Ethical and legal considerations in the care of the infant with end-stage renal disease whose parents elect conservative therapy. An American perspective.

When parents elect conservative treatment for infants with end-stage renal disease (ESRD), their choice is medically, ethically, and legally acceptable, since dialysis and transplantation for young infants are still in the range of innovative and experimental treatments. Pediatric nephrologists have been reluctant to view these treatments as standard for very young infants because of doubts about their efficacy, technical difficulties in providing them for tiny patients, uncertainty about their short-term and long-term risks, and the suffering that they can create. Because these renal replacement therapies are not yet established, it is the responsibility of parents to determine whether the benefits of treatment outweigh its burdens for their infants. Physicians have an obligation to ensure that parents make a well-considered decision, and to provide them with counsel and support.