Parental Refusal of Surgery in an Infant With Tricuspid Atresia

Author:

Kon Alexander A.1,Patel Angira2,Leuthner Steven3,Lantos John D.4

Affiliation:

1. Naval Medical Center San Diego and the University of California San Diego School of Medicine, San Diego, California;

2. Lurie Children’s Hospital, Chicago, Illinois;

3. Medical College of Wisconsin, Milwaukee, Wisconsin; and

4. Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri

Abstract

We present a case of a fetal diagnosis of tricuspid atresia (TA). The pregnant woman and her husband requested that the baby be treated with only palliative care. The cardiologist did not think it would be appropriate to withhold life-prolonging surgery once the infant was born. The neonatologist argued that outcomes for TA are similar to those for hypoplastic left heart syndrome, and the standard practice at the institution was to allow parents to choose surgery or end-of-life care for those infants. The team requested an ethics consultation to assist in determining whether forgoing life-prolonging interventions in this case would be ethically supportable. In this article, we ask a pediatric intensivist, a pediatric cardiologist, and a neonatologist to discuss the ethics of withholding life-sustaining treatment of a baby with TA.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology, and Child Health

Reference39 articles.

1. American Academy of Pediatrics Committee on Bioethics: guidelines on foregoing life-sustaining medical treatment.;American Academy of Pediatrics Committee on Bioethics;Pediatrics,1994

2. American Academy of Pediatrics policy statements on bioethics: summaries and commentaries: part 2.;Mercurio;Pediatr Rev,2008

3. Infants’ best interests in end-of-life care for newborns.;Willems;Pediatrics,2014

4. Intermediate results of hybrid versus primary Norwood operation.;DiBardino;Ann Thorac Surg,2015

5. Late outcomes of infants supported by extracorporeal membrane oxygenation following the Norwood operation.;Alsoufi;World J Pediatr Congenit Heart Surg,2015

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