bioethics (1994) Guidelines on forgoing life-sustaining medical treatment. Pediatrics 93:532–536.Google Scholar
  10. 10.
    Faden RR, Beauchamp TL (1986) A history and theory of informed consent. Oxford University Press, New York.Google Scholar
  11. 11.
    Pearlman RA, Miles SH, Arnold RM (1993) Contributions of empirical research to medical ethics. Theoretical Medicine 14;197–210.PubMedCrossRefGoogle Scholar
  12. 12.
    Uhlmann RF, Pearlman RA, Cain KC (1988) Ability of physicians and spouses to predict resuscitation preferences of elderly patients. Journal of Gerontology 43:115–121.Google Scholar
  13. 13.
    Veatch RM (1989) Death, dying, and the biological revolution. Yale University Press, New Haven.Google Scholar
  14. 14.
    Gillett G (1990) Consciousness, the brain and what matters. Bioethics 4:181–198.PubMedCrossRefGoogle Scholar
  15. 15.
    Ashwal S, Cranford R, Bernat JL et al (The Multi-Society Task Force on Persistent Vegetative State) (1994) Medical aspects of the persistant vegetative state. The New England Journal of Medicine 330:1499–1508; & 330:1572–1579.Google Scholar
  16. 16.
    Cassell EJ (1991) The nature of suffering and the goals of medicine. Oxford University Press, New York.Google Scholar
  17. 17.
    Carnevale FA (1991) High technology and humanity in intensive care: finding a balance. Intensive Care Nursing 7: 23–27.PubMedCrossRefGoogle Scholar
  18. 18.
    Carnevale FA (1995) The experience of critically ill children. L’infirmiere du Quebec 3:21 (abst).Google Scholar
  19. 19.
    Carnevale FA (1995) The experience of families of critically ill children: Family system transitions. Canadian Psychology 36:233 (abst).Google Scholar
  20. 20.
    Carnevale FA (1990) A description of stressors and coping strategies among parents of critically ill children - a preliminary study. Intensive Care Nursing 6:4–11.PubMedCrossRefGoogle Scholar
  21. 21.
    Spiro ME (1993) Is the Western conception of the self’peculiar’ within the context of the world cultures? Ethos 21:107–153.CrossRefGoogle Scholar
  22. 22.
    Carnevale FA (1995) “I want to help people:” Ethics, nursing, and critical care. Official Journal of the Canadian Association of Critical Care Nurses 6:10–11.Google Scholar
  23. 23.
    Taylor KM (1988) Physicians and the disclosure of undesirable information. In: Lock M, Gordon D (eds) Biomedicine examined. Kluwer Academic Publishers, Dordrecht, 441–463.CrossRefGoogle Scholar
  24. 24.
    Kaufert JM, O’Neil JD (1990) Biomedical rituals and informed consent: Native Canadians and the negotiation of clinical trust. In: Weisz G (ed), Social science perspectives on Medical Ethics. Kluwer Academic, Boston, 41–63.CrossRefGoogle Scholar
  25. 25.
    Gordon DR (1990) Embodying illness, embodying cancer. Culture, Medicine, and Psychiatry 14:275–297.Google Scholar
  26. 26.
    Lock M (1995) Contesting the natural in Japan: Moral dilemmas and technologies of dying. Culture, Medicine and Psychiatry 19:1–38.PubMedCrossRefGoogle Scholar
  27. 27.
    Taffet GE, Teasdale TA, Luchi RJ (1988) In-hospital cardiopulmonary resuscitation. Journal of The American Medical Association 260:2069–2072.PubMedCrossRefGoogle Scholar
  28. 28.
    Murphy DJ (1988) Do-not-resuscitate orders: Time for reappraisal in long-term-care institutions. Journal of The American Medical Association 260:2098–2101.PubMedCrossRefGoogle Scholar
  29. 29.
    Schiedermayer DL (1988) The decision to forgo CPR in the elderly patient. Journal of The American Medical Association 260:2096–2097.PubMedCrossRefGoogle Scholar
  30. 30.
    Youngner SJ (1988) Who defines futility? Journal of The American Medical Association 260:2094–2095.PubMedCrossRefGoogle Scholar
  31. 31.
    Weijer C, Elliott C (1995) Pulling the plug on futility. British Medical Journal 310:683–684.PubMedCrossRefGoogle Scholar
  32. 32.
    Vernon DD, Dean JM, Timmons OD, Banner W, Allen-Webb EM (1993) Modes of death in the pediatric intensive care unit: Withdrawal and limitation of supportive care. Critical Care Medicine 21:1798–1802.PubMedCrossRefGoogle Scholar
  33. 33.
    Jayes RL, Zimmerman JE, Wagner DP, Draper EA, Knaus WA (1993) Do-not-resuscitate orders in the intensive care units. Journal of The American Medical Association 270:2213–2217.PubMedCrossRefGoogle Scholar
  34. 34.
    American Medical Association (1991) Guidelines for the appropriate use of do-not-resuscitate orders. Journal of The American Medical Association 265:1868–1871.CrossRefGoogle Scholar
  35. 35.
    American Hospital Association. (1994) Values in conflict: Resolving ethical issues in health care. American Hospital Association, Chicago.Google Scholar
  36. 36.
    Callahan D (1983) On feeding the dying. Hastings Center Report 13:22.PubMedGoogle Scholar
  37. 37.
    Seigler M, Weisbard AJ (1985) Against the emerging stream: Should fluids and nutritional support be discontinued? Archives of Internal Medicine 145:129–131.CrossRefGoogle Scholar
  38. 38.
    Lynn J, Childress JF (1983) Must patients always be given food and water? Hastings Center Report 13:17–21.PubMedGoogle Scholar
  39. 39.
    de Wachter MAM (1992) Euthanasia in the Netherlands. Hastings Center Report 22:23–30.PubMedCrossRefGoogle Scholar
  40. 40.
    Singer P (1995) A report from Australia: The legalisation of voluntary euthanasia in the northern territory. Bioethics 9:419–436.PubMedCrossRefGoogle Scholar
  41. 41.
    Callahan D (1992) When self-determination runs amok. Hastings Center Report 22:52–55.PubMedCrossRefGoogle Scholar
  42. 42.
    Capron AM (1992) Euthanasia in the Netherlands: American observations. Hastings Center Report 22:30–33.PubMedGoogle Scholar
  43. 43.
    Moulin DE, Latimer EJ, Macdonald N, et al (1994) Statement on euthanasia and physician- assisted suicide. Journal of Palliative Care 10:80–81.PubMedGoogle Scholar
  44. 44.
    Ad Hoc Committee of the Harvard Medical School (to Examine the Definition of Brain Death) (1968) A definition of irreversible coma. Journal of The American Medical Association 205:85–88.CrossRefGoogle Scholar
  45. 45.
    Veatch RM (1993) The impending collapse of the whole-brain definition of death. Hastings Center Report 23:18–24.PubMedGoogle Scholar
  46. 46.
    Walters JW (1991) Anencephalic infants as organ sources. Bioethics 5:326–341.PubMedCrossRefGoogle Scholar
  47. 47.
    Arnold RM, Youngner SJ (eds) (1993) Ethical, psychosocial, and public policy implications of procuring organs from non-heart-beating cadavers (special issue). Kennedy Institute of Ethics Journal 3:103–278.Google Scholar
  48. 48.
    Teo B (1991) Organs for transplantation: The Singapore experience. Hastings Center Report 21:10–13.PubMedCrossRefGoogle Scholar
  49. 49.
    Rix BA (1990) The importance of knowledge and trust in the definition of death. Bioethics 4:232–236.PubMedCrossRefGoogle Scholar
  50. 50.
    Cushman R, Holm S. (1990) Death, democracy and public ethical choice. Bioethics 4:237–252.PubMedCrossRefGoogle Scholar
  51. 51.
    Hoshino K (1993) Legal status of brain death in Japan: Why many Japanese do not accept ’brain death’ as a definition of death. Bioethics 7:234–238.PubMedCrossRefGoogle Scholar
  52. 52.
    Ohnuki-Tierney E (1994) Brain death and organ transplantation: Cultural bases of medical technology. Current Anthropology 35:233–254.PubMedCrossRefGoogle Scholar
  53. 53.
    Lock M, Honde C (1990) Reaching consensus about death: Heart transplants and cultural identity in Japan. In: Weisz G (ed) Social science perspectives on medical ethics. Kluwer Academic Publishers, Dordrecht, p.99–119.CrossRefGoogle Scholar
  54. 54.
    Fabrega H (1990) An ethnomedical perspective of medical ethics. Journal of Medicine and Philosophy 15:593–625.PubMedGoogle Scholar
  55. 55.
    Fox RC, Swazey JP (1984) Medical morality is not bioethics - Medical ethics in China and the United States. Perspectives in Biology and Medicine 27:336–360.PubMedGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1996

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  • F. A. Carnevale

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