Tommy* was only 2 years old when he was admitted to our ICU. He was a bright toddler, full of joy and laughter. His parents loved him dearly, and they cared for him with great affection. Tommy's family did not have a pool, but they did have a small fishpond in the backyard. No one ever thought about putting a fence around the fishpond; how dangerous could such a small pond be? Well, it seems it was quite dangerous, and one morning Tommy's mother found him face down in it. She called 911, and Tommy's heart began beating after prolonged cardiopulmonary resuscitation. He was admitted to our ICU unconscious and unresponsive. Two days went by, and Tommy showed no sign of neurologic recovery. Although his other organ systems improved, he had no purposeful movements. I had been meeting with the parents every day in anticipation of our discussion that...
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July 2006
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July 01 2006
Answering the Question: “Doctor, if This Were Your Child, What Would You Do?”
Alexander A. Kon, MD
Alexander A. Kon, MD
Department of Pediatrics and Program in Bioethics, University of California at Davis, Sacramento, California
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Address correspondence to Alexander A. Kon, MD, Pediatrics and Bioethics, University of California at Davis, 2516 Stockton Blvd, Sacramento, CA 95817. E-mail: aakon@ucdavis.edu
Pediatrics (2006) 118 (1): 393–397.
Article history
Accepted:
January 05 2006
Citation
Alexander A. Kon; Answering the Question: “Doctor, if This Were Your Child, What Would You Do?”. Pediatrics July 2006; 118 (1): 393–397. 10.1542/peds.2005-2655
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Well said. Although, the example given for the "first" question was unfortunate because it would be unlikely that any pediatric intensivist could decide the "best" intervention for a ruptured AVM based on current evidence better than a neurosurgeon or an interventional radiologist. On the whole, though, Dr. Kon did articulate very well what many of us think about in the PICU. I could still argue that in the situations described, the intensivist still has a choice of using the "Truog Maneuver" as there is no evidence that the stress to the parents will be any less whether the physician declines to answer or answers "the question" given the enormous burden of their decisions. I believe that to answer or not to answer will ultimately be dependent on the physician's own cultural upbringing and attitudes towards another person's tragedy.
Conflict of Interest:
None declared