Challenges in reconciling best interest and parental exercise of autonomy in pediatric life-or-death situations

Abstract

Aim: To study attitudes of Norwegian pediatricians regarding ethical dilemmas related to acute, life-saving treatment. Methods: A questionnaire describing 6 currently incompetent patients who need resuscitation, was administered electronically to all members of the Norwegian Pediatric Association (NPA) (n = 676). Recipients were asked questions about ethical challenges regarding decision-making in acute life-or-death situations. Herein we focused on the four pediatric patients: a 24 week premature, a term infant, a 2 month old, and a 7 year old. The prognosis for the children was described in identical terms as far as survival and likelihood of sequelae. Results: There was a 39.4% response rate (n = 266). A greater proportion of the respondents stated that they would treat than assessed treatment to be in the patients best interest, respectively 88% (would treat) vs. 75% (best interest) for the premature, 86% vs. 71% for the term infant, 100% vs. 100% the 2-month-old,98% vs. 94% for and the 7 year old. For the two newborns 72% and 62% respectively would accept parental refusal. Conclusion: For Norwegian pediatricians, there is a discrepancy between their assessment of best interest and their willingness to treat and accept parental refusal of treatment. This suggests that there are significant ethical and legal challenges in pediatric medicine and biomedical ethics.