The decision to withdraw or withhold life-sustaining treatment for children and young people in Intensive Care Units: guidance for nurses

The decision to withdraw or withhold life-sustaining treatment in paediatric and neonatal intensive care units (ICUs) is both complex and emotive for everyone involved.

All members of the treating healthcare team, led by the consultant in charge, should be involved in the decision-making process.This guideline is intended to be used by nurses when situations arise where it may be ethical and legal to consider withholding or withdrawing life-sustaining medical treatment.

Introduction

The decision to withdraw or withhold life-sustaining treatment in paediatric and neonatal intensive cares is both complex and emotive for everyone involved. All members of the treating healthcare team, lead by the consultant in charge, should be involved in the decision-making process. The underlying ethical and legal rationale for all treatments is that they should be in the best interests of the child .

This guideline is intended to be used by nurses when situations arise where it may be ethical and legal to consider withholding or withdrawing life-sustaining medical treatment (see table below); it is not intended to replace existing guidance on the decision to withdraw or withhold life sustaining treatment but should be used in conjunction with it.

Ethical and legal considerations

As stated above, the overriding legal and ethical principle is that all treatment decisions must be taken in the child’s best interests.

There is no ethical or legal duty to continue life-sustaining treatment where it is evidently excessively burdensome relative to the likely benefits and can therefore be considered not to be in the child’s best interests.

Those with parental responsibility have moral, ethical and legal responsibilities for their child’s upbringing, including decisions related to medical care and its withdrawal, subject to such decisions being in the child’s best interests. In the UK withholding and withdrawing treatment are regarded as legally equivalent.

The decision-making process

All members of the treating healthcare team are part of the decision-making process; their individual views should be sought and accorded due weight.

Decisions should be made with the participation of parents on the basis of shared knowledge and mutual trust and respect.

It is the consultant in charge of the case who should lead the decision making process and always bears the final responsibility for the chosen course of action.

Situations where it may be ethical and legal to consider withholding or withdrawing life-sustaining treatment:

Communication within the healthcare team

When the question of withholding or withdrawing treatment is raised, all members of the clinical team should have an appropriate and equal opportunity to express their views and opinions.

Communication with the family

When the option of withholding or withdrawing life-sustaining treatment has been raised the consultant and bedside nurse should discuss this with the parents.

 

Document control information

Approved by

Guideline Approval Group

Reviewing and Versioning

First introduced: 
13 January 2016
Date approved: 
13 January 2016
Review schedule: 
Three years
Next review: 
13 January 2019
Document version: 
2.0