The ethics of withholding and withdrawing dialysis therapy in infants.

Pediatric nephrologists may encounter infants with renal failure who have either unexpectedly survived lung hypoplasia at birth or whose renal failure could be treated but comorbid conditions exist. As a member of the health care team, the pediatric nephrologist may be asked to guide therapeutic intervention with parents, family members, and other care-givers. We present a case study that illustrates some of the difficulties that may arise when conflicting social and economic pressures, as well as public opinion and legal authority, enter the decision-making process. Clinical, theoretical, legal, and economic considerations involved in the ethical decision process are presented. Some tentative guidelines for approaching such dilemmas are offered bearing in mind a goal of consensual decision making.