ROUNDS Mechanical Ventilation for a Child With Quadriplegia

Parents generally have the right to make medical decisions for their children. This right can be challenged when the parents’ decision seems to go against the child’s interests. The toughest such decisions are for a child who will survive with physical and neurocognitive impairments. We discuss a case of a 5-year-old boy who suffered a spinal injury as a result of a motor vehicle accident and whose father requests discontinuation of life support. Many experts recommend a “trial of therapy” to clarify both prognosis and quality of life. The key ethical question, then, is not whether to postpone a decision to forego mechanical ventilation. Instead, the key question is how long to wait. Parents should be allowed time to see what life will be like for themselves and for their child. Most of the time, life turns out better than they might have imagined. Comments are provided by 2 pediatric intensivists, Drs William Novotny and Ronald Perkin of East Carolina University, and by a specialist in rehabilitation, Dr Debjani Mukherjee of the Rehabilitation Institute of Chicago. Pediatrics 2014;134:593–597 AUTHORS: William E. Novotny, MD,a Ronald M. Perkin, MD, MA, FCCM, FAAP,a Debjani Mukherjee, PhD,bc and John D. Lantos, MDd aDepartment of Pediatrics, East Carolina University, Greenville, North Carolina; bNorthwestern University Feinberg School of Medicine, Chicago, Illinois; cDonnelley Ethics Program, Rehabilitation Institute of Chicago, Chicago, Illinois; and dUniversity of Missouri at Kansas City and Children’s Mercy Hospital, Kansas City, Missouri