Abstract
In this chapter, we consider how a commitment to acting in a child’s interests can be brought to bear on three specific ethical quandaries that face those caring for children at the end of life, and how such a commitment might seem to cohere or be in tension with other principles such as autonomy and justice. We examine the status of ‘do not resuscitate’ orders in children and argue that they cannot exist in children in the same form as in adults. Since the standard of ethical permissibility is set by the interests of the child, rather than the preferences of parent or doctor, there is no single person with authority to agree an adult-style DNR. Looking at clinically-assisted feeding or hydration, we argue that withholding, withdrawing, commencing or continuing it each constitutes an intervention and needs to be carefully justified by considering its burdens and harms in the broadest sense reasonable. Finally, we consider ‘palliative sedation’ and suggest that, while there are circumstances under which sedation is an inevitable result of adequate symptom control, impaired consciousness does not of itself represent a way to control symptoms and should not be deliberately induced.
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Notes
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Progressive muscle weakness.
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As adults in their own right, parents have certain legal rights which might conflict with their duty to care for their child. For example, a parent is entitled to believe on religious grounds that, on balance, measles vaccination is likely to do her child more harm than good. That belief is, however, incorrect for most children, and if she acts on it she is harming the child and so is acting immorally. In the name of adult freedom the law offers some protection (albeit limited) to the right of parents to choose to harm their child. But even that legal permission does not alter the moral obligation on parents not to do so.
References
Beauchamp, T., and J. Childress. 2009. Principles of biomedical ethics. New York: Oxford University Press.
Bluebond-Langner, M., J.B. Belasco, and M. Demesquita Wander. 2010. I want to live, until i don’t want to live anymore: Involving children with life-threatening and life-shortening illnesses in decision-making about care and treatment. Nursing Clinics of North America 45: 329–343.
Bruera, E., D. Hui, S. Dalal, I. Torres-Vigil, J. Trumble, J. Roosth, S. Krauter, C. Strickland, K. Unger, J.L. Palmer, J. Allo, S. Frisbee-Hume, and K. Tarleton. 2013. Parenteral hydration in patients with advanced cancer: A multicenter, double-blind, placebo-controlled randomized trial. Journal of Clinical Oncology 31: 111–118.
Gillam, L. 2016. The Zone of parental discretion: An ethical tool for dealing with disagreement between parents and doctors about medical treatment for a child. Clinical Ethics 11: 1–8.
Good, P., R. Richard, W. Syrmis, S. Jenkins-Marsh, and J. Stephens. 2014. Medically assisted hydration for adult palliative care patients. Cochrane Database Syst Rev Cd006273.
Guggenheim, M. 2005. What’s wrong with children’s rights, Cambridge. Mass: And London, England, Harvard University Press (Kindle).
Hooper, S., C. P. Sabatino, and R. L. Sudore. 2020. Improving medical-legal advance care planning. J Pain Symptom Manage.
Meert, K.L., S. Eggly, M. Pollack, K.J. Anand, J. Zimmerman, J. Carcillo, C.J. Newth, J.M. Dean, D.F. Willson, and C. Nicholson. 2008. Parents’ perspectives on physician-parent communication near the time of a child’s death in the pediatric intensive care unit. Pediatr Crit Care Med 9: 2–7.
Siriphuwanun, V., Y. Punjasawadwong, W. Lapisatepun, S. Charuluxananan, K. Uerpairojkit, and J. Patumanond. 2014. The initial success rate of cardiopulmonary resuscitation and its associated factors in patients with cardiac arrest within 24 hours after anesthesia for an emergency surgery. Risk Manag Healthc Policy 7: 65–76.
Steinberg, L. 2010. A dual systems model of adolescent risk-taking. Developmental Psychobiology 52: 216–224.
United Nations General Assembly 1989. Convention on the rights of the child: Adopted and opened for signature, ratification and accession by general assembly resolution 44/25. Geneva.
Winter, S.M. 2000. Terminal nutrition: Framing the debate for the withdrawal of nutritional support in terminally ill patients. American Journal of Medicine 109: 723–726.
Further Reading
Beauchamp, Thomas and Childress, James. 2009. Principles of Biomedical Ethics 6 edn. New York: Oxford University Press.
Wilkinson, Dominic. 2013. 'Best interest and the Carmentis machine', Death or disability ?: the 'Carmentis machine' and decision-making for critically ill children. Oxford: Oxford University Press.
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Hain, R., Craig, F. (2022). End of Life: Resuscitation, Fluids and Feeding, and ‘Palliative Sedation’. In: Nortjé, N., Bester, J.C. (eds) Pediatric Ethics: Theory and Practice . The International Library of Bioethics, vol 89. Springer, Cham. https://doi.org/10.1007/978-3-030-86182-7_15
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