Limiting and rationing treatment in paediatric and neonatal intensive care

In this chapter I consider the ethical decisions surrounding the provision and limitation of treatment offered to children requiring intensive care. I focus on the processes surrounding end of life decision making and consider how the concepts of futility, burden and uncertainty should impact upon these decisions. I also examine resource allocation to children's critical care services. The discussion does not provide a structure that will solve any given situation. It does take a practical approach to the issues faced by considering why we should engage in life limiting discussions; When they should occur; Who should be involved; How they should be carried out; and where and by what means withholding or withdrawal should occur. I have drawn the discussions closer to clinical practice with the intention of making them more useful, for those engaged in direct patient care, than those focused around philosophical principles.