Abstract
Advancements in medical science and pediatric intensive care have significantly improved
outcomes for children undergoing hematopoietic stem cell transplantation (HSCT). Critical
care management of HSCT patients requires pediatric intensivists to deal with ethical
issues including aggressiveness of care and futility, limiting treatment, shared decision-making
with families of critically ill children, and decision-making in the context of multi-disciplinary
management of complex patients. This paper will discuss the fundamental ethical principles
to enable pediatric intensivists to address questions of medical decision-making.
Medical futility will be explored and strategies for dealing with both the practical
and emotional implications of this for the pediatric intensivist will be addressed.
Another important issue related to critical care of the HSCT patient is establishing
goals of care, specifically related to end of life care decisions. A framework for
end of life communication with families will be provided. Finally, this paper will
discuss the potential conflicts resulting from multi-disciplinary care of the HSCT
patient in the pediatric intensive care unit. As medical management of the HSCT patient
continues to evolve, awareness of the ethical issues surrounding their care is important
for both patient and provider.
Keywords
Hematopoietic stem cell transplantation - pediatric intensive care unit - medical
management
