Ethical challenges in the care of infants with intestinal failure and lifelong total parenteral nutrition.

Families, pediatric surgeons, and other care givers face difficult ethical challenges as they balance the benefits and burdens of total parenteral nutrition (TPN) and bowel transplantation in the face of uncertainty and the inability to predict which infants with intestinal failure are likely to have good outcomes. This article presents an analysis of 3 TPN cases using a comparison with dialysis and kidney transplantation, an older and more established technology for which ethical guidelines are proposed in the literature. The authors conclude that pediatric surgeons should recommend TPN in cases in which it is expected to be a temporary measure until bowel function is restored. TPN should not be recommended when other comorbidities make survival unlikely or when the infant is neurologically devastated. In the case of lifelong TPN in which bowel transplantation is only an option when TPN fails, pediatric surgeons should defer to parents in their choice about the use of lifelong TPN. Copyright 2001 by W.B. Saunders Company