Paediatric end-of-life care and cardiopulmonary resuscitation

Area of Science:

• Pediatric Medicine
• Bioethics
• Healthcare Policy

Background:

• Paediatricians frequently care for children with life-limiting conditions.
• A revised policy on end-of-life care was issued by the College of Physicians and Surgeons of Ontario in March 2023.

Purpose of the Study:

• To explore the implications of the new policy for Ontario paediatricians.
• To highlight principles for end-of-life care decision-making applicable beyond Ontario.
• To discuss the impact on clinicians' moral distress.

Main Methods:

• Policy analysis and commentary.
• Discussion of ethical considerations in paediatric end-of-life care.
• Exploration of clinical decision-making processes.

Main Results:

• The policy necessitates careful consideration of resuscitative measures.
• It underscores the need for early and ongoing patient and family engagement.
• It stresses the importance of preventing bias in decision-making, particularly regarding protected characteristics.

Conclusions:

• Effective end-of-life care requires longitudinal engagement and ethical decision-making.
• Clinicians must ensure decisions about Cardiopulmonary Resuscitation (CPR) are free from bias related to a child's race, age, or disability.
• The policy provides a framework to support paediatricians in complex end-of-life care scenarios.