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Ethical Decision-Making in Pediatric Dialysis

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Pediatric Dialysis

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Abstract

Dialysis is a lifesaving intervention for children with end-stage kidney disease. In some cases, it may be appropriate to forgo dialysis treatment. This chapter will review the history of provision of dialysis, the best interest standard and harm principle in pediatric medical decision-making, the technological imperative, and the ethical equivalence of withholding and withdrawing life-sustaining treatments like dialysis. Next, we will review considerations of and a process for forgoing pediatric dialysis including addressing disagreements, futility, available resources, and time-limited trials. Finally, we will consider decision-making for special populations including fetuses and pregnant women, neonates, the developmentally disabled, those with multiple comorbid conditions, those who cannot be transplant candidates, undocumented immigrants or refugees, and adolescents nearing adulthood.

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Authors and Affiliations

  1. Divisions of Nephrology and Bioethics and Palliative Care, Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA, USA

    Aaron Wightman

  2. Pediatric Nephrology Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France

    Bruno Ranchin

  3. Department of Pediatrics and Child Health, Max Rady College of Medicine, Section of Pediatric Nephrology, Winnipeg, MB, Canada

    Aviva M. Goldberg

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  1. Aaron Wightman
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  2. Bruno Ranchin
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  3. Aviva M. Goldberg
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Correspondence to Aaron Wightman .

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Editors and Affiliations

  1. Department of Pediatrics, University of Missouri-Kansas City, School of Medicine, Division of Pediatric Nephrology, Children’s Mercy Kansas City, Kansas City, MO, USA

    Bradley A. Warady

  2. Stanford University School of Medicine, Division of Pediatric Nephrology, Department of Pediatrics, Palo Alto, CA, USA

    Steven R. Alexander

  3. Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany

    Franz Schaefer

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Wightman, A., Ranchin, B., Goldberg, A.M. (2021). Ethical Decision-Making in Pediatric Dialysis. In: Warady, B.A., Alexander, S.R., Schaefer, F. (eds) Pediatric Dialysis. Springer, Cham. https://doi.org/10.1007/978-3-030-66861-7_42

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