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Bioethics in the Pediatric ICU

Ethical Dilemmas Encountered in the Care of Critically Ill Children

Laura Miller-Smith, Ásdís Finnsdóttir Wagner, John D. Lantos


ISBN 13: 978-3030009427

This book examines the many ethical issues that are encountered in the Pediatric Intensive Care Unit (PICU). It supports pediatricians, nurses, residents, and other providers in their daily management of critically ill children with the dilemmas that arise. It begins by examining the evolution of pediatric critical care, and who is now impacted by this advancing medical technology. Subsequent chapters explore specific ethical concerns and controversies that are commonly encountered. These topics include how to conduct end-of-life discussions with families facing a myriad of challenging choices. It goes on to explore the concept of futility, and what that does and does not mean in the pediatric ICU setting.

Controversial subjects such as children as organ donors, particularly using donation after cardiac death, in addition to issues surrounding the declaration of brain death are covered. Additional chapters address resource allocation, and also analyze the use of long-term technology in chronically critically ill children. Chapters include case examples with guidance on how to work through similar difficulties and decision-making. While this book is specifically targeted for care providers at the ICU bedside, it is also of benefit to medical students, students in bioethics, practicing ethical consultants and families who are dealing with critically ill children.


"This thoughtful book is a literate and troubled search for the lost soul of doctoring. It feels as though the author could not restrain himself from spilling onto paper what he had observed as the paradoxes and contradictions, the triumphs and tragedies, of the practice of healing. It is worth anyone's time to read this succinct and erudite contribution to the issues of the goals of medicine and doctoring." - Journal of the American Medical Association

"For anyone who wishes a relatively brief, easy-to-read, thoughtful, and deeply penetrating examination of the issues facing medicine today, this is the book to read...John Lantos, a pediatrician, teacher, and bioethicist, opens and closes the book with unanswered questions. In doing so his purpose is 'to think about the roles and responsibilities within the ever-metastasizing enterprise that we will call the health system.' Particularly, he wants to 'think about what doctors do within that system, what doctors once did, and what doctors out to do.'...In short, the author, whose religious background is Judaism, provides much food for thought for the Christian and for the medical profession." - Ethics and Medicine

"John Lantos's anecdotes and analyses reveal a thinking and compassionate physician whose heart and mind are constantly in conflict... a highly personal and pained account of the angst-ridden role of U.S. physicians in financially driven managed care systems... Lantos tackles head on such subjects as euthanasia, withdrawal of treatment, the worthiness of human life and the cost of care for patients with incurable diseases." - The Toronto Globe and Mail

About the Author

John Lantos Portrait

John Lantos grew up in the rugged mountains of western Pennsylvania coal country. His father, a physician, was his childhood hero and role model.  His mother, a poet at heart, inspired him to become a writer.  He is an award-winning pediatrician, a prolific author, a beloved teacher, and an inspirational speaker.


Lantos was a resident in DC during the national controversy about Baby Doe, a baby with Down Syndrome.  That sparked a lifelong interest in bioethics and led to a post-doc fellowship at The University of Chicago. There, his groundbreaking work on neonatal bioethics and health policy led to leadership roles as Chief of General Pediatrics and Associate Director of the MacLean Center for Clinical Medical Ethics, and Associate Editor of Pediatrics.  Fifteen years ago, he moved to Kansas City to create and develop the Children’s Mercy Bioethics Center. 

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