When care does not cure : ethical issues in neonatology and paediatrics

Abstract

Fortunately, most childhood illness is curable without any lasting sequelae. Indeed, death in childhood is an unlikely event in 2001. Although approximately 10% of all newborns in Malta and Gozo require intensive care, less than 10% of these will succumb. About 8% of these early deaths are due to extreme prematurity (Le. before 28 completed weeks of gestation), with a smaller percentage due to congenital anomalies and infection. Less than 1 % of older children do not survive and most of these deaths are due to childhood cancer and accidental injury. In children, death is usually not a totally unexpected event but can be anticipated after a short or long term illness. For these, a point is reached when cure is no longer possible and cure is replaced by palliative care. The transition from cure to care can be difficult and ethical dilemmas are not uncommon at this stage. Indeed, many of the decisions that need to be addressed are complex, and many issues relating to the dying child rarely provide a simple answer. These invariably have a significant impact on the child as an individual, his/her family and friends, as well as society at large. If this transition is to be appropriate and acceptable, a code of practice based on sound ethical values is essential