Witholding & Withdrawing of Life Support in Children

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CPG - Witholding & Withdrawing of Life Support in Children
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  CLINICAL PRACTICE GUIDELINES WITHHOLDING AND WITHDRAWINGOF LIFE SUPPORT IN CHILDREN MINISTRY OF HEALTH MALAYSIA B   E   R   S   A T  U  ã  B  E  R U S A  H A  ã   B   E   R   B  A   K   T    I    ã December 2005MOH/P/PAK/102.05(GU) ACADEMY OF MEDICINE  Statement of Intent This clinical practice guideline is meant to be a guide for clinical practice,based on the best available evidence at the time of development.Adherence to these guidelines may not necessarily ensure the bestoutcome in every case. Every health care provider is responsible for themanagement of his/her unique patient based on the clinical picturepresented by the patient and the management options available locally. Review of the Guidelines This guideline was issued in 2005 and will be reviewed if new evidencebecomes available.CPG Secretariatc/o Health Technology Assessment UnitMedical Development DivisionMinistry of Health MalaysiaLevel 4, Block E1, Parcel E,Government Office Complex,62250, Putrajaya.Available on the following website:http//www.moh.gov.myhttp://www.acadmed.org.my  GUIDELINE DEVELOPMENT AND OBJECTIVESGuideline Development The working group for the development of this guideline comprised ofpaediatricians, a paediatric anaesthesiologist and a legal advisor from the Ministryof Health and the Ministry of Education, as well as a legal personnel from theprivate sector. This guideline is based on the findings of a systematic review ofcurrent medical literature, taking into consideration local paediatric practices.The grading of evidence is based on a modified version of that suggested by theCatalonian Agency for Health Technology Assessment & Research, Spain. Thedraft guidelines were sent to various paediatricians for comment and feedback.These guidelines have also been presented to the Technical Advisory Committeefor Clinical Practice Guidelines and the Health Technology Assessment andClinical Practice Guidelines Council, Ministry of Health Malaysia for review andapproval. Objectives The aim of this guideline is to aid paediatricians and intensivists in clinical decisionmaking by providing well-balanced evidence based information and expert adviceon management of withholding and withdrawing of life support in children. Clinical Questions The clinical questions for this guidelines are:(i)When should withholding or withdrawal of life support be consideredin children?(ii)What are the legal implications of withholding or withdrawal of lifesupport?(iii)What are the economic implications of withholding or withdrawal oflife support?(iv)How should withholding or withdrawal of life support be carried out? Target Population This guideline is applicable to children under the age of 18 years old who arecritically ill and require life support or are on life support. Target Group This guideline is meant for all healthcare professionals who are involved inproviding clinical management of withholding and withdrawing of life support inchildren. i  GUIDELINES DEVELOPMENT COMMITTEE Dr Wong Swee Lan (Chairperson) Consultant Paediatrician(General Paediatrics and Child Health)and Head Department of PaediatricsHospital Kuala LumpurDato’ Dr Lim Nyok LinConsultant Paediatrician(Neonatology)and Head Department of PaediatricsSelayang HospitalDr Lim Yam NgohConsultant Paediatrician(Nephrology)Department of PaediatricsKuala Lumpur HospitalDr ThavaranjithamConsultant Paediatric AnesthesiologistPaediatric InstituteKuala Lumpur HospitalProf. Ong Lye ChooConsultant Paediatrician ( Neurology)Universiti Kebangsaan MalaysiaHospitalProf. Madya Dr Lucy LamConsultant Paediatrician(Intensive Care)University Malaya Medical CenterMs Miriam GeorgeAdvocate & SolicitorShearn Delamore & Co7 th Floor, Wisma Hamzah–Kwong Hing,Kuala LumpurDr Hussien ImamConsultant Paediatrician(Neurology)and Head Department of PaediatricsPenang HospitalDr Amar Singh HSSConsultant Paediatrician(Community Paediatrics)and Head Department of PaediatricsIpoh HospitalDr Teh Keng HwangConsultant Paediatrician(Intensive Care)and Head Department of PaediatricsAlor Setar HospitalDr Hasmawati HassanConsultant Paediatrician(Neonatology)Kota Bharu HospitalProf Boo Nem YunConsultant Paediatrician (Neonatology)Universiti Kebangsaan MalaysiaHospitalProf. Jackie HoConsultant Paediatrician (Neonatology)Head, Department of PaediatricsPerak Medical CollegeMiss Farahnini DusukiLecturerLaw FacultyInternational Islamic University ii
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