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

Although consensus on a medical treatment plan is ideally achieved through a process of shared decision making, disagreements about whether life-sustaining interventions should be initiated or continued can occur and are sometimes difficult to resolve. When parents (or other appropriate surrogate decision makers) desire treatments for their child that are not medically recommended, these “potentially nonbeneficial” interventions must be systematically considered in the context of contemporary ethical principles and relevant laws and regulations while keeping in mind the historical and cultural underpinnings that might be playing a role, the potential for racial bias and socioeconomic disparities, the role of spirituality and values in consideration of quality-of-life determinations and end-of-life care, and the nuance of probabilistic uncertainty. This technical report accompanies a clinical report of the same name and offers a stepwise approach for responding to parental requests for potentially nonbeneficial treatment to support pediatricians and other physicians in engaging and supporting patients, their families, and care teams in navigating these disagreements.