In 2006 the RCH published its  policy / guideline on Withholding and Withdrawing Life-Sustaining Medical Treatment (WWLSMT). This page contains links to the guideline and a range of resources that may be relevant to clinicians managing children in this situation.

Extensive consultation with RCH hospital staff (including a clinician survey and an audit of current documentation practices in the hospital) revealed a need for a form to document the outcomes of discussions with families regarding WWLSMT in a unified and structured format. The completed forms will be filed at the front of the patient's current medical record behind the 'essential particulars' form. The forms will soon be available in all relevant clinical areas. A sample of the newly developed form is linked and this will soon be interactive so you can click on the area of interest for more information.

Clinical staff also expressed interest in specific communication resources and skills training. There are some useful links below and we are currently looking into skills training options for the future.

Guidelines

• RCH guideline/policy
• AMA position
• RCPCH guideline, Withholding or Withdrawing Life Sustaining Treatment in Children: A Framework for Practice (PDF 212KB)
• GMC (Withholding and WIthdrawing Life-prolonging Treatments: Good Practice in Decision-Making)
• Guidelines on Forgoing Life-Sustaining Medical Treatment, Pediatrics, Official journal of the American Academy of Pediatrics. (PDF)
• Recommended Reading: BMA (Withholding and withdrawing life-prolonging medical treatment: guidance for decision making)

WWLSMT form

• Life Limiting Condition Form (WWLSMT / Advanced Directive / Resuscitation Order)
  
• Example of a Clinicians letter to accompany the form (PDF 41KB) 

Ethical background

• Summary of the major ethical issues for clinicians (PDF 50KB)

Legal framework

• Summary of the major legal issues-Jim Tiballs (PICU, RCH)
• Recommended reading-'Ethics, Law and Medical Practice'; Kerry J Breen, Stephen M Cordner, Vernon D Plueckhahn. Pub. Allen and Unwin, 1997.
• For clarification of legal issues in individual patient cases at RCH, clinicians should contact the hospital lawyer, Tel (03) 9345 5156   or   (03) 9345 5132

Communication resources

• Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers (The Medical Journal of Australia)
• Answering the Question: "Doctor, if This Were Your Child, What Would You Do?" Pediatrics, Official journal of the American Academy of Pediatrics.
• Three Principles to Improve Clinician Communication for Advance Care Planning: Overcoming Emotional, Cognitive, and Skill Barriers. (PDF) JOURNAL OF PALLIATIVE MEDICINE Volume 7, Number 6, 2004
• Avoiding Iatrogenic Harm to Patient and Family While Discussing Goals of Care Near the End of Life, Weiner, JS; Roth, J. J Pall Med Apr 2006 9(2): 451-463
• Communicating With Children and Families: From Everyday Interactions to Skill in Conveying Distressing Information, Pediatrics, Official journal of the American Academy of Pediatrics.
• Calgary Cambridge guide to the medical interview - communication process

Children's bioethics centre

The  Children's Bioethics Centre was launched on August 12th 2008. It will fulfill a number of roles, covering clinical liaison, education and research. The services  available include current case consultation, facilitated case review, facilitated group discussions, review of policy issues and education sessions. Any RCH staff member can request a clinical ethics consultation or discussion. The Ethics service aims to provide urgent advice regarding imminent clinical decisions within a 24 hour period.