The Ethical Point of View in Prolonged Mechanical Ventilation and Home Ventilation

Prolonged mechanical ventilation (PMV) and home ventilation (HV) have increasingly become accepted practice for children who cannot be liberated from a ventilator. Technology has facilitated this, along with changing attitudes to healthcare and quality of life. However, unique ethical issues arise for every child being faced with the prospect of PMV/HV, alongside population ethical dilemmas that arise through the necessary resource need for such an undertaking. In this chapter, we identify the ethical issues that commonly arise and the considerations that may be necessary. These issues are necessarily framed by the healthcare system and wider societal values within which they are debated. We suggest that the ethical validity of each decision about PMV/HV can be best guaranteed by following an ethically sound decision-making process. This process should include contingencies for when a decision cannot be agreed upon by the child and their family and the healthcare team.