Page 76 - Proceeding of Plenary Abstract of Parallel Symposim

ERIA

Ethical Dilemmas the End of Life in Intensive Care

Rismala Dewi
Department of Child Health, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
Abstract
Background End of life is a condition that often met in intensive care, which is clinical condition when
the patient is dying or likely to die in hours, days, or months. End of life care should be based on doctor’s
knowledge, parents or family opinion, and patient’s rights of themselves. Medical consent for under age
children can be given by parents or their guardian, considering age limitation for taking medical approval
in Indonesia is above 20 years. This situation has a potential to cause a conflict between ethics, sciences,
and laws. Objective To find out ethical issues that occurs during end of life care and its solutions. Methods
This review was made by summarized reports, literatures, and clinical experiences. Results Ethical principles
in medicine are beneficence, non maleficence, autonomy, and justice. In emergency setting, decisions need
to be made in a short time, whether to perform resuscitation and continue life-sustaining treatment. The
problem occurs when parents or families show a disagreement with the plan, such as administering narcotics,
withdrawal of medical intervention, pain and symptom management, etc. It has been found for being ethical
dilemmas for healthcare workers. Euthanasia is a way to shorten patient’s suffering in end of life. It is illegal in
Indonesia as its regulation in laws constitution. Palliative care can be better solution to improve quality of life
in terms of psychosocial, spriritual, and physical as long as curative treatment is still ongoing. Conclusion Any
treatment should be decided by consent and ethical consideration to make the best decision for the patient.
Palliative can be an option in end of life care.
Keywords: end of life; ethics; dilemmas; euthanasia; palliative.

The Role of Pediatric Intensive Care in the Limited Resources Setting With High Child
Mortality Rate

Ririe Fachrina Malisie
Department of Child Health, Faculty of Medicine Universitas Sumatera Utara, Pediatric Emergency and Intensive Care Unit H.Adam Malik General Hospital
Medan, North Sumatera, Indonesia

Abstract
Background Pediatric intensive care is healthcare for the sickest children whose at risk of dying or having adverse
outcomes. Critically ill children need rapid identification, prioritization and urgent treatment. Fifty percent of
deaths of children in hospital occur within 24 hours of admission. In limited resources countries, the majority
of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate
numbers of staff, and rapid access to necessary medications, supplies and equipment.Objective To describe the role
of Pediatric Intensive Care in the limited resources setting with high child mortality rate. Methods This review was
searched all known literature in the references to relevant studies. Results There were three delays setting developed
to explain why childhood mortality significantly high in limited resource areas. First delay, too late to decide and
to seek care, second delay in reaching the appropriate facility, and the third delay in receiving quality care at the
facility. Infections, such as tuberculosis, sepsis, pneumonia, and malaria continue to have a high mortality and
90% of childhood trauma deaths occur in low middle income countries. When beds and supplies are limited,
PICU admissions should be limited to illness and injury that are reversible or curable. Having admission criteria
based on outcomes will prevent the use of limited critical care resources for children with terminal or untreatable
conditions or for those unlikely to benefit. There is a misconception that critical care has to be complicated and
technologically sophisticated. Paediatric emergency and intensive care need not be expensive nor excessively
dependent on complex technology, as long as it focus and kept on ABC of the basic and proper interventions.
Clinical protocols, care pathways, and checklists can be an effective strategy for facilitating the use of evidence-
based practice, and standardizing care across different providers.Conclusion Pediatric Intensive Care services can be
utilized to improve outcomes if it combined of community recognition of serious illness, early access to care, referral,
and safe transportation of the infant and children with critically ill condition.
Keywords: pediatric intensive care; limited rersources setting; high child mortality

Kongres Nasional Ilmu Kesehatan Anak XVIII 61