Is There Ever a Role for the Unilateral Do Not Attempt Resuscitation Order in Pediatric Care?

Abstract

Care for children as they near the end of life is difficult and very complex. More difficult still are the decisions regarding what interventions are and are not indicated during these trying times. Occasionally, families of children who are nearing the end of life disagree with the assessment of the medical team regarding these interventions. In rare cases, the medical team can be moved to enact a do not attempt resuscitation order against the wishes of the patient's parents. This article presents one such illustrative case and discusses the ethical issues relevant to such challenging clinical scenarios. The authors posit that such a unilateral do not attempt resuscitation order is only appropriate in very limited circumstances in pediatric care. Instead, focus should be placed on open discussion between parents and members of the clinical team, shared decision making, and maintenance of the clinician-parent relationship while simultaneously supporting members of the clinical team who express discomfort with parental decisions. The authors propose an alternative framework for approaching such a conflict based on clinician-parent collaboration and open communication.

Integration of Pediatric Palliative Care Into Cardiac Intensive Care: A Champion-Based Model

“…Prognostic uncertainty, divergent views on treatment goals, and a lack of consensus on what constitutes a good outcome create ethical dilemmas and may contribute to conflict with families and between interdisciplinary team members. Clinicians are increasingly faced with providing treatment that is at odds with their moral compass, 32,34,[48][49][50][51][52] highlighting the importance of highquality, value-based communication and development of trusting relationships between families and medical team members to provide goal-concordant care and mitigate moral distress. 38,39,44,[53][54][55][56] Traditionally, the cure-oriented CICU culture has resulted in delayed or absent involvement of subspecialty PPC.…”

Tell Parents the Truth, but Tell It Slant

“…If no such cause is found, the resuscitation leader can stop resuscitative measures following an individually-defined appropriate duration." 5 There is an alternative to these 3 bad choices, but that alternative requires a little imagination and a little more tolerance for ambiguity than is currently fashionable. Such ambiguity is endorsed and described by writers who focus their work on the complex moral psychology of tragic choices.…”

Limitación del Soporte Vital en la Unidad de Cuidados Intensivos Pediátricos: Una Orientación Bioética

“…Lo anterior, no niega la existencia de futilidad, pero evita su abuso, abocándose a la verdadera futilidad como: las situaciones menos frecuentes en donde la intervención o continuidad de la atención médica no de expectativa de beneficio fisiológico para el paciente pediátrico (Bosslet et al 2015;Fundora et al 2020;Kon et al 2016), recomendando un consenso del mismo que surja de la comunicación y planificación de cuidado compartido entre los profesionales de la salud y representantes legales del niño (Bosslet et al 2015;Marron, Jones, y Wolfe 2018;Miller-Smith 2018).…”