Table 3.
Options for dealing with parental dissent regarding life-sustaining treatment.
| Favored option for dealing with parental dissent | Justificationsa |
|---|---|
| Override parental decisions |
Justification for overriding parental decisions when parents refuse indicated LST: Physicians’ medical expertise, duty to deliver care according to best evidence Protection of the child’s best interests Justification for overriding parental decisions when parents request non-indicated LST: Avoidance of harm to the child Other patients’ interests in case of limited resources Clear and reassuring legislation, refusal to act against own conscience |
| Comply with parental decisions |
Justification for complying with parental decisions when parents refuse indicated LST: Parents’ decision-making power, necessity of parental consent Uncertain clinical judgments, recommendations that may be rejected Parents’ better ability to assess the child’s presumed wishes Justification for complying with parental decisions when parents request non-indicated LST: Avoidance of doctor shopping and associated harm for the child Parents’ well-being Close relationship with parents, difficulties withstanding parents’ firm demands Subjectivity of medical decisions Court rulings expected to be in favor of parents, fear of legal consequences |
| Search consensus: give parents time, continue negotiations, and shared decision-making |
Justification for searching consensus with parents when parents refuse indicated LST: More time for parental coping Justification for searching consensus with parents when parents request non-indicated LST: More time for parental coping Importance for parents to see the disease progressing |
| Suggest change of physician |
Justification for change of physician when parents request non-indicated LST: Duty to offer all possibilities, broken trust Chance that a second physician confirms the decision |
LST: life-sustaining treatment.
a
Listed order of reasons does not reflect priority.