Heroics at the End of Life in Pediatric Cardiac Intensive Care: The Role of the Intensivist in Supporting Ethical Decisions around Innovative Surgical Interventions

Thanks to significant medical and surgical advancements and innovations in the past century, most children with critical heart disease can hope to live a long and healthy life. Unfortunately, despite these advancements, some children do not respond to conventional therapies and are at high-risk of dying. Under these heart-breaking circumstances, some families and medical teams may understandably search for alternative therapies that may help save the child’s life. Under such dire circumstances, unconventional cardiac surgical or catheter-based interventions are sometimes considered. These interventions are often unproven, with unclear risks and benefits. The use of unconventional heroic therapies can in some cases be lifesaving and in other cases only place additional burdens on the child without a positive outcome. These decisions are rife with ethical questions. An ethical approach to the consideration of unconventional interventions under these dire and often time-pressured circumstances in the cardiac intensive care unit is necessary to protect the best-interests of the child and optimize the medical decision-making process. Pediatric cardiac intensivist care providers are well-positioned to support ethical decision-making. This manuscript provides a framework for intensive care providers to understand and apply the ethical considerations of the use of unconventional interventions in this setting.