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• Is limiting parental authority the answer?
  Veronica Neefjes
  Published on: 12 June 2017

• Published on: 12 June 2017

  Is limiting parental authority the answer?

  • Veronica Neefjes, Consultant Paediatric Oncologist N/A

  The authors conclude here that when withdrawing treatment in PICU is considered parents' refusal
  to consent can cause additional suffering as clinicians tend to extend burdensome treatment beyond
  what they think is reasonable to allow parents time to reconsider. Moreover, both parents and
  clinicians try to avoid approaching the courts for a decision.
  On the basis of these findings the authors suggest that limiting parental authority by using the concept of parental assent instead of consent could lead to an expeditious resolution in cases of disagreement and should be the focus of further research.
  This suggestion is not supported by the parental quotes used in this article. Indeed, one of the parent's objection to a court decision stems from his opinion that the decisions regarding withdrawal of treatment should be the domain of the parents. Limiting parental authority might therefore lead to increased adversarial relationships between the treating team and parents especially when parental views are overruled.
  Some quotes in this article as well as other research show that parents at the end of their child's life need time to
  often extensively research alternative treatments 'because you just need to have looked and
  exhausted every avenue'. Rather than limiting parental authority, it may thus be better to start the
  discussion regarding end of life care, including withholding treatment earlier....

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  The authors conclude here that when withdrawing treatment in PICU is considered parents' refusal
  to consent can cause additional suffering as clinicians tend to extend burdensome treatment beyond
  what they think is reasonable to allow parents time to reconsider. Moreover, both parents and
  clinicians try to avoid approaching the courts for a decision.
  On the basis of these findings the authors suggest that limiting parental authority by using the concept of parental assent instead of consent could lead to an expeditious resolution in cases of disagreement and should be the focus of further research.
  This suggestion is not supported by the parental quotes used in this article. Indeed, one of the parent's objection to a court decision stems from his opinion that the decisions regarding withdrawal of treatment should be the domain of the parents. Limiting parental authority might therefore lead to increased adversarial relationships between the treating team and parents especially when parental views are overruled.
  Some quotes in this article as well as other research show that parents at the end of their child's life need time to
  often extensively research alternative treatments 'because you just need to have looked and
  exhausted every avenue'. Rather than limiting parental authority, it may thus be better to start the
  discussion regarding end of life care, including withholding treatment earlier.
  This would allow parents time to explore the presence or absence of other treatment options whilst
  their child is still relatively well. Given that the majority of children that die in PICU due to
  withholding treatment suffer from a chronic illness(1) and referral to palliative care services
  reduces the number of children dying in hospital(2), I would argue that earlier referral to paediatric palliative care services might well prevent the conundrum during PICU admissions described in this article.

  1. Burns JP, Sellers DE, Meyer EC, Lewis-Newby M, Truog RD. Epidemiology of death in the
  PICU at five U.S. teaching hospitals*. Crit Care Med. 2014 Sep;42(9):2101–8.
  2. Fraser LK, Miller M, Draper ES, McKinney PA, Parslow RC, on behalf of the Paediatric
  Intensive Care Audit Network. Place of death and palliative care following discharge from
  paediatric intensive care units. Arch Dis Child. 2011 Dec 1;96(12):1195–8.

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  Conflict of Interest:
  None declared.

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