Mirjam A de Vos1, Antje A Seeber2, Sjef K M Gevers3, Albert P Bos4, Ferry Gevers5, Dick L Willems1. 1. Section of Medical Ethics, Division of Public Health and Epidemiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 2. Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 3. Department of Health Law, Division of Public Health & Epidemiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 4. Department of Paediatric Intensive Care, Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 5. Egmond, The Netherlands.
Abstract
BACKGROUND: In the ethical and clinical literature, cases of parents who want treatment for their child to be withdrawn against the views of the medical team have not received much attention. Yet resolution of such conflicts demands much effort of both the medical team and parents. OBJECTIVE: To discuss who can best protect a child's interests, which often becomes a central issue, putting considerable pressure on mutual trust and partnership. METHODS: We describe the case of a 3-year-old boy with acquired brain damage due to autoimmune-mediated encephalitis whose parents wanted to stop treatment. By comparing this case with relevant literature, we systematically explored the pros and cons of sharing end-of-life decisions with parents in cases where treatment is considered futile by parents and not (yet) by physicians. CONCLUSIONS: Sharing end-of-life decisions with parents is a more important duty for physicians than protecting parents from guilt or doubt. Moreover, a request from parents on behalf of their child to discontinue treatment is, and should be, hard to over-rule in cases with significant prognostic uncertainty and/or in cases with divergent opinions within the medical team. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BACKGROUND: In the ethical and clinical literature, cases of parents who want treatment for their child to be withdrawn against the views of the medical team have not received much attention. Yet resolution of such conflicts demands much effort of both the medical team and parents. OBJECTIVE: To discuss who can best protect a child's interests, which often becomes a central issue, putting considerable pressure on mutual trust and partnership. METHODS: We describe the case of a 3-year-old boy with acquired brain damage due to autoimmune-mediated encephalitis whose parents wanted to stop treatment. By comparing this case with relevant literature, we systematically explored the pros and cons of sharing end-of-life decisions with parents in cases where treatment is considered futile by parents and not (yet) by physicians. CONCLUSIONS: Sharing end-of-life decisions with parents is a more important duty for physicians than protecting parents from guilt or doubt. Moreover, a request from parents on behalf of their child to discontinue treatment is, and should be, hard to over-rule in cases with significant prognostic uncertainty and/or in cases with divergent opinions within the medical team. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Entities:
Keywords:
Allowing Minors to Die; End of Life Care; Family; Minors/Parental Consent; Right to Refuse Treatment
Authors: Claire A Richards; Helene Starks; M Rebecca O'Connor; Erica Bourget; Taryn Lindhorst; Ross Hays; Ardith Z Doorenbos Journal: Am J Hosp Palliat Care Date: 2017-11-27 Impact factor: 2.500
Authors: Claire A Richards; Helene Starks; M Rebecca O'Connor; Erica Bourget; Ross M Hays; Ardith Z Doorenbos Journal: Am J Hosp Palliat Care Date: 2017-10-08 Impact factor: 2.090
Authors: A Aranka Akkermans; J M W J Joyce Lamerichs; M J Marcus Schultz; T G V Thomas Cherpanath; J B M Job van Woensel; M Marc van Heerde; A H L C Anton van Kaam; M D Moniek van de Loo; A M Anne Stiggelbout; E M A Ellen Smets; M A Mirjam de Vos Journal: Palliat Med Date: 2021-06-28 Impact factor: 4.762