• A Hernández González, Ma T Hermana Tezanos, R Hernández Rastrollo, F J Cambra Lasaosa, A Rodríguez Núñez, I Failde, and Grupo de Etica de la SECIP.
• Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Puerta del Mar de Cadiz, Avda. Ana de Viya 21, 11009 Cádiz, Spain. artucadiz@ono.com
• An Pediatr (Barc). 2006 Jun 1; 64 (6): 542-9.

ObjectivesTo assess physicians' awareness and experience of ethical problems that arise when dealing with critically ill children in pediatric intensive care units (PICUs).Material And MethodsQuestionnaires containing 20 questions about ethical dilemmas and attitudes related to the care of children admitted to PICUs were mailed to 43 PICUs in Spain.ResultsNinety-five responses corresponding to 24 residents and 71 attending physicians were received from 21 PICUs. The occurrence of ethical dilemmas in the PICU was recognized by 96.8 % of the respondents. The most frequent method of solving these problems was through medical consensus (80 %), while family participation in the decision making process was highly variable. A total of 95.8 % of respondents stated that decisions to limit therapy were made in their PICU, although only one third of these decisions were written in the medical record. The most frequent form of therapeutic limitation was the do not resuscitate order. One third (32.6 %) of participants considered there were ethical differences between withdrawal and withholding of treatment. Attending physicians had greater experience of therapeutic limitation than did residents, but their opinions on the subject were similar.ConclusionsEthical dilemmas are common in the PICU. In this setting, decisions about limitation of therapy are frequent, although many physicians admit to not being clear on this issue or on other aspects of clinical ethics. Family members' participation in the decision making process is insufficient in Spanish PICUs.

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