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Four wishes for Aubrey

19 January 2012

BS Carter, JB Brown, S Brown and EC Meyer

In the critical care environment, what begins as cure-oriented and lifeextending treatment may become unsuccessful in overcoming the patient’s increasingly complex pathophysiology. A case from the neonatal intensive care unit is presented and used to elaborate upon care transitions toward palliative and supportive care that can be rendered in the hospital, at home or in a hospice facility. Successful transitions may rest upon anticipatory guidance by the primary physician and team, or a consultant, to facilitate and enable parents and team members alike in addressing the hard realities that cure, or even successful ICU discharge, is unlikely. A simple mechanism of addressing and accommodating a family’s wishes is provided. Journal of Perinatology (2012) 32, 10–14; doi:10.1038/jp.2011.171; published online 17 November 2011

Keywords: palliative care; end-of-life; communication; decisionmaking; critically ill children; parental satisfaction

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