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The ethics of withholding and withdrawing dialysis in children

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Book cover Pediatric Dialysis

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Abstract

Few issues in pediatric practice are more complex and difficult than those for doctors and clinical staff faced with the decision to withhold or withdraw life-prolonging treatment such as dialysis1,2. In the 1960s and 1970s when dialysis was developing, there were serious doubts about offering renal replacement therapy (RRT) to children with all its attendant traumas and uncertain outcomes. The increasing use of chronic peritoneal dialysis in the 1980s enabled us to treat children of all ages and sizes and deliver the treatment at home. However, “having the technology” has brought increasing ethical dilemmas especially in the treatment of infants where there are significant variations in practice3-5.

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References

  1. Shooter M, Watson A. The ethics of withholding and withdrawing dialysis therapy in infants. Pediatr Nephrol. 2000;14:347–51.

    Article  PubMed  CAS  Google Scholar 

  2. Shooter M. The ethics of withholding and withdrawing therapy in infants and young children. In: Fine RN, Alexander SR, Warady BA, editors. CAPD/CCPD in Children, 2nd edn. Boston: Kluwer, 1998: pp. 433–50.

    Chapter  Google Scholar 

  3. Cohen C. Ethical and legal considerations in the care of the infant with end-stage renal disease whose parents elect conservative therapy. Pediatr Nephrol. 1987;11:49–64.

    Google Scholar 

  4. Bunchman TE. The ethics of infant dialysis. Perit Dial Int. 1996;16(Suppl 1):3–6.

    Google Scholar 

  5. Geary DF. Attitudes of pediatric nephrologists to management of end-stage renal disease in infants. J Pediatr. 1998;133:154–6.

    Article  PubMed  CAS  Google Scholar 

  6. Barratt TM, Greifer I. Pediatric nephrology around the world overview. In: Barratt TM, Avner ED, Harmon WE, editors. Pediatric Nephrology, 4th edn. Baltimore; Lippincott Williams and Wilkins, 1999:1349–72.

    Google Scholar 

  7. Watson AR, Akatcherian C. Ethics and Chronic Renal Failure. In: ESPN Handbook. Basel: Novartis, 2002: pp. 398–401.

    Google Scholar 

  8. Withholding and withdrawing life prolonging medical treatment. Guidance for decision-making. London: BMA, 2000: pp. 25–38.

    Google Scholar 

  9. Neu S, Kjellstrand CM. Stopping long-term dialysis: an empirical study of withdrawal of life-supporting treatment. N Engl J Med. 1986;314:14–20.

    Article  PubMed  CAS  Google Scholar 

  10. Cassel CK, Moss AH, Rettig RA, Lewinsky NG. Ethical issues. In: Rettig RA, Lewinsky NG, editors. Kidney Failure and the Federal Government. Washington DC: National Academy Press, 1991: pp. 51–61.

    Google Scholar 

  11. Galla JH. Clinical practice guideline on shared decision-making in the appropriate initiation of and withdrawal from dialysis. J Am Soc Nephrol. 2000;11:1340–2.

    PubMed  CAS  Google Scholar 

  12. Moss AH, Levine DZ. Shared decision-making in dialysis: the new RPA/ASN Guideline on appropriate initiation and withdrawal of treatment. Am J Kidney Dis. 2001;37:1081–91.

    Article  PubMed  CAS  Google Scholar 

  13. Buzzi F, Cecioni R, Di Paolo M. National bioethics in nephrology: Guidelines for decisionmaking in Italy. J Nephrol. 2001;14:93–7.

    PubMed  CAS  Google Scholar 

  14. Auer J. Issues surrounding the withdrawal of dialysis treatment. Nephrol Dial Transplant. 1998;13(5):1149–51.

    Article  PubMed  CAS  Google Scholar 

  15. Moss AH. Managing conflict with families over dialysis discontinuation. Am J Kidney Dis. 1998;31(5):868–83.

    Article  PubMed  CAS  Google Scholar 

  16. Mallick N, El Marasi A. Dialysis in the elderly, to treat or not to treat? Nephrol Dial Transplant. 1999;14(1):37–9.

    Article  PubMed  CAS  Google Scholar 

  17. Oreopoulos DG. Withholding or withdrawing dialysis: some ethical considerations. Perit Dial Int. 1996;16(Suppl 1):S389–92.

    PubMed  Google Scholar 

  18. Coulthard MG, Crosier J. Outcome of reaching end stage renal failure in children under 2 years of age. Arch Dis Child. 2002;87:511–17.

    Article  PubMed  CAS  Google Scholar 

  19. Balfour-Lynn IM, Tasker RC. Futility and death in paediatric medical intensive care. J Med Ethics. 1996;22:279–81.

    Article  PubMed  CAS  Google Scholar 

  20. Goy AY, Mok Q. Identifying futility in a paediatric critical care setting: a prospective observational study. Arch Dis Child. 2001;84:265–8.

    Article  Google Scholar 

  21. Royal College of Pediatrics and Child Health. Withholding or Withdrawing Life-saving Treatment in Children: A Framework for Practice. London: Royal College of Pediatrics and Child Health, 1997.

    Google Scholar 

  22. Doyal L, Larcher VF. Drafting guidelines for the withholding or withdrawing of life sustaining treatment in critically ill children and neonates. Arch Dis Child Fetal Neonatal Ed. 2000;83:F60–3.

    Article  PubMed  CAS  Google Scholar 

  23. Riano I, Malaga S, Callis L, Loris C, Martin-Govantes J, Navarro M, Vallo A. Towards guidelines for dialysis in children with end-stage renal disease. Pediatr Nephrol. 2000;15:147–62.

    Google Scholar 

  24. Campbell AGM. Quality of life as a decision-making criterion. In: Goldworth A, Silverman W, Stevenson DK et al, editors. Ethics and Perinatology. Oxford: Oxford University Press, 1995: pp. 82–103.

    Google Scholar 

  25. Re R. Adult: Medical Treatment. 1996; 2 FLR 99.

    Google Scholar 

  26. Re J. A Minor: Wardship: Medical Treatment. 1990; 3 All ER 930.

    Google Scholar 

  27. Truog RD, Levine DZ. Discontinuing immunosuppression in a child with a renal transplant: are there limits to withdrawing life support? Am J Kidney Dis. 2001;38(4):901–15.

    Article  PubMed  Google Scholar 

  28. Chiswick M. Parents and end of life decisions in neonatal practice. Arch Dis Child Fetal Neonatal Ed. 2001;85:F1–3.

    Article  PubMed  CAS  Google Scholar 

  29. Warady BA, Herbert D, Sullivan EK, Alexander SR, Tejani A. Renal transplantation, chronic dialysis, and chronic renal insufficiency in children and adolescents. The 1995 Annual Report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol. 1997;11:49–64.

    Article  PubMed  CAS  Google Scholar 

  30. Verrina E, Zacchello G, Perfumo F, Edefonti E, Sorino P, Bassi S et al. Clinical experience in the treatment of infants with chronic peritoneal dialysis. Adv Perit Dial. 1995;11:281–4.

    PubMed  CAS  Google Scholar 

  31. Bunchman TE. Infant dialysis; the future is now. J Pediatr. 2000;136:1–2.

    Article  PubMed  CAS  Google Scholar 

  32. Kari JA, Gonjaley C, Lederman SE et al. Outcome and growth of infants with severe chronic renal failure. Kidney Int. 2000;57:1681–87.

    Article  PubMed  CAS  Google Scholar 

  33. Waz WR. An Ethical Dilemma in Subspecialty Pediatrics. Semin Nephrol. 1998;18(3):355–70.

    PubMed  CAS  Google Scholar 

  34. Doyal L, Henning P. Stopping treatment for end-stage renal failure. The rights of children and adolescents. Pediatr Nephrol. 1994;8(6):768–71.

    Article  PubMed  CAS  Google Scholar 

  35. Gabbai N, Rauch-Elnekave H, Spitz M, Weissman I. Treatment decisions in paediatric dialysis: Children’s versus parental rights. Edtna-Erca J. 1999;25(4):39–41.

    PubMed  CAS  Google Scholar 

  36. American Academy of Pediatrics Committee on Bioethics Ethics and the care of critically ill infants and children (review). Pediatrics. 1996;98:149–52.

    Google Scholar 

  37. Watson AR. An ethics of clinical practice committee: should every hospital have one? Proc R Coll Physicians Edin. 1999;29:335–7.

    Google Scholar 

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Authors
  1. A. R. Watson
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  2. M. Shooter
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Editor information

Editors and Affiliations

  1. Children’s Mercy Hospital, University of Missouri, Kansas City School of Medicine, Kansas City, MO, USA

    Bradley A. Warady

  2. University Children’s Hospital, Heidelberg, Germany

    Franz S. Schaefer

  3. Health Science Center, State University of New York at Stony Brook, Stony Brook, NY, USA

    Richard N. Fine

  4. Lucille Packard Children’s Hospital at Stanford, Stanford University, School of Medicine, Stanford, CA, USA

    Steven R. Alexander

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© 2004 Springer Science+Business Media Dordrecht

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Watson, A.R., Shooter, M. (2004). The ethics of withholding and withdrawing dialysis in children. In: Warady, B.A., Schaefer, F.S., Fine, R.N., Alexander, S.R. (eds) Pediatric Dialysis. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-1031-3_30

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  • DOI: https://doi.org/10.1007/978-94-007-1031-3_30

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-3770-9

  • Online ISBN: 978-94-007-1031-3

  • eBook Packages: Springer Book Archive

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