How are Ethical Problems Resolved in a Paediatric Intensive Care?
Few studies have explored how medical ethics works in practice specifically in terms of the social processes that result in a decision regarding an ethical problem. This is particularly so in the case of children’s intensive care. More than a decade of teaching healthcare ethics to both nurses and doctors prompted a study to examine how ethical problems are resolved in a children’s intensive care unit. This qualitative study addressed this question in a single large children’s intensive care unit in England. The study was guided by grounded theory in examining via individual face to face unstructured and semi-structured interviews what ethical problems were encountered and how they were resolved. Interviews were conducted mainly with doctors and nurses working on an intensive care unit. Two admitting consultant doctors and three parents were also interviewed. The analysis of data gathered in 20 interviews was developed using Strauss and Corbin’s (1998) framework. A theory emerged from the analysis of the data that revealed the most prominent ethical problems in children’s intensive care related to end-of-life situations. Most significant among these was the decision to withdraw life-preserving interventions from a child. The theory outlines a process by which health professionals involved in the care and treatment of a child in intensive care negotiated a consensus on the point at which it was no longer appropriate to continue life-preserving interventions. This consensus was then presented to parents. Parental assent to withdrawal was facilitated, when not immediately forthcoming, by a process of persuasion.
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