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Biomedical subjects

Walter M Robinson

Publications and source records attributed to Walter M Robinson.

8 recordsLinked to original sources
PubMed2005

Integrating palliative care into chronic care for children with severe neurodevelopmental disabilities.

BACKGROUND: Children with severe neurodevelopmental disabilities and complex medical conditions are a growing and unique segment of the pediatric population. The increasing use of life sustaining technologies has provided the chance at an extended life and increasing inclusion within the broader community. Families work to overcome personal and professional biases, clinical uncertainties, and pragmatic obstacles to improve quality of life. Little attention, however, has been paid to the unique challenges of caring for a dying child affected with neurodevelopmental delay. DISCUSSION: In this paper we outline several specific barriers to the provision of excellent end-of-life care for these children and their families. We also outline our approach for overcoming these barriers. SUMMARY: The benefit of comprehensive palliative care in select pediatric populations has been demonstrated. Extending and tailoring those service to meet the unique needs of children with severe disabilities is the next logical step in that continuum. Ultimately, acknowledging that the lives of children with neurodevelopmental disabilities and their families have a unique quality will permit the human face of medical care to keep pace with technologic advances. Appreciation of the value of a perhaps incomparable quality of life will allow for a better quality of dying for children with severe neurodevelopmental disabilities.

Attitude of Health Personnel↗
PubMed2003

Ethical issues concerning cardiac surgery in patients with syndromic abnormalities.

Advances in surgical techniques, cardiac anesthesia, and pre- and postoperative care have made the surgical treatment of complex congenital cardiac disease available to an ever-increasing number of children, including those with a wide range of extracardiac anomalies. Over the past few decades cardiac surgery in infants and children with syndrome-associated physical and mental conditions has undergone a remarkable change, with previously held norms abandoned for new standards. The social, ethical, and clinical appropriateness of these changes has been the focus of much attention. In this article, we provide a brief history of cardiac surgery in children with congenital syndromes, discuss some groundbreaking cases such as that of "Baby Doe," and present some rules of thumb for the pediatric cardiac surgeon and cardiologist to use when caring for children with congenital syndromes.

Abnormalities, Multiple↗
PubMed2003

Role of brain death and the dead-donor rule in the ethics of organ transplantation.

The "dead-donor rule" requires patients to be declared dead before the removal of life-sustaining organs for transplantation. The concept of brain death was developed, in part, to allow patients with devastating neurologic injury to be declared dead before the occurrence of cardiopulmonary arrest. Brain death is essential to current practices of organ retrieval because it legitimates organ removal from bodies that continue to have circulation and respiration, thereby avoiding ischemic injury to the organs. The concept of brain death has long been recognized, however, to be plagued with serious inconsistencies and contradictions. Indeed, the concept fails to correspond to any coherent biological or philosophical understanding of death. We review the evidence and arguments that expose these problems and present an alternative ethical framework to guide the procurement of transplantable organs. This alternative is based not on brain death and the dead-donor rule, but on the ethical principles of nonmaleficence (the duty not to harm, or primum non nocere) and respect for persons. We propose that individuals who desire to donate their organs and who are either neurologically devastated or imminently dying should be allowed to donate their organs, without first being declared dead. Advantages of this approach are that (unlike the dead-donor rule) it focuses on the most salient ethical issues at stake, and (unlike the concept of brain death) it avoids conceptual confusion and inconsistencies. Finally, we point out parallel developments, both domestically and abroad, that reflect both implicit and explicit support for our proposal.

Brain Death↗