A practical and ethical toolkit for last‐minute refusal of anesthetic in children

Massie, John; Skinner, Adam; McKenzie, Ian; Gillam, Lynn

doi:10.1111/pan.14201

Cited by 9 publications

(5 citation statements)

References 19 publications

(37 reference statements)

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“…The aim is to reduce pre-operative anxiety, which can increase resistance and also correlates with “high postoperative pain, increased analgesic and anaesthetic consumption, and prolonged hospital stay” [ 31 ]. The case of a resisting 12-year-old who was deceived into taking ketamine was therefore approved by an ethicist [ 32 ]. Sedation can be highly effective.…”

Section: Resultsmentioning

confidence: 99%

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The involvement and autonomy of young children undergoing elective paediatric cardiac surgery: a qualitative study

Alderson

Cohen

Davies

et al. 2022

J Cardiothorac Surg

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Background Standards generally reported in the literature about informing children and respecting their consent or refusal before elective heart surgery may differ from actual practice. This research aims to summarize the main themes in the literature about paediatric anaesthesia and compare these with research findings on how health professionals counsel young children before elective heart surgery, respect their consent or refusal, and maintain patient-centred care. Methods This qualitative research involved: literature reviews about children’s consent to surgery and major interventions; observations of wards, clinics and medical meetings in two paediatric cardiology departments, October 2019 to February 2020; audio-recorded semi-structured interviews with 45 hospital staff, including 5 anaesthetists, and related experts, November 2019 to April 2021; interviews with 16 families, with children aged 6- to 15-years and their parents shortly after elective heart surgery, and some months later (reported in other papers); thematic data analysis; and research reports on how different professions contribute to children’s informed decisions for heart surgery. Results The medical, ethics and English legal literature tend to assume legal minors cannot refuse major recommended treatment, and cannot consent until they are 12 years or older. Little is said about informing pre-competent children. If children resist, some anaesthetists rely on sedation and distraction, and avoid much informed discussion, aiming to reduce peri-operative anxiety. However, interviewees reported informing young children, and respecting their consent or refusal before elective surgery. They may delay elective surgery and provide further information and support, aiming to reduce fear and promote trust. Six years of age was commonly cited as the threshold for respecting consent to heart transplantation. Conclusion Differing views about younger children’s competence, anxiety and best interests support different reactions to children’s consent and refusal before elective heart surgery. This paper reports the zero-restraint policy followed for over a decade in at least one leading surgery centre. The related law and literature need to be updated, to take more account of evidence of actual practice.

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Section: Resultsmentioning

confidence: 99%

“…Yet pre-meds and distraction are used, not as in the first approach to replace supportive discussions, but to supplement them. And the aim is not to deceive children, as in the ketamine example [ 32 ], but to help them to relax and smile with their knowing agreement and cooperation.…”

Section: Resultsmentioning

confidence: 99%

The involvement and autonomy of young children undergoing elective paediatric cardiac surgery: a qualitative study

Alderson

Cohen

Davies

et al. 2022

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…Young patients may either be respected or else protected with enforced treatment if needed. Anaesthetists may either inform or distract young patients ( Litman, 2011 ; Massie et al, 2021 ). There are cost-effective efficient quick interventions or slow inefficient ones ( Munteanu and Jordan, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Children’s understanding and consent to heart surgery: Multidisciplinary teamwork and moral experiences

Alderson

Bellsham‐Revell

Dedieu

et al. 2022

J Child Health Care

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Mainstream law and ethics literature on consent to children’s surgery contrasts with moral experiences of children and adults observed in two heart surgery centres. Research interviews were conducted with 45 practitioners and related experts, and with 16 families of children aged 6 to 15, admitted for non-urgent surgery, as well as an online survey. Thematic data analysis was informed by critical realism and childhood studies. Impersonal adult-centric mainstream literature assumes young children cannot consent. It is based on dichotomies: adult/child, competent/incompetent, respect or protect children, inform or distract them, use time swiftly or flexibly, verbal/non-verbal communication, respect or control children and reason/emotion. Through their moral experiences, adults and children resolve these seeming dichotomies. Through understanding young children’s reasoning and emotions about complex distressing decisions related to heart surgery, adults share knowledge, control, trust and respect with them. They see children’s consent or refusal before non-urgent surgery as a shared personal moral experience within the child’s life course, beyond mere legal compliance. Adults help children to understand and ‘want’ the surgery that offers things they value: better health or to ‘be more like their friends’. If children are not convinced, sometimes surgery is postponed or occasionally cancelled.

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“…We would like to thank Massie et al 1 for highlighting the challenging ethical issue of refusal of anesthesia.…”

Section: When Children Refuse Their Anesthetic-restrain Deceive or Postpone?mentioning

confidence: 99%

When children refuse their anesthetic—restrain, deceive, or postpone?

Wellesley

Sogbodjor

Martin

2021

Pediatric Anesthesia

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A practical and ethical toolkit for last‐minute refusal of anesthetic in children

Cited by 9 publications

References 19 publications

The involvement and autonomy of young children undergoing elective paediatric cardiac surgery: a qualitative study

The involvement and autonomy of young children undergoing elective paediatric cardiac surgery: a qualitative study

Children’s understanding and consent to heart surgery: Multidisciplinary teamwork and moral experiences

When children refuse their anesthetic—restrain, deceive, or postpone?

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