ABSTRACT
A model is presented for providing home care services for children dying from cancer and for their families. Forty-two families whose children were patients at the Midwest Children's Cancer Center received home care during the first two years of this program. Variations in patient age, diagnosis, or family structure did not preclude successful participation in home care. In all families, the medical and nonmedical financial burdens of inpatient and outpatient hospital care were reduced when the child died at home. Since this program was initiated, terminal care has shifted from hospital-based medical management to nursing support in the home for the majority of children at our cancer center.
Subject(s)
Home Care Services , Neoplasms/nursing , Terminal Care , Adolescent , Adult , Child , Child, Preschool , Evaluation Studies as Topic , Fees and Charges , Female , Home Care Services/economics , Home Nursing , Humans , Infant , Male , Middle Aged , Parents/education , Terminal Care/economics , WisconsinABSTRACT
Bone marrow transplantation has been utilized for the treatment of severe aplastic anemia in a program at The Children's Hospital Medical Center. A protocol has been developed to help ensure that the interests and rightful claims of all involved parties will be taken into account. Three cases are presented. In one case all involved parties concurred with the plan for bone marrow transplantation. In a second case the prospective donor was deemed mentally incompetent to give truly informed consent for the procedure. In a third case the parents were unwilling to have their child undergo transplantation. The ethical issues raised in these cases suggest the need for further development of a moral technology to enhance decision-making competence and to aid in the recognition and application of the rights of children without impeding the advancement of pediatric medicine.