Tracheostomy Placement in Severe Neurologic Impairment: Ethical Considerations and Provider Perspectives.

1. Describe the ethical issues commonly encountered when tracheostomy placement is considered for children with severe neurologic impairment, and empathize with the diversity of perspectives on how these ethical questions should be answered. 2. Appreciate the need for systematic processes for determining tracheostomy eligibility in children with severe neurologic impairment and related comorbidities. Tracheostomy placement in children with severe neurologic impairment raises ethical questions and the potential for provider moral distress. This presentation will describe commonly confronted ethical considerations. The presentation then describes a multidisciplinary national survey being implemented to evaluate the diversity of provider perspectives and practices on tracheostomy placement in children with severe neurologic impairment. Tracheostomies are increasingly being considered in pediatric patients with severe neurologic impairment (SNI). The decision to pursue tracheostomy is weighty in part due to the frequency of clinical complications and the level of care required of caregivers. Pediatric care team members may experience moral distress when tracheostomies are considered in patients with SNI. Commonly cited ethical issues include concerns for quantitative futility, poor quality of life, parental decision making that is not fully informed, and poor utilization of a scarce resource. Because these concerns are value-laden, conflicts can occur between the medical team and parents and within the medical team itself. We hypothesize that providers from different subspecialties may hold differing perspectives. 1. Identify ethical considerations in tracheostomy placement in children with SNI, and 2. Describe a national survey which will evaluate the diversity of care team perspectives re: tracheostomy placement in children with SNI. A clinical case of a child with SNI being considered for tracheostomy will be presented, including perspectives from the parents and members of the care team. Ethical considerations will be enumerated and discussed. A national survey which assesses personal and institutional perspectives of providers from varied subspecialties across the country (planned implementation in Fall 2023) will be introduced. Survey results (preliminary or final) will be presented. The decision surrounding tracheostomy placement in children with SNI is complex, and reasonable people often disagree on its appropriateness. Systematic processes are necessary to ensure that clinical and ethical concerns are negotiated equitably and consistently from patient to patient. Ethical / Legal Aspects of Care; Management of Medical Interventions [ABSTRACT FROM AUTHOR]