Challenges in Reconciling Best Interest and Parental Exercise of Autonomy in Pediatric Life-or-Death Situations

Hagen EM, Therkelsen OB, Førde R, Aasland O, Janvier A, Hansen TW. J Pediatr. 2012; 161 (1): 146-51. Epub 2012 Feb 23.

Article in English.

Abstract on Pubmed:

OBJECTIVE: To study attitudes regarding life-saving interventions. STUDY DESIGN: An Internet questionnaire describing 6 patients of different ages needing resuscitation was sent to members of the Norwegian Pediatric Association (n = 676): a 24-week gestational age infant, a term infant, a 2-month-old infant, a 7-year, a 50-year, and an 80-year-old individual. Neonates had similar or better described outcomes than older patients.

RESULTS: A total of 266 people responded (39.4%). The majority would resuscitate all the patients except the 80-year-old. The majority thought that resuscitation was in the best interest of the younger 5 patients, but fewer thought so for neonates (P < .05). Although the majority of the respondents thought that resuscitation was in the neonates' best interest (71% for 24-week-old and 75% for term infant), significantly more would accept comfort care at parental demand (62% for 24-week-old and 72% for term infant), unlike for other scenarios. Quality of life was used to justify decision making; 25% used the length of the life for neonates to motivate their answers. Patients were prioritized for resuscitation in the following order: 2-month-old infant, 7-year-old child with multiple disabilities, 50-year-old adult, the neonates, and lastly the 80-year-old individual.

CONCLUSION: There are challenges in reconciling best interest and parental exercise of autonomy in pediatric life-or-death situations. Neonates seem to be devalued.

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