Most children who become ill, even those with life-threatening disorders, recover to lead satisfying lives. Nonetheless, the course of disease may at times cause health care professionals and families to consider whether continued treatment truly represents the best option. Sometimes limiting or stopping life support seems most appropriate, especially if treatment only preserves biological existence or if the overall goal of therapy has shifted to the maintenance of comfort. Based on the existing consensus in ethics and law, the following guidelines for professionals caring for children suggest elements in decisions to forgo life-sustaining medical treatment (LSMT).1-4

Decisions to withhold or withdraw LSMT may seriously tax the intellectual and emotional reserves of all parties. Patients, families, physicians, and other members of the medical care team should have access to and feel free to use ethics consultants or ethics committees in addition to the other resources on which they usually rely.5,6

PRELIMINARY NOTATIONS

Life-sustaining medical treatment encompasses all interventions that may prolong the life of patients. Although LSMT includes the dramatic measures of contemporary practice such as organ transplantation, respirators, kidney (dialysis) machines, and vasoactive drugs, it also includes less technically demanding measures such as antibiotics, insulin, chemotherapy, and nutrition and hydration provided intravenously or by tube.7

The term "forgo" refers to both stopping a treatment already begun as well as not starting a treatment. Although many health care professionals feel reluctant to discontinue life-sustaining treatments, most philosophical and legal commentators find no important ethical or legal distinction between not instituting a treatment and discontinuing treatment already initiated.

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