Responding to Parental Requests for Potentially Nonbeneficial Treatment in Life-Threatening Situations: Clinical Report

Although consensus on medical treatment for critically ill children is ideally achieved through shared decision making, disagreements on the appropriate course of action can occur. This clinical report provides practical guidance for pediatricians and other physicians in navigating and resolving disputes when parents (or other appropriate surrogate decision makers for children) request interventions that are not medically recommended and are determined to be “potentially nonbeneficial.” Although this can occur over a range of medical contexts, this statement focuses on life-threatening situations. This statement provides ethical background in a historical context, offers a basic framework for approaching disagreements about provision and continuation of life-sustaining interventions, and offers a stepwise approach to preventing intractable disputes. This process includes working to form a goal-concordant treatment plan and systematically responding to parental requests for potentially nonbeneficial treatment by way of diligent information gathering, mobilization of institutional resources, and providing families with options for transfer and appeal. This clinical report is supported by an accompanying technical report of the same title.