Treating an intervention level 1 patient: futile or brave?

Abstract

An ethical dilemma describes conflicting opinions by different members of the care team. This article focuses on AJ, a five-year-old child with cerebral palsy, who was born deaf and blind as a result of having contracted rubella in utero. The case is examined against Sokol’s four-quadrant analysis of ethical issues, giving a framework designed to facilitate the systematic identification and analysis of clinical ethical problems. The issue is whether the medical team should have palliated AJ, or continued with invasive therapy and feeding. The conclusion is that paediatric palliative care is often difficult, but that the dietitian has a duty to contribute his or her knowledge to benefit the patient.

Keywords: futile treatment, cerebral palsy, gastro-oesophageal reflux disease, palliative care, nasogastric feeding, nasojejunal feeding