End-of-life issues in paediatric intensive care

Paediatric intensivists routinely face life and death decisions. Increased ability to prolong life through technological advances has challenged the traditional ethical principles of autonomy, beneficence, non-maleficence and justice. The medical decision-making process is optimised by having a physician leader and incorporating family perspectives. Physicians must maintain their commitment to the patient even after the decision to forgo life-sustaining therapy is made. In such situations, a carefully constructed, individualised management plan is necessary for the palliative care of the child. This review discusses the general ethical framework used in formulating a philosophy of care in the paediatric ICU, the dynamics of the decision-making process, and management strategies to improve end-of-life care.