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Ethical challenges with the advancement of hematopoietic stem cell transplant
08 July 2014
22 August 2014
28 July 2015 (online)
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.