At the International Conference on Emergency Medicine held in Amsterdam, two groups that don’t often overlap came together.

Dr. Nemat Alsaba from the Geriatric EM Special Interest Group and Dr. Simon Chu from the Pediatric EM Special Interest Group pulled together a 90-minute session that took most of the large audience by surprise in discovering how similar are the issues in providing end-of-life care in the ED between the very young and the very old – whether unexpected sudden death or extended pre-death care.  

Two or three members from each SIG presented challenging cases from their own experience – the healthy 3-week-old with the sudden collapse; the robust 92-year-old with the sudden collapse; and others. They discussed how they had managed them clinically and reflected on the many other challenges the cases presented – communications, ethics, medico-legal considerations. 

After we heard about five cases, Drs. Colin Powell and Don Melady moderated a panel discussion* to explore the similarities and differences across the life spectrum through the lens of bioethical considerations.  We discovered that there were far more similarities than differences!  

Common themes that arose in both age groups:

• The challenges around addressing the ethical imperative of autonomy when dealing with patients are not able to express themselves and their own wishes;
• The challenges of address beneficence – when there are occasionally differing definitions of what “doing good” means for the different parties.  
• The challenges of addressing non-maleficence when “doing bad” (e.g. permitting natural death) may actually be in the best interest of the patient;
• The challenges of addressing justice especially social justice where in systems with limited resources, “doing everything” for one patient may mean that other patients get less;
• The importance of involving family and other caregivers in decision-making, as challenging as that may be;
• The importance of clear communication from the clinical team including excellent listening skills.  

Don Melady, Canada