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Christian Hervé, Isabel Fauriel and French colleagues surveyed doctors in nephrology centres to find out more about how decisions to withdraw or withhold potentially life-sustaining treatment (LST) for a child were made. They classfied the criteria used by the 31 doctors inteviewed under 11 headings and found practice and criteria varied considerably between centres. In arguing that the decison making process should be made more consistent they suggest guidelines which would contain 4 main criteria for withdrawing/withholding LST. The 'starter' Annalisa below uses these criteria as Attributes but is intended merely to illustrate how any such criteria-based guideline could be given greater structure and transparency, while ensuring an individualised patient-specific decision - renal insufficiency in neonatal period
- incurable extrarenal disease
- severe neurological condition
- impossibity of providing necessary care/support either in family or via social services
- Withhold or withdraw life-sustaining treatment
- Continue or initiate life-sustaining treatment
All left at default setting of 50%. Should be best belief judgments for a specific patient in their specific context Left at default settings of equal weights As implied by  Ratings and Weightings and hence at default setting of equal scores I Fauriel, G Moutel, M-L Moutard, L Montuclard, N Duchange, I Callies, I François, P Cochat, C Hervé (2004) Decisions concerning potentially life-sustaining treatments in paediatric nephrology: a multicentre study in French-speaking countries Nephrology DialysisTransplantation 19: 1252-1257 Herve et al found all doctors were reluctant to involve parents in the decision making to the extent now mandated both ethically (in most Western jurisdictions) and legally (under French law). For 21/31 doctors 'informing the parents consisted largely of gradually helping the parents to accept the medical decision'.
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