Bioethics in the Pediatric ICU: Ethical Dilemmas Encountered in the Care of Critically Ill Children

1. Front Matter

   Pages i-vii

   PDF

2. Introduction

   • Laura Miller-Smith, Ásdís Finnsdóttir Wagner, John D. Lantos

   Pages 1-4

3. Epidemiology of Critical Illness in Children

   • Laura Miller-Smith, Ásdís Finnsdóttir Wagner, John D. Lantos

   Pages 5-11

4. The Historical Foundation of Pediatric Critical Care

   • Laura Miller-Smith, Ásdís Finnsdóttir Wagner, John D. Lantos

   Pages 13-28

5. Shared Decision Making and End-of-Life Discussions in the PICU

   • Laura Miller-Smith, Ásdís Finnsdóttir Wagner, John D. Lantos

   Pages 29-43

6. The Difficulty with Determining Whether Someone is Dead

   • Laura Miller-Smith, Ásdís Finnsdóttir Wagner, John D. Lantos

   Pages 45-68

7. Intractable Disagreements About Futility in the PICU

   • Laura Miller-Smith, Ásdís Finnsdóttir Wagner, John D. Lantos

   Pages 69-92

8. Chronically Critically Ill with Technological Dependence

   • Laura Miller-Smith, Ásdís Finnsdóttir Wagner, John D. Lantos

   Pages 93-109

9. Critical Care Resource Utilization

   • Laura Miller-Smith, Ásdís Finnsdóttir Wagner, John D. Lantos

   Pages 111-123

10. Pediatric Organ Donation and Transplantation

    • Laura Miller-Smith, Ásdís Finnsdóttir Wagner, John D. Lantos

    Pages 125-145

11. Moral Distress in the PICU

    • Laura Miller-Smith, Ásdís Finnsdóttir Wagner, John D. Lantos

    Pages 147-159

12. Conclusion

    • Laura Miller-Smith, Ásdís Finnsdóttir Wagner, John D. Lantos

    Pages 161-164

This book examines the many ethical issues that are encountered in the Pediatric Intensive Care Unit (PICU). It supports pediatricians, nurses, residents, and other providers in their daily management of critically ill children with the dilemmas that arise. It begins by examining the evolution of pediatric critical care, and who is now impacted by this advancing medical technology. Subsequent chapters explore specific ethical concerns and controversies that are commonly encountered. These topics include how to conduct end-of-life discussions with families facing a myriad of challenging choices. It goes on to explore the concept of futility, and what that does and does not mean in the pediatric ICU setting.  Controversial subjects such as children as organ donors, particularly using donation after cardiac death, in addition to issues surrounding the declaration of brain death are covered. Additional chapters address resource allocation, and also analyze the use of long-term technology in chronically critically ill children.  Chapters include case examples with guidance on how to work through similar difficulties and decision-making.  While this book is specifically targeted for care providers at the ICU bedside, it is also of benefit to medical students, students in bioethics, practicing ethical consultants and families who are dealing with critically ill children.

• pediatric critical care
• pediatric bioethics
• end-of-life care
• moral distress
• ethical decision making
• PICU
• children as organ donors
• medical ethics
• bioethics and the child
• critical care medicine
• bioethics and humanities
• pediatric ethics

“This book is specifically intended for care providers … also benefit ethics consultants or students looking for a concise book on the ethical issues in pediatric critical care. … This would be a welcome resource for providers or other scholars engaged in the care of critically ill children. It offers a concise and well-researched treatment of ethical issues that arise in the pediatric ICU and provides practical guidance for those working in the field.” (Annie B. Friedrich, Doody's Book Reviews, 27 September, 2019)

• Pediatric Critical Care Medicine, Children’s Mercy Hospital Department of Pediatrics, University of Missouri-Kansas, Kansas City, USA

  Laura Miller-Smith, Ásdís Finnsdóttir Wagner

• Children’s Mercy Hospital Bioethics Center and Department of Pediatrics, University of Missouri-Kansas, Kansas City, USA

  John D. Lantos

Laura Miller-Smith, MD

Laura Miller-Smith, MD, is a pediatric intensivist at Children’s Mercy Hospital in Kansas City, Missouri, and is a an Associate Professor of Pediatrics at University of Missouri in Kansas City.  She completed the Pediatric Bioethics Certificate Program at Children’s Mercy Center for Bioethics, and currently serves as Chairperson of the Hospital Ethics Committee.  She additionally serves on the Society of Critical Care Medicine’s Ethics Committee.  Specific interests include organ donation, issues surrounding the determination of death, and technology dependence in critically ill children.

Ásdís Finnsdóttir Wagner, DO

Ásdís Finnsdóttir Wagner, DO, is a pediatric intensivist at Children’s Mercy in Kansas City. She is a graduate of the Pediatric Bioethics Certificate Program at Children’s Mercy Center for Bioethics and has conducted research on end-of-life issues and communication within the pediatric intensive care unit. She isan active member of the Ethics Committee at Children’s Mercy. She is currently Assistant Professor of Pediatrics at University of Missouri in Kansas City and serves as Educational Liaison for resident and medical student education within the critical care department.

John Lantos, MD

John Lantos, MD, is a general pediatrician and bioethicist. He has served as President of both the American Society of Bioethics and Humanities and the American Society of Law Medicine and Ethics. He has also held many leadership positions in the American Academy of Pediatrics.  He was a member of President Clinton’s health reform task force in 1993 and a consultant to President Bush’s Bioethics Council.  

He has published hundreds of peer-reviewed articles and many books, including The Lazarus Case, Neonatal Bioethics, and Do We Still Need Doctors?

He is currently Director of a Pediatric Bioethics Center and Children’s Mercy Hospital and Professor of Pediatrics at University of Missouri in Kansas City.

Policies and ethics