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

• Published in: The Journal of pediatrics 2012-07, Vol.161 (1), p.146-151
• Main Authors: Hagen, Eirik M., MD, Therkelsen, Øystein B., MD, Førde, Reidun, MD, PhD, Aasland, Olaf, MD, Janvier, Annie, MD, PhD, Hansen, Thor Willy Ruud, MD, PhD
• Format: Article
• Language: English
• Subjects: adults; Aged, 80 and over; Attitude to Health; attitudes and opinions; Biological and medical sciences; Child; children; decision making; exercise; General aspects; gestational age; Humans; Infant; Infant, Newborn; Internet; Medical sciences; Middle Aged; neonates; Parents - psychology; patients; Pediatrics; people; Personal Autonomy; quality of life; questionnaires; Resuscitation; Surveys and Questionnaires
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2012.01.017

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.