Both dying children and their families are treated with disrespect when the presumption of consent to cardiopulmonary resuscitation (CPR) applies to all hospitalized children, regardless of prognosis and the likely efficacy of CPR. This “opt-out” approach to CPR fails to appreciate the nuances of the special parent–child relationship and the moral and emotional complexity of enlisting parents in decisions to withhold CPR from their children. The therapeutic goal of CPR is not merely to resume spontaneous circulation, but rather it is to provide circulation to vital organs to allow for treatment of the underlying proximal and distal etiologies of cardiopulmonary arrest. When the treating providers agree that attempting CPR is highly unlikely to achieve the therapeutic goal or will merely prolong dying, we should not burden parents with the decision to forgo CPR. Rather, physicians should carry the primary professional and moral responsibility for the decision and use a model of informed assent from parents, allowing for respectful disagreement. As emphasized in the palliative care literature, we recommend a directive and collaborative goal-oriented approach to conversations about limiting resuscitation, in which physicians provide explicit recommendations that are in alignment with the goals and hopes of the family and emphasize the therapeutic indications for CPR. Through this approach, we hope to help parents understand that “doing everything” for their dying child means providing medical therapies that ameliorate suffering and foster the intimacy of the parent–child relationship in the final days of a child’s life, making the dying process more humane.
Skip Nav Destination
Article navigation
March 2013
Special Article|
March 01 2013
The Culture of Dysthanasia: Attempting CPR in Terminally Ill Children
Jonna D. Clark, MD;
aPediatric Critical Care Medicine, and
bTreuman Katz Center for Pediatric Bioethics, Department of Pediatrics, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, Washington; and
Address correspondence to Jonna D. Clark, MD, MA, Seattle Children’s Hospital, Critical Care Medicine M/S 8866, 4800 Sand Point Way NE, Seattle, WA 98105-0371. E-mail: jonna.clark@seattlechildrens.org
Search for other works by this author on:
Denise M. Dudzinski, PhD
cDepartment of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington
Address correspondence to Jonna D. Clark, MD, MA, Seattle Children’s Hospital, Critical Care Medicine M/S 8866, 4800 Sand Point Way NE, Seattle, WA 98105-0371. E-mail: jonna.clark@seattlechildrens.org
Search for other works by this author on:
Address correspondence to Jonna D. Clark, MD, MA, Seattle Children’s Hospital, Critical Care Medicine M/S 8866, 4800 Sand Point Way NE, Seattle, WA 98105-0371. E-mail: jonna.clark@seattlechildrens.org
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Pediatrics (2013) 131 (3): 572–580.
Article history
Accepted:
October 19 2012
Citation
Jonna D. Clark, Denise M. Dudzinski; The Culture of Dysthanasia: Attempting CPR in Terminally Ill Children. Pediatrics March 2013; 131 (3): 572–580. 10.1542/peds.2012-0393
Download citation file:
Comments