In Turkey, physicians often determine the type of treatments, where the

In Turkey, physicians often determine the type of treatments, where the treatments are delivered, and the healthcare team for children undergoing cancer treatment (Kilicarslan-Toruner and Akgun-Citak, 2013). For the most part, medical judgment of long-term outcomes impacts these difficult decisions, but physicians in some countries (e.g., Malaysia, Singapore) must also consider the financial burden that will be assumed by the parents because of the medical care (Martinez et al., 2005). In other countries, the medical cost is deferred to government agencies, insurances order PNPP companies, or other entities. The predominate decision maker and financial constraints can effect the decisions made for critically ill children. A current legal case in the United States illustrates some of the complexities of decisionmaking for children. The mother of a child declared brain dead has taken legal action (Winkfield vs. Children’s Hospital Oakland) against the hospital caring for her child prohibiting the physicians from removing the child from the ventilator. The child was originally admitted to the hospital to undergo a complex adenotonsillectomy, uvulopalatopharyngoplasty and submucous resection of bilateral inferior tubinates for treatment of sleep apnea. The medical history of the child is not presented in the court documents available. Following the surgical procedure, the child was transferred to the intensive care unit as planned. The child was alert, but actively bleeding from her mouth. Within an hour, the child went into cardiac arrest. Even though the child was resuscitated, the length of time without oxygen and blood flow led to irreversible brain damage and brain death was declared two days later by two separate physicians in accordance with the standards set forth by the Task Force of Brain Death in Children (2011). The California Health and Safety Code ?7180 states that an individual who has sustained “irreversible cessation of all function of the entire brain, including the brain stem,” is dead. According to this, the child is dead, even if her heart continues to beat. However, the mother refused to accept the child is dead and petitioned the court requesting her child continue to receive treatment and surgical placement of a tracheostomy tube and gastric tube. The decision being made here is whether or not a child, who has been declared brain dead, should be removed from a ventilator or should the parent be able to request ventilator and nutritional support for a child who is legally dead. The court documents offer insight into the mother’s perspective of the case, but offers little information about the HCPs views. The mother reported that her child appeared to be `quietly’ sleeping. Additionally, the mother is Christian and she believes that, as long as, her daughter’s heart is beating her daughter is still alive and should be treated with respect. If the ventilator is removed from the child, the mother views that as killing her daughter. Another reason the mother is reluctant to remove the ventilator is because she has had similar experiences with others who were also declared brain dead who recovered and led a normal life. The factors that influenced this mother’s decision to keep her daughter on a ventilator are potential lack of understanding ofInt J Nurs Stud. Author manuscript; available in PMC 2015 September 01.NIH-PA Author get BRDU manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptAllenPageneurological injury, religious beliefs,.In Turkey, physicians often determine the type of treatments, where the treatments are delivered, and the healthcare team for children undergoing cancer treatment (Kilicarslan-Toruner and Akgun-Citak, 2013). For the most part, medical judgment of long-term outcomes impacts these difficult decisions, but physicians in some countries (e.g., Malaysia, Singapore) must also consider the financial burden that will be assumed by the parents because of the medical care (Martinez et al., 2005). In other countries, the medical cost is deferred to government agencies, insurances companies, or other entities. The predominate decision maker and financial constraints can effect the decisions made for critically ill children. A current legal case in the United States illustrates some of the complexities of decisionmaking for children. The mother of a child declared brain dead has taken legal action (Winkfield vs. Children’s Hospital Oakland) against the hospital caring for her child prohibiting the physicians from removing the child from the ventilator. The child was originally admitted to the hospital to undergo a complex adenotonsillectomy, uvulopalatopharyngoplasty and submucous resection of bilateral inferior tubinates for treatment of sleep apnea. The medical history of the child is not presented in the court documents available. Following the surgical procedure, the child was transferred to the intensive care unit as planned. The child was alert, but actively bleeding from her mouth. Within an hour, the child went into cardiac arrest. Even though the child was resuscitated, the length of time without oxygen and blood flow led to irreversible brain damage and brain death was declared two days later by two separate physicians in accordance with the standards set forth by the Task Force of Brain Death in Children (2011). The California Health and Safety Code ?7180 states that an individual who has sustained “irreversible cessation of all function of the entire brain, including the brain stem,” is dead. According to this, the child is dead, even if her heart continues to beat. However, the mother refused to accept the child is dead and petitioned the court requesting her child continue to receive treatment and surgical placement of a tracheostomy tube and gastric tube. The decision being made here is whether or not a child, who has been declared brain dead, should be removed from a ventilator or should the parent be able to request ventilator and nutritional support for a child who is legally dead. The court documents offer insight into the mother’s perspective of the case, but offers little information about the HCPs views. The mother reported that her child appeared to be `quietly’ sleeping. Additionally, the mother is Christian and she believes that, as long as, her daughter’s heart is beating her daughter is still alive and should be treated with respect. If the ventilator is removed from the child, the mother views that as killing her daughter. Another reason the mother is reluctant to remove the ventilator is because she has had similar experiences with others who were also declared brain dead who recovered and led a normal life. The factors that influenced this mother’s decision to keep her daughter on a ventilator are potential lack of understanding ofInt J Nurs Stud. Author manuscript; available in PMC 2015 September 01.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptAllenPageneurological injury, religious beliefs,.