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  • Title: [Limitations to care; evaluation of decision making concerning the death of 104 children in a surgical intensive care unit].
    Author: Tibboel D, Mourik M, Hazebroek FW, Molenaar JC.
    Journal: Ned Tijdschr Geneeskd; 1994 May 07; 138(19):953-8. PubMed ID: 8196789.
    Abstract:
    OBJECTIVE: To analyse the decision-making process concerning withholding and withdrawal of life-sustaining treatment in children who died in a paediatric surgical intensive care unit. DESIGN: Retrospective evaluation of medical and nursing records from the period 1988-1992. SETTING: Sophia Children's Hospital-University Hospital Rotterdam. METHOD: The evaluation concerned 104 children who died in the paediatric surgical intensive care unit during the study period. The causes of death were classified according to the classification proposed in a recent report issued by the Dutch Association of Paediatricians. A distinction was made between newborns and older children. RESULTS: In both newborns and older children, about half of the children had died because treatment was either withheld (4/104) or withdrawn (53/104). There were no cases of 'intentional termination of life in emergencies'. The remaining children had died in spite of medical treatment that had been considered worthwhile. CONCLUSION: The problems and guidelines suggested from the field of neonatology are applicable not only to newborns with severe congenital anomalies, but also to older children. Evaluation of the decision-making process should not be limited to medical-technical and nursing aspects, but should also include the experiences of the parents and the treatment team.
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