Withdrawal of Treatment in a Pediatric Intensive Care Unit at a Children’s Hospital in China: A 10-year Retrospective Study

Abstract

Background: Published data and practice recommendations on end-of-life care generally reflect Western practice frameworks; there are limited data that refer to withdrawing treatment of children in China. Methods: Withdrawing treatment of children in the pediatric intensive care unit (PICU) of a regional children’s hospital in eastern China from 2006 to 2017 was studied retrospectively. Withdrawing treatment was divided into medical withdrawal and premature withdrawal as defined. The guardian’s self-reported reasons for abandoning the child’s treatment were recorded from 2011.Results: The incidence of withdrawing treatment from children in the PICU decreased significantly, for premature withdrawal, from a 3-year average of 15.1% in 2006–2008 to 1.9% in 2015–2017 (87.4% reduction). The overall incidence of withdrawal of care reduced over the time period, and withdrawal of therapy by guardians was the main contributor to the overall reduction. The median age of children from whom treatment was withdrawn increased from 14.5 (interquartile range: 4.0–72.0) months in 2006 to 40.5 (interquartile range: 8.0–99.0) months in 2017. Among the reasons given by guardians of children whose treatments were withdrawn in 2011–2017, “illness is too severe” ranked first, accounting for 66.3%, followed by “condition has been improved” (20.9%). Only a few of the guardians ascribed withdrawing treatment to economic reasons.Conclusions: The frequency of withdrawal of medical therapy has changed over time in this children’s hospital PICU, and parental decision-making has been a large part of the change.

Physician decision-making process about withholding/withdrawing life-sustaining treatments in paediatric patients: a systematic review of qualitative evidence

“…In PPC; an ethically sensitive EOL decision that is frequently made is withholding/withdrawing LST in situations where LST is no longer deemed to be meaningful or effective [13]. Hospital-wide audits of paediatric deaths [14][15][16][17] and retrospective studies in paediatric intensive care units (PICUs) [18,19] revealed that a significant factor associated with children's deaths is the medical decision to withhold/withdraw LST.…”

Neonatal Euthanasia and the Groningen Protocol

“…There is significant variability, however, regarding when and in which cases life-prolonging interventions can or should be limited or withdrawn. Further, there is variability regarding who holds the authority to make such decisions (Lago et al 2008;Liu et al 2020;McHaffie et al 1999; National Institute for Health and Care Excellence 2016 (updated 2019); Weise et al 2017).…”