End-of-life issues in the pediatric emergency department

The death of a child is one of the most tragic and stressful times in the life of a parent or caretaker. The natural order seems contradicted. Countless and unforeseen problems and challenges exist for the family of the child who died. Physicians, however, are also greatly affected by the death of a patient. In Western society, death has become institutionalized and secularized, and there are fewer societal support systems to facilitate bereavement. Physicians may find themselves in the unexpected role of providing these services at the time of death. Despite or perhaps because of these challenges, there are many appropriate and well-received interventions for bereaved families. The emergency department (ED) is a place where many lives are saved and a few lost. Most ED deaths are unexpected and are usually caused by trauma or acute infections. But many children with terminal diseases, chronic illnesses, and technological dependence are now living at home, and may present to the ED with complications leading to death. This article will address many of the procedural and ethical issues surrounding end-of-life care for children in the ED.