Reasons for parental withdrawal of care in a pediatric intensive care unit in China

Background: The past decade saw the establishment of pediatric intensive care units (PICU) across China. This occurred in the context of increasing private shares of medical costs. Payment schemes have not kept pace with the increased availability and demand. As a result a substantial number of parents, in the face of financial constraints, choose to withdraw the medical care of children even when recovery is expected. Objective: We set out to describe the experience of one PICU in Changsha, an industrialized city near the center of the country with a population of 7.3 million. Results: During the two-year period 883 patients were admitted to the PICU. One hundred one (11%) patients died during their hospital stay. Of these 69 (68%) died after parents elected to withdraw care. A large proportion (33 out of 69 48%) cited economic factors as a reason behind the decision. Compared with the non-withdrawal group the cases had lower disease severity at admission and on the day of death. On the day of death 34% in the withdrawal group had lower disease severity than at admission, showing clinical improvement. The mean hospital charge for the ICU stay was RMB35,000 (~$5600). Conclusion: A substantial proportion of patients in a Chinese urban PICU died after parents chose to withdraw their care in the face of financial hardship, even while some were showing clinical improvement. The society has an obligation, and, likely, an economic incentive, to share this burden.