Physician Authority, Family Choice, and the Best Interest of the Child

Area of Science:

• Pediatric Ethics
• Bioethics
• Decision Theory

Background:

• Physician-family disagreements are common in pediatric end-of-life care.
• Key ethical dilemmas involve when families can demand or refuse life-sustaining treatment (LST) for newborns.

Purpose of the Study:

• To analyze physician-family disagreements regarding LST for imperiled newborns using decision theory.
• To propose ethical guidelines for LST decisions, balancing potential life with patient suffering.

Main Methods:

• Application of decision theory principles to ethical dilemmas in pediatric care.
• Analysis of family decision-making strategies (maximax, minimax) in the context of child welfare.

Main Results:

• Family choices, when aligned with the child's best interest, should not be constrained.
• Both maximax and minimax decision strategies can serve the child's best interest.
• A proposed guideline allows families to demand LST if a welcome life is possible and refuse if suffering is excessive.

Conclusions:

• Decision theory provides a framework for resolving LST disputes in pediatrics.
• Guidelines should empower families to prioritize a life worth welcoming and avoid unbearable suffering for the child.