Do not resuscitate decisions in pediatric patients

The Case A 4-year-old boy with metastatic neuroblastoma undergoes stem cell transplantation following intensive chemotherapy and radiation. 17 days post-transplant, with the success of anti-cancer treatment and stem cell rescue unclear, he develops an acute bowel obstruction. His parents feel that, after many months of therapy, especially over the last few weeks, their son should not have to endure “heroic” treatment. They do not want him to have cardiopulmonary resuscitation (CPR) and the oncologists have agreed to a “do not resuscitate” (DNR) order, given the boy's overall poor prognosis. The parents would like him to have palliative surgery to relieve the bowel obstruction. The anesthesiologists and surgeons request suspension of the DNR order for the surgery. The parents do not understand why it is acceptable to forgo resuscitation on the oncology unit, but not in the operating room.Attempts to resuscitate a person from an apparently “lifeless” state date back to at least biblical times: When Elisha came into the house, he saw the child lying dead on his bed. So he went in and closed the door on the two of them, and prayed to the Lord. Then he got up on the bed and lay upon the child, putting his mouth upon his mouth, his eyes upon his eyes, and his hands upon his hands; and while he lay bent over him, the flesh of the child became warm.