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Ethical Issues Around Pediatric Death: Navigating Consent, Assent, and Disagreement Regarding Life-Sustaining Medical

Silvana Barone1, Yoram Unguru2

  • 1Division of General Pediatrics and Adolescent Medicine, The Johns Hopkins Hospital, Johns Hopkins University Berman Institute of Bioethics, 200 North Wolfe Street, Baltimore, MD 21287, USA.

Child and Adolescent Psychiatric Clinics of North America
|September 17, 2018
PubMed

Insights

Navigating medical treatment decisions for children with life-limiting illnesses is challenging. This article clarifies parental permission, assent, and emerging capacity to aid healthcare providers and families.

Area of Science:

  • Pediatric medicine
  • Bioethics
  • Medical decision-making

Background:

  • Decisions about experimental therapies and life-sustaining treatment for children with life-limiting illnesses cause distress and conflict.
  • Families and healthcare providers face significant challenges in these complex situations.

Purpose of the Study:

  • To review concepts of parental permission (consent), assent, and emerging capacity in pediatric medical decision-making.
  • To discuss decision-making capacity in adolescents, particularly in end-of-life contexts.
  • To provide strategies for minimizing conflict between children and families.

Main Methods:

  • Literature review of concepts related to consent, assent, and capacity in pediatric care.
  • Discussion of adolescent decision-making in emotionally charged end-of-life scenarios.
  • Identification of conflict resolution strategies.

Main Results:

  • Clarification of parental permission, assent, and emerging capacity in pediatric decision-making.
  • Exploration of adolescent capacity in serious illness contexts.
  • Presentation of practical strategies for managing disagreements.

Conclusions:

  • Understanding consent, assent, and capacity is crucial for ethical pediatric care.
  • Effective communication and conflict resolution strategies can support families and healthcare providers.
  • Adolescent autonomy should be respected within the bounds of their emerging capacity.

Keywords:
AdolescentsAssentConsentDeathDecision-makingLife-sustaining medical treatment

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