Withholding/withdrawing life sustaining treatment in pediatrics: an ethical analysis

A main end-of-life (EOL) decision frequently taken in pediatric palliative care (PPC) is withholding/withdrawing live sustaining treatments (LST). Decision-making on withholding/withdrawing LST in children is ethically sensitive and physicians have a key role in this process. EOL decision-making in PPC has been developed for years in Europe, Belgium and The Netherlands are representative in this development. PPC in China is still at a standstill, Chinese physicians have poor experience on withholding/withdrawing LST in pediatric settings. The overall aim of this project is to understand physicians’ ethical perceptions regarding withholding/withdrawing LST in children and to use these insights to develop a clinical-ethical framework which is valuable to clinical practice. We will synthesize empirical and ethical literature on physicians’ perspectives towards withholding/withdrawing LST in pediatrics; investigate Flemish and Chinese pediatricians’ perspectives on withholding/withdrawing LST in pediatrics and to identify similarities and differences; develop a clinical-ethical framework to support and facilitate ethics-based decision-making processes for withholding/withdrawing LST in pediatrics. The resulting insights and learned lessons will be transferred to China and key future pathways and initiatives for EOL decision-making within PPC in China will be proposed.