Abstract

Abstract The legal and ethical framework for decision-making in paediatric intensive care is more complex than in adult practice. Although the primary duty of care is to the child, the decisions usually involve parents or guardians acting as advocates for the child. It is important that good lines of communication are established as soon as possible between the paediatric intensive care unit staff and the parents or guardians because changes in the child’s condition can happen very rapidly. The paediatric intensive care unit environment is complex and fraught with risks. Interventions must often be immediate before informed consent can be obtained. Allocations of intensive care resources, consent to treatment, withholding or withdrawing intensive care, diagnosis of brain death, organ donation and medical accidents all give problems. Each case must be considered individually with the overriding principle of acting at all times in the best interests of the child within the prevailing locally determined medical, social and legal rules.

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