Withholding and withdrawing life-sustaining treatment in children.

Modern medicine gives us the ability to prolong life even in situations where it may not be right to do so. This article discusses some of the complex ethical and legal issues surrounding withholding and withdrawing life-sustaining treatment in children, including the concepts of futility, best interests and intolerability. We advocate the use of a structured framework to help guide decision-making, particularly in the more difficult situations. The lack of a morally or legally significant difference between withholding and withdrawing treatment is discussed, as is the role of the doctrine of double effect (particularly in relation to the use of neuromuscular blocking agents during withdrawal of ventilatory support).