Responding to Parental Requests for Potentially Nonbeneficial Treatment in Life-Threatening Situations: Clinical...

Area of Science:

• Pediatric critical care ethics
• Medical decision-making for children
• Bioethics and healthcare policy

Background:

• Shared decision-making is ideal for pediatric critical care, but disagreements can arise.
• Disputes often involve parental requests for potentially nonbeneficial interventions in life-threatening situations.

Purpose of the Study:

• To provide practical guidance for pediatricians on resolving disputes over potentially nonbeneficial treatments.
• To offer a framework for ethical decision-making regarding life-sustaining interventions for critically ill children.
• To outline a stepwise approach to prevent and manage intractable treatment disagreements.

Main Methods:

• Review of ethical background and historical context of medical decision-making.
• Development of a framework for approaching disagreements on life-sustaining treatments.
• Proposal of a stepwise approach including goal-concordant planning, information gathering, and institutional resource mobilization.

Main Results:

• A structured approach to managing parental requests for potentially nonbeneficial treatments is presented.
• Emphasis on diligent information gathering and mobilizing institutional support for families.
• Options for transfer and appeal are provided to families facing intractable disputes.

Conclusions:

• Physicians can effectively navigate and resolve disputes concerning potentially nonbeneficial treatments for critically ill children.
• A systematic approach fosters goal-concordant care and respects surrogate decision-makers' rights while prioritizing the child's best interests.
• This guidance supports ethical practice in pediatric critical care, aiming to prevent intractable conflicts.