Navigating Parental Requests for Nonbeneficial Medical Treatment: New AAP Guidance
HealthDay News — The American Academy of Pediatrics (AAP) has issued new clinical and technical reports offering guidance on how to navigate and resolve disputes when parents request medical treatments deemed potentially nonbeneficial by physicians. The reports, published online March 23 in Pediatrics, focus on situations where interventions are not medically recommended, particularly in life-threatening cases.
The guidance, developed by St. Jude Children’s Research Hospital physician Deena Levine, MD, and colleagues, aims to provide a framework for pediatricians and other physicians facing these challenging ethical dilemmas.
Ethical Considerations and Goal-Concordant Planning
According to the AAP reports, it is ethically permissible to forgo interventions considered physiologically futile or illegal, regardless of parental wishes. Physicians have a moral obligation to refrain from offering such treatments. A key recommendation is formulating a treatment plan that aligns with the patient’s or parent’s goals. This process, the reports emphasize, is essential for patient- and family-centered care and can prevent intractable conflict.
Resolving Disputes and Seeking Second Opinions
When parents continue to request treatment that the medical team believes is nonbeneficial, the guidance suggests gathering additional information and involving relevant parties. A clear resolution process should be established, beginning with obtaining a second opinion to clarify misunderstandings and foster common ground between parents and physicians. Consideration should similarly be given to transferring care to another institution if a resolution cannot be reached.
Balancing Parental Autonomy and Patient Well-being
The reports acknowledge the emotional burden on families facing difficult medical decisions. In situations where a systematic approach fails to resolve disagreements, transfer is not feasible, and the requested therapy has uncertain or low-level potential benefit without significant risk of harm, the AAP suggests it may be reasonable to continue providing ongoing life-sustaining medical treatment, considering the emotional toll of unilaterally withholding or withdrawing interventions.
Transparency and Disclosure
One author disclosed ties to Chiesi USA.
Abstract/Full Text – Clinical Report
Abstract/Full Text – Technical Report
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