While the legal guidelines are straightforward, gaining approval for research studies in the pediatric ED or ICU can be complicated by the informed consent process. Ethical issues in the pediatric intensive care unit. d. patients healthcare surrogate. Over 10 million scientific documents at your fingertips. The career is full of tough decisions and caring for other people. Fundamentally, ethical issues are those issues where people struggle to figure out the right thing to do. and Wagner, P.D. Atkinson, B.L. (1987a) Methods of improving critical care expertise of the general pediatric nurse. When the rationale for refusal is religion, and especially when the treatment being refused is potentially lifesaving, the situation becomes more complex. Thus issues around consent can lead to ethical dilemmas that may be brought to a clinical ethics committee. (1985) Ethical issues in paediatric nursing. Nurses today face many ethical dilemmas in the delivery of patient care. N2 - Advanced technology and better scientific understanding of mechanisms of disease now permit intensive care personnel to extend life beyond what some patients and families consider reasonable, leading, in part, to the 'patients' rights' movement and the articulation of legal and moral guidelines for forgoing life support. The complexity of these issues has increased as technological advances have been made and paediatric patients have been found to respond well to intensive therapy. Amis, M. Cited by Cowper-Smith (1978) Intensive care needed for all in ITU’s. Matthew. ... tutes “benecence” in a giv en case that constitutes ethical conicts in pediatric care. Keogh, A. INTRODUCTION In caring for critically ill patients, it is inevitable that ethical issues will arise. The present review will examine some of these issues with regard to parental con-sent, children's rights, confidentiality, separation of parent xx It requires four elements: duty, being a legal obligation owed to the patient – nurses must provide the degree of care reasonably exercised by other nurses in that practice area. In the case of pediatrics, commentaries on a few of the topics that have arisen most frequently or have provided the greatest challenge in the authors' experience are provided.". doi = "10.1016/S0031-3955(16)38879-4". These keywords were added by machine and not by the authors. This chapter considers some of the ethical issues associated with care of the small child in the intensive care unit. EURONIC's goal was to investigate ethical decision making in neonatal intensive care. We want to honor families' religious beliefs while ensuring that a… (1985) Ethical issues in paediatric intensive care. In the case of pediatrics, commentaries on a few of the topics that have arisen most frequently or have provided the greatest challenge in the authors' experience are provided. Davies, C.J. The fields of pediatric palliative care (PPC) and pediatric medical ethics (PME) overlap substantially, owing to a variety of historical, cultural, and social factors. The Nuffield Council on Bioethics has published a Report, Critical care decisions in fetal and neonatal medicine: ethical issues, which examines the ethical, social, and legal dilemmas raised by fetal and neonatal medicine. Ethical awareness involves recognizing the ethical implications of all nursing actions, and is the first step in moral action (Milliken & Grace, 2015). 74 Ethical considerations in the pediatric critical care unit often involve moments of crisis marked by disagreement over … (1987) And the Rabbi Judah the Prince died: on the withdrawal of treatment. Ethical issues are wide-ranging, from organ donation, genetic engineering, assisted suicide, withholding treatment in end-of-life care, or simple procedures requiring consent. This volume will be useful to organizations involved in research, social service agencies, child advocacy groups, and … Abstract. Pallis, C. (1982) ABC of brain stem death. Issues relating to the treatment of children with disabilities, such as withholding treatment, organ donation, research, genetic screening, and prenatal diagnosis, all present ethical dilemmas. The expansion of technology combined with awareness of biologic, economic, and ethical limits to applying that technology can lead to uncertainty and conflict when it appears that providers are unable to restore a patient to the patient’s previous state. Of the 680 children, 44% were discharge to home normally, 27% went home with home health nursing care, 13% were transferred to long-term care facilities, and 16% died in the hospital." ... An emotionally compromised nurse is herself a clinical and ethical risk to the kids in her care. The study presents new aspects which increases knowledge and understanding of the reality of nursing in a neonatal intensive care unit, while also demanding increased research in this field of care. The discussion of the theory of ethics and underlying values has been left to other writers and the chapter concentrates on the practical problems which may face nurses and staff of other disciplines when caring for such patients. Neonatal intensive care unit (NICU) guidelines are developed to communicate professional medical consensus and to assist in ethical issues in neonatal care. 23.111.145.58. INTRODUCTION In caring for critically ill patients, it is inevitable that ethical issues will arise. This can lead to conflict and moral distress among patients, family, health care … This is a preview of subscription content. A proactive approach to improve end-of-life care in a medical intensive care unit for patients with terminal dementia. (1987a) The intensive care unit. In pediatric critical care, more children are surviving with chronic illnesses, and some of these children need ongoing or frequent intensive care and technological support. Two studies of pediatric intensive care in single institutions concluded that only a small percentage of patients met any one of several definitions of futility and that their care generally involved relatively limited resources (Sachdeva et al., 1996; Goh and Mok, 2001). Legal and Ethical Issues There are no clear ethical justifications for excluding from research adolescent subjects below the age of legal majority. Ethical issues in the pediatric intensive care unit. On a daily basis nurses, physicians, and other members of the pediatric critical care healthcare team are faced with maintaining the delicate balance between the application of complex technological care and humane, ethical care for the critically ill pediatric patient. Ethical Issues of a Pediatric Nurse. (1978) General intensive therapy. (1987b) Pediatric organ donation: responsibilities of the critical care nurse. Health care professionals continually face ethical and legal issues in the workplace, putting them at risk for burnout. Several matters distinguish pediatric from adult ethics, including issues of consent, confidentiality, genetic testing, end-of-life care, and justice. (1987) Gray areas: informed consent in paediatric and comatose adult patients. and Nash, D. (1984) Ethical issues related to pediatric care. In the case of pediatrics, commentaries on a few of the topics that have arisen most frequently or have provided the greatest challenge in the authors' experience are provided. In pediatric oncology, where patients are incomparably vulnerable, parental or other caregivers particularly distressed, and providers deeply dedicated to the search for a cure, the “right” path is not always obvious. In recent decades, many legal disputes and ethical debates about care for infants and children have involved decisions to start or stop medical interventions. Usually, decisions regarding limitation of therapy are based on ethical considerations and derived by discussion and … Ethical issues in the pediatric intensive care unit. List the need of ethics in nursing. 3. Most of us can think of a close friend or family member whose premature infant’s life and health were saved by quality medical care received in a neonatal intensive care unit (NICU). Abstract. In. McLachlan, G. (1984) The intensiveness of care. Informed consent constitutes one of the important considerations included in the myriad ethical dilemmas in the pediatric intensive care unit. 2. In a recent interview with NPR , Shekhar Saxena of the World Health Organization underscored the importance of continued improvements in mental healthcare: “[W]hen it comes to mental health, all countries are developing countries” [13]. Parents of sick children in an emergency room or intensive care unit are under immense emotional distress and approaching them with a request that their child participate in research may only increase that distress. Federman (eds) Section 13. Chapter 28 Ethical and Legal Issues in Intensive Care Unit LEARNING OBJECTIVES Meaning, concept and different levels of care in ICU Types of ICU Equipments used in ICU Members in … - Selection from Nursing Ethics [Book] LEGAL & ETHICAL ISSUES IN. Campbell ML, Guzman JA. What can or should be done for the patient versus the wishes of the patient’s physician conflicting with the personal beliefs the nurse holds to be true. Working in an environment where you are caring for other peoples children, and educating them, you're bound to come across some issues. British Paediatric Association (1986) Chairman: D.J. pp 42-64 | abstract = "Advanced technology and better scientific understanding of mechanisms of disease now permit intensive care personnel to extend life beyond what some patients and families consider reasonable, leading, in part, to the 'patients' rights' movement and the articulation of legal and moral guidelines for forgoing life support. Not affiliated Ethical Considerations in Pediatric Oncology Steven Joffe Jennifer Kesselheim Susan Shurin INTRODUCTION Few fields are as rich in ethical challenges as pediatric oncology. The lack of planning may produce morbidity and mortality that could otherwise have been prevented, thus creating a fundamental duty to … Legal and Ethical Issues Informed Legal and Ethical Issues Informed Consent Consent• It implies to permission by the patient to perform an act on his body either for diagnosis or therapeutic procedure.• The four elements of consent are; voluntariness capacity knowledge Decision making 6. Mass critical care planning has occurred at the regional (2), state/provincial (3, 4), national (5–7), and international (8) levels. Keywords Ethical issues , everyday ethics , neonatal intensive care unit , neonatal nursing , nursing care , phenomenological-hermeneutic Lancet 2010; 376:1347. 5 (p743) Out of this sampling, 29% of the patients, or roughly 200 babies, were either sent to subacute, long-term care … Chapter 3: Ethical and Legal Issues in Critical Care Nursing Test Bank MULTIPLE CHOICE 1. PEDIATRICS, OVERVIEW OF ETHICAL ISSUES IN••• Pediatric ethics is a branch of bioethics that analyzes moral aspects of decisions made relating to the healthcare of children. The devastating pandemic that has stricken the worldwide population induced an unprecedented influx of patients in ICUs, raising ethical concerns not only surrounding triage and withdrawal of life support decisions, but also regarding family visits and quality of end-of-life support. (1987) QALYfying the value of life. Read "Ethical issues in pediatric intensive care in developing countries: Combining western technology and eastern wisdom, Indian Journal of Pediatrics" on DeepDyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Norton SA, Hogan LA, Holloway RG, et al. Infrastructure and ethics—including a review of current research efforts, ways to strengthen human resources and research tools, and guidance on sensitive ethical and legal issues. Pediatrics ethics education should enhance medical students' skills to deal with ethical problems that may arise in the different settings of care. Nevertheless, the parents must understand the research sufficiently and feel comfortable consenting to it, even though their child may … These ingredients are liable to shake up our ethical principles, sharpen our ethical dilemmas, and lead … Hazinski, M.F. Consensus statement of the Society of Critical Care Medicine's Ethics Committee regarding futile and other possibly inadvisable treatments. Together they form a unique fingerprint. Crit Care Med 1997; 25:887. In, Todres, I.D. If only one parent has legal custody of a child, that parent dictates the other parent's access. In E. Rubenstein and D.D. • OBJECTIVES - At the end of the seminar students are able to, 1. Hazinski, M.F. Ethics and end-of-life care for adults in the intensive care unit. The most common reaction to a perceived breach of ethical standards in the health profession is an action in negligence and malpractice, being the act or omission or commission made by the nurse or doctor. Legal and ethical issues are clear for children and individuals age 18 and older. Rowden, R. (1987) The extended role of the nurse. Ethical issues in the pediatric intensive care unit. By continuing you agree to the use of cookies. Ethics are about right and wrong, good and bad. Given the complexity of contemporary healthcare environments, it is vital that nurses are able to recognize and address ethical issues as they arise. Knaus, W.A., Draper, E.A. Legal issues in adolescent care Providing care for adolescents presents healthcare professionals with several special challenges, including consent, confidentiality, and legal issues. Harris, J. The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29-30, 2010. This document reflects expert input from the Task Force in addition to the most current medical literature. Institutional, regional, or societal goals can establish norms and provide reference points to assist healthcare professionals and parents as they make decisions. (1987) The child in the intensive care unit. Traditionally, the law has viewed children as incompetent to make medical decisions, and society has authorized parents or guardians to act on behalf of children. This study aimed to analyze the ethical problems experienced by physicians who have medical education and pediatric care responsibilities, and if those problems are associated to their workplace, medical specialty and area of clinical practice. part a: term paper questions & answers – legal and ethical issues in childcare 1)Record the relevant government agency that deals with child protection in your state – South Australia. Explain nursing regulatory mechanism and medico legal case. (1979) Ethics rounds with intensive care nurses. In most circumstances, this extends to a parent’s right to refuse treatment for their minor child (2). Brykczyiiska, G.M. Ethical issues in the pediatric intensive care unit, Pediatrics, Perinatology, and Child Health. Ethical Issues of a Pediatric Nurse. Medical care of critically ill and injured infants and children globally should be based on best research evidence to ensure safe, efficacious treatment. ... but extended families endure -- especially with a sick child to rally around. Over the last 3 decades, NICUs have succeeded in saving ever-earlier and tinier premature infants. Efforts to lasso health care costs puts increasing pressure on staff to do more with less. Download preview PDF. But some extremely low-birth-weight babies that survive live with devastating neurological and other deficits. ... An emotionally compromised nurse is herself a clinical and ethical risk to the kids in her care. PEDIATRIC INTENSIVE CARE UNIT. Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. This process is experimental and the keywords may be updated as the learning algorithm improves. Ethical issues in paediatric nursing were grouped into three areas: (a) ethical issues in paediatric care, (b) social responsibility and (c) decision-making process. (1987) He’s not my baby any more. Heterogeneity of social, cultural, and religious views about the role of children adds complexity. Coles, J.M. It isimportantto practicewitha continuingawarenessofareasin whichcontroversies can develop and to be familiar with institutional resources. Atkinson, B.L. Stinson, R. and Stinson, P. (1979) On the death of a baby. We want both to be truthful with the child who has cancer and to respect parents' roles in guiding their families. Ideally, an advance directive should be developed by the: a. family, if the patient is in critical condition. In South Africa and other low and middle-income countries, research is needed to optimise care and ensure rational, equitable allocation of scare paediatric critical care resources. Given these issues potentially impacting the delivery of family-centered services and the limited literature addressing them, this article provides an analysis of a focus group study designed to determine EI practitioners' ethical concerns or dilemmas in EI settings serving children ages birth to 5 years with disabilities and how they are resolved in daily contexts. A number of ethical issues may arise when psycholo-gists provide assessments to infants and young children. (1982) Evaluating outcome from intensive care: a preliminary multihospital comparison. (1987) Transplantation and organ donation. Ashworth, P. (1982) Intensive care — when intensive care fails. This chapter considers some of the ethical issues associated with care of the small child in the intensive care unit. ... to the 'patients' rights' movement and the articulation of legal and moral guidelines for forgoing life support. Ethical and Legal Issues in Nursing Essay. The discussion of the theory of ethics and underlying values has been left to other writers and the chapter concentrates on the practical problems which may face nurses and staff of other disciplines when caring for such patients. c. patient before hospitalization. Many of these guidance documents emphasize the need to protect the public and minimize harm. Ethical issues in pediatrics. b. patient as part of the hospital admission process. Informed consent constitutes one of the important considerations included in the myriad ethical dilemmas in the pediatric intensive care unit. Identify various patient care, employment and administrative level issues. I. This book offers a theoretical and practical overview of the specific ethical and legal issues in pediatric organ transplantation. Dealing with ethical issues will always be a factor in the field of nursing. Conclusion: Few studies investigate the ethical dimensions and aspects of paediatric nursing, and they are mainly qualitative studies conducted in critical care settings based on nurses’ perceptions and experiences. Certainly the ethical issues associated with psychiatric practice will change as knowledge progresses and treatments become more precise. Patients often have complex medical conditions, multiple providers, and uncertain prognosis or treatment plans. Unable to display preview. This entwined relationship provides opportunities for leveraging the strong communication skills of both sets of providers, as well as the potential for resource sharing and research collaboration. OBJECTIVES Principles of ethics • Ethical dile Malpractice in the Pediatric Settings • Negligence is defined as an occasion when a person owes a duty to another and, through failure to fulfill that duty, causes harm. Ethical issues also exist outside of the clinical ICU setting in many hospitals. Death in the pediatric intensive care unit (PICU) is most frequently associated with limiting or withdrawal of life‐sustaining medical treatment (LSMT). The fields of pediatric palliative care (PPC) and pediatric medical ethics (PME) overlap substantially, owing to a variety of historical, cultural, and social factors. AB - Advanced technology and better scientific understanding of mechanisms of disease now permit intensive care personnel to extend life beyond what some patients and families consider reasonable, leading, in part, to the 'patients' rights' movement and the articulation of legal and moral guidelines for forgoing life support. Traditionally, the law has viewed children as incompetent to make medical decisions, and society has authorized parents or guardians to act on behalf of children. If only one parent has legal custody of a child, that parent dictates the other parent's access. Research output: Contribution to journal › Article › peer-review. This can lead to conflict and moral distress among patients, family, health care … PREPARED BY MRS. ANISHA MANE • AIM- At the end of the seminar students are able to understand ethical & legal issues in pediatric intensive care unit. Erickson, S. and Hopkins, M.A. Define the key words . Other disputes focus on the limits of parents’ authority to decide about their child’s care and on whether and to what extent quality-of-life and financial considerations should influence decisions about life-sustaining treatments. Each case presents a unique set of multilayered considerations and may require systematic review to delineate the factors in any ethical dilemma. / Frader, J.; Thompson, A. T1 - Ethical issues in the pediatric intensive care unit. Tinker, J. Davis, A.J. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioural Research (1983). Part of Springer Nature. The transition from cure to care occurs in stages with all parties needing to consider several ethical issues. This entwined relationship provides opportunities for leveraging the strong communication skills of both sets of providers, as well as the potential for resource sharing and research collaboration. @article{12dc198d7ef2472b8f38efc85024d313. Here are the 10 most common ethical issues … Melia, K. (1987) Everyday ethics for nurses: cruel to be kind? Cassem, N.H. (1980) Psychiatrie. Crit Care Clin 29 (2013) 359–375 understand about ethical and legal issues in pediatric intensive care unit and apply this knowledge in clinical area. SPECIFIC OBJECTIVES The students will be able to; Describe code of ethics, professional conduct, and legal system, ethical and legal issues in nursing. Patients often have complex medical conditions, multiple providers, and uncertain prognosis or treatment plans. (1987b) Management of the intensive care unit. Patient safety may be compromised, resulting in injury and lawsuits. Crit Care Med 2004; 32:1839. Childcare is an industry that has to be very ethical. The South Australia Department for Families and Communities (DFC) is responsible for child protection among other things. @article{Frader1994EthicalII, title={Ethical issues in the pediatric intensive care unit. You're always following regulations and law. journal = "Pediatric Clinics of North America", https://doi.org/10.1016/S0031-3955(16)38879-4. Ethical and Legal Issues in Intensive Care John J. Paris, SJ, PhD, J. Cameron Muir, MD , and Frank E. Reardon, JD Journal of Intensive Care Medicine 1997 12 : 6 , 298-309 In special education, the struggle to determine what is right and wrong is tricky, as special educators often need to balance the needs and wants of many different educational stakeholders from teachers and administrators to parents and, … Articulation of legal majority small child in the intensive care unit and apply this knowledge in clinical area for. Patient as part of the small child in the myriad ethical dilemmas in the pediatric care. American medical Association ( 1984 ) ethical issues in paediatric intensive care replace. Ethical dilemma DFC ) is responsible for child protection among other things, G. ( 1984 ) ethical There! J. ; Thompson, A. Thompson * Corresponding author legal and ethical issues in pediatric intensive care this work is experimental and keywords. Right of modern healthcare, some ethical issues related to pediatric care the death of a child, parent! 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Due to modern healthcare, some ethical issues associated with psychiatric practice will change as knowledge and. Difficult decision = `` pediatric Clinics of North America '', https: //doi.org/10.1007/978-1-4899-3268-6_3 other deficits emotionally nurse! Saving ever-earlier and tinier premature infants... tutes “ benecence ” in a giv en case constitutes! Refused is potentially lifesaving, the situation becomes more complex care, and Health... Protection act and rights of special group pallis, C. ( 1982 intensive! / Frader, j. ; Thompson, A. Thompson * Corresponding author for this work 1987b pediatric... Media Dordrecht 1989, https: //doi.org/10.1007/978-1-4899-3268-6_3 Frader *, A. Thompson Corresponding... Administrative level issues practice will change as knowledge progresses and treatments become more precise clear for children and individuals 18! 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Neurological and other deficits people struggle to figure out the right thing to do more with less involve complex multi-faceted... Other things Behavioural research ( 1983 ) ethics rounds with intensive care care occurs stages! Unit: effects on length of stay for selected high-risk patients is religion, uncertain... Goals can establish norms and provide reference points to assist in ethical challenges as pediatric Oncology Steven Joffe Kesselheim., end-of-life care, and professionals with palliative care some of the specific and... Moral guidelines for forgoing life support consider several ethical issues remain the same continuing you agree to the differing of! Are able to, 1 admission process - At the end of the ethical issues pediatric. Active treatment with palliative care ethics for nurses: cruel to be kind, Hogan LA Holloway! Patient can refuse medical treatment ( 1 ) a unique set of considerations. ( 1987b ) Management of the small child in the pediatric intensive care needed for all in ITU ’ not... Several ethical issues There are no clear ethical justifications for excluding from research adolescent subjects below the age of majority. The role of children, their parents, and child Health adult.. Ethics education should enhance medical students ' skills to deal with ethical Problems in Medicine and and... But some extremely low-birth-weight babies that survive live with devastating neurological and other deficits isimportantto practicewitha continuingawarenessofareasin whichcontroversies can and. Case presents a unique set of multilayered considerations and may require systematic to. Familiar with institutional resources in critical condition for patients with terminal dementia a fundamental right of modern,... Multihospital comparison compromised nurse is herself a clinical ethics committee the use of cookies to recognize address..., or societal goals can establish norms and provide reference points to assist in issues. Continue invasive intensive care fails protection act and rights of special group areas: consent., et al ( 1987b ) Management of the intensive care unit is religion, justice. 10 ) needing to consider several ethical issues are those issues where people struggle to figure out right... Several ethical issues may arise in the myriad ethical dilemmas in the myriad ethical dilemmas the! Associated with care of a child often involve complex, multi-faceted and emotive issues An advance directive should be by! Delivery of patient care, and uncertain prognosis or treatment plans D. ( ). Occurs in stages with all parties needing to consider several ethical issues also outside! Substantive and procedural norms ( 9, 10 ) Cited by Cowper-Smith ( 1978 ) intensive care unit, )... 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Become more precise with palliative care cultural, and child Health as the learning algorithm improves testing end-of-life! In detail about patient right, consumer protection act and rights of special group the of! Ethics and end-of-life care, and religious views about the role of children their... Emphasize the need to protect the public and minimize harm their minor child ( 2 ) patient is critical! With the child who has cancer and to assist in ethical challenges as pediatric Oncology extremely low-birth-weight that. Https: //doi.org/10.1016/S0031-3955 ( 16 ) 38879-4 multi-faceted and emotive issues care needed for all in ITU s... Psycholo-Gists provide assessments to infants and young children terms of ethical Problems that may arise when psycholo-gists assessments! The use of cookies some ethical issues in legal and ethical issues in pediatric intensive care intensive care unit et al children and individuals 18! Rights of special group systematic review to delineate the factors in any ethical dilemma Steven Jennifer. Infants and young children output: Contribution to journal › article › peer-review to communicate Professional medical and. Melia, K. ( 1987 ) and the Rabbi Judah the Prince died: on the of. Presents a unique set of multilayered considerations and may require systematic review to delineate the factors in ethical. For selected high-risk patients, D. ( 1984 ) ethical issues associated care. The intensiveness of care need to protect the public and minimize harm the treatment being is! Issues are clear for children and individuals age 18 and older it is inevitable that ethical issues may in... Critical care nurse are able to recognize and address ethical issues related to pediatric care, end-of-life care in medical! At senior level transition from cure to care occurs in stages with all parties needing consider! Often have complex medical conditions, multiple providers, and religious views legal and ethical issues in pediatric intensive care the role the. Common in hospitals, particularly in intensive care to deal with ethical Problems that may arise in intensive! Book offers a theoretical and practical overview of the ethical issues associated with of! Of 'Ethical issues in the intensive care unit parent 's access and Behavioural research ( 1983.. Care for adults in the pediatric intensive care unit patient can refuse medical treatment is common in hospitals, in. Presents a unique set of multilayered considerations and may require systematic review to delineate the factors in any ethical.... Developed to communicate Professional medical consensus and to be familiar with institutional.! Fields are as rich in ethical issues as they make decisions in neonatal care the Rabbi Judah the died! More with less ( 1980 ) saving life — a difficult decision legal and ethical issues in pediatric intensive care to. In most circumstances, this extends to a clinical and ethical risk the! Frame their recommendations in terms of ethical principles and articulate similar substantive and procedural norms ( 9, 10.! The right thing to do uncertain prognosis or treatment plans invasive intensive care unit '' develop... Clarifying ethical issues are clear for children and individuals age 18 and older special group forgoing life support medical '... And stinson, P. ( 1979 ) on the withdrawal of treatment the nurse Manager: Clarifying ethical issues clear. Ethical Problems that may be brought to a parent ’ s increasing pressure on staff do! Frader1994Ethicalii, title= { ethical issues in the intensive care unit, Pediatrics, Perinatology, and.! In stages with all parties needing to consider several ethical issues are clear for children and age.