Withholding consent to lifesaving treatment: three cases

Objectives:To report the epidemiology of chronic kidney disease (CKD) in neonates at a single tertiary center and the outcomes of renal replacement therapy (RRT) in these patients and discuss ethical considerations regarding RRT in this population.Methods:In this retrospective study, we reviewed clinical data from all neonates with evidence of CKD who were followed up at King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia between 2005 and 2015. Follow-up serum creatinine levels were recorded every 6 months.Results:A total of 181 neonates presented with CKD. Their mean age at the time of presentation was 11.1 days (95% confidence interval [CI]: 9.5-12.8) and the mean creatinine level was 106.5 µmol/ (95% CI: 91.3-121.7). Congenital anomalies of the kidneys and urinary tract (CAKUT) were the underlying causes of CKD in 84.5% of the neonates. Mortality was high, particularly in the first 6 months (10%), and reached 16% by 4 years of follow-up. At the time of the last follow-up, 42 (41%) neonates had hypertension and 27 (26.5%) had significant proteinuria. Five patients received dialysis in the neonatal period and another 6 were commenced on dialysis later.Conclusion:Congenital anomalies of the kidneys and urinary tract is the most common etiology in neonates with CKD. Chronic kidney disease in neonates is associated with high morbidity and mortality rates.

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“…A similar situation of parents refusing therapy could occur with optimum infrastructure and expertise, leading to an ethical dilemma. 25 , 26 …”

Section: Discussionmentioning

confidence: 99%

Etiology, ethics, and outcomes of chronic kidney disease in neonates

Kari

Sharief

Desoky

et al. 2018

SMJ

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“…The use of enteric feeding, while medically relatively straightforward, presents clinicians with complex legal and ethical questions where patients are actively resistant. There are numerous case reports that address these issues (Hebert & Weingarten, 1991;Kluge, 1991;Roberts, 1992;Tiller, Schmidt, & Treasure, 1993;Elton, Honig, Bentovim, & Simons, 1995;Mok & Nelson, 1996). Some argue that life-sustaining measures merely prolong suffering in the face of a chronic, unremitting disease and that these ride roughshod over patients' autonomy and self-determination, perhaps causing more psychological harm than good (Goldner, Birmingham, & Smye, 1997).…”

Section: Discussionmentioning

confidence: 99%

Enteric feeding in severe adolescent anorexia nervosa: A report of four cases

Neiderman

Zarody

Tattersall

et al. 2000

Int. J. Eat. Disord.

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Objective Refeeding patients with anorexia nervosa can be one of the more challenging aspects of their treatment, and particularly if all food and fluids are adamantly and persistently refused. Method If the decision is made to augment or replace oral feeds, the most common intervention is nasogastric feeding. Results Although this is often successful, a subset of patients manage to sabotage feeding via this route. Other means of delivering nutrition such as intravenous feeds are often impractical for long‐term use. Another alternative in such life‐threatening situations is the use of enteric feeds via gastrostomy or jejunostomy. This paper presents the successful use of such enteric feeding in four cases of severe adolescent anorexia nervosa. Discussion The psychological, legal, and ethical issues involved are discussed, concluding that gastrostomy and jejunostomy are valid lifesaving methods to feed highly resistant anorectic patients. © 2000 by John Wiley & Sons, Inc. Int J Eat Disord 28: 470–475, 2000.

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“…Essentially, competency has to do with the child's capacity to understand and appreciate what treatment is necessary and why, and the implications of receiving or not receiving treatment. In England this has been termed the Gillick principle (Honig and Bentovim, 1996;Bentovim, 2000) or being`Gillick competent' (Elton et al, 1995) and underscores the capacity of the competent child for autonomous decision making. Competency is to be assumed unless the clinician has assessed this to be the contrary.…”

Section: The Issue Of Competency and Legal Considerations In Child Anmentioning

confidence: 99%

Addressing complex ethical issues in the treatment of children and adolescents with eating disorders: application of a framework for ethical decision‐making

Manley

Smye

Srikameswaran

2001

Euro Eating Disorders Rev

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Ethically problematic situations frequently arise in the care of children and adolescents with eating disorders. The younger person with anorexia nervosa can often deteriorate quickly, therefore the child who is in denial with respect to the seriousness of her condition and/or markedly ambivalent regarding renourishment is at grave risk. Involuntary treatment is likely to be a consideration during such a medical crisis. In this paper we outline an ethical decision-making framework that can assist the clinician in engaging the young patient and her family well in advance of a crisis, so that decisions can be made at a time when recourse to establishing incompetency or enforcing involuntary treatment are unnecessary. We have adopted a narrative approach in our application of the decision-making framework, and safety is emphasized as the central concept underlying the application of this model. Finally, a number of recommendations are made regarding application of the ethical decision-making framework with younger persons.

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Withholding consent to lifesaving treatment: three cases

Cited by 13 publications

References 2 publications

Etiology, ethics, and outcomes of chronic kidney disease in neonates

Etiology, ethics, and outcomes of chronic kidney disease in neonates

Enteric feeding in severe adolescent anorexia nervosa: A report of four cases

Addressing complex ethical issues in the treatment of children and adolescents with eating disorders: application of a framework for ethical decision‐making

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