Table 2

Broad reason types identified in the review

Clinical factorsQuality of life factorsMoral imperatives and dutyPersonal factors and values
Supporting technology initiationBenefit of treatment19; Best interest (of the child17; Clinical need11 17 20–28; Requirement to make a decision14; Prognosis16; Treatment8 28–34; Treatment decision29; Uncertainty35Awareness of future consequences20; Future health36 37, Hope38; Hope for future technological improvement20; Possibilities of the technology35; Improve life expectancy39; Survivorship40; Well-being28Altruism38; Coercion of physicians41; Communication 21 42; Decision-making29; Ethical conflicts17; Fear13 19; Human rights23 24; Information31; Requirement to share information28; Legal obligation43; Obligation13 19 21 38; Treatment resources33; Pressure11; Short-term outcome26Anxiety44; Attitude towards value of life35; Being positive35; Experience maturity35; Hope for the future37; Purpose of role as physician19; Responsibility23 26 35 45; Values17; Wishes of parents or staff46
Rejecting technology initiationClinical decision11; Clinical need8 11 13 21 28 45; Clinical judgement12 47; End-of-life care48; Following guidelines49; Guidelines17; Intensive treatment48; Judgement of futility14; Prognosis16 21 24 42; Prognostication 22; Requirement to make a decision14; Treatment8 27 29 34; Treatment decision26Quality of life 50; Unconsciousness of patient43; Well-being 28Communication15 24 42 51; Corporate policy49; Decision-making30; Disputes and obstacles to good care44; Duty12 52; Ethics12 29 Fear43; Interpretation of policy49; Information provision26 39; Legal influence47; Medical principle24; Moral dilemmas21; Obligation to relieve suffering19; Obligation53; Purpose of role19; Responsibility23 24 28 35 47 52; Widespread belief52Being familiar with patient or ward13; Compassion19; Cultural influences49; Distress44; Emotions35; Experience maturity15 35; Professional experience13; Professional objectivity 35; Religion13; Values 16 52
Unclear whether supporting or rejecting technology initiationAdvocating for child23; Best interests of child15; Care burden54; Care pathway50; Clinical need11 39; Decision-making8 14 31 34; Difficulty of prognosis55; End-of-life care30 48; Evaluation16 56; Evidence for prognosis18; Flexibility24; Guidelines17; Intensive treatment48; Judgement24; Prognosis 23 45 46 56; Prognostication22; Time pressure to act15; Treatment8 28 29 32–34 48; Treatment decision8 26 32; Uncertainty35Longitudinal responsibility26
; Outcomes30 31 42 45; Social value7
; Socioeconomic differences48
; Survival54
; Well-being28
Beneficence55; Capacity and resources18 50; Communication24 34 35 37 43 51 55 57; Compromise56; Conflict 15; Contextual reasons16; Decision-making8 29 30 32 57 58; Dilemma16; Duty to act59; Duty to save life15; Ethical and philosophical meaning7; Ethical questions26; Family burden16; Fear11 19 35 59; Human rights23; Information 18 29–32 37 39 54 58; Justice55; Legal obligation53; Obligation13 19 21 53; Opportunity for discussion13; Overriding wishes of others 51; Parental decision-making8 32; Pressure35; Resource allocation16; Respect24; Role of physician21; Shared decision-making17; Sharing responsibility19; Sharing the decision27Apprehension19; Assumptions40; Attitudes to decisions8; Compassion59; Conviction as in belief 7; Experience28 35 45 56; Feelings35 39; Grief32; Impartiality15; Information60; Information provision26; Openness14; Parental satisfaction37; Personal feelings35; Professional objectivity35; Responsibility23 24 26 28 45 46 53 56 57 60 61; Risk/danger18 37; Survivorship19; Values16