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. 2022 Dec;48(12):1068-1075.
doi: 10.1136/medethics-2020-107099. Epub 2021 Jul 19.

Initiating technology dependence to sustain a child's life: a systematic review of reasons

Denise Alexander  1 , Mary Brigid Quirke  1 , Jay Berry  2   3 , Jessica Eustace-Cook  4 , Piet Leroy  5 , Kate Masterson  1 , Martina Healy  6   7 , Maria Brenner  8
Affiliations

Initiating technology dependence to sustain a child's life: a systematic review of reasons

Denise Alexander et al. J Med Ethics. 2022 Dec.

Abstract

Background: Decision-making in initiating life-sustaining health technology is complex and often conducted at time-critical junctures in clinical care. Many of these decisions have profound, often irreversible, consequences for the child and family, as well as potential benefits for functioning, health and quality of life. Yet little is known about what influences these decisions. A systematic review of reasoning identified the range of reasons clinicians give in the literature when initiating technology dependence in a child, and as a result helps determine the range of influences on these decisions.

Methods: Medline, EMBASE, CINAHL, PsychINFO, Web of Science, ASSIA and Global Health Library databases were searched to identify all reasons given for the initiation of technology dependence in a child. Each reason was coded as a broad and narrow reason type, and whether it supported or rejected technology dependence.

Results: 53 relevant papers were retained from 1604 publications, containing 116 broad reason types and 383 narrow reason types. These were grouped into broad thematic categories: clinical factors, quality of life factors, moral imperatives and duty and personal values; and whether they supported, rejected or described the initiation of technology dependence. The majority were conceptual or discussion papers, less than a third were empirical studies. Most discussed neonates and focused on end-of-life care.

Conclusions: There is a lack of empirical studies on this topic, scant knowledge about the experience of older children and their families in particular; and little written on choices made outside 'end-of-life' care. This review provides a sound basis for empirical research into the important influences on a child's potential technology dependence.

Keywords: applied and professional ethics; children; decision-making; quality/value of life/personhood; technology/risk assessment.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Data search and selection process.
Figure 2
Figure 2
Ages of children who are the subjects of the reasons to initiate or not initiate technology dependence.
Figure 3
Figure 3
Distribution of reason types by country. European multi-country collaborations are: Luxembourg, Netherlands, Sweden, France, Germany, UK, Italy, Spain; Italy, Spain, France, Germany, Netherlands, UK and Sweden; Ireland / UK;Germany / Switzerland; Austria, Switzerland and Germany; UK / Belgium
Figure 4
Figure 4
Themes identified in the narrow reason types.
See this image and copyright information in PMC

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