Limitation and interruption of treatments in tracheoventilated tetraplegic children who have suffered spinal cord injury

The decision to limit and interrupt treatment for the population of tracheoventilated tetraplegic children who have suffered spinal cord injury imply a very complex process. This issue is not addressed in the literature. Affected children have a major motor and ventilatory dependence requiring invasive survival techniques, in contrast with normal cognitive functions. We wondered about the proportion of these patients for whom the question of limiting or interrupting treatment has been asked, as well as the circumstances that led us to think about the need for a decision to limit or interrupt treatment. Two main questions then arose: What are the obstacles that oppose a "serene" reflection on the limitation and interruption of treatment in tracheoventilated tetraplegic children following spinal cord injury? What are the ways to move forward in this decision-making? We then created an interdisciplinary working group in collaboration with the regional pediatric palliative care team. Three key steps in the course of care and management of tracheoventilated tetraplegic children following spinal cord injury have been identified and analyzed retrospectively. Different obstacles are put forward: the absence of etiological diagnosis, the iatrogenic origin of the lesion, the hope of recovery, the benefit of the doubt, the preserved cognitive functions. There is a moral prohibition to consider a limitation and interruption of treatment in these children, despite a severely affected quality of life. The uniqueness of each situation must be taken into account in the reflection on the overall care of these children. (c) 2023 Elsevier Masson SAS. All rights reserved.