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Cited by 51Palliative Care and End-of-Life IssuesEthics and Legal Issues in Pediatric HealthcarePalliative and Oncologic Care

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The Culture of Dysthanasia: Attempting CPR in Terminally Ill Children

Clark, Jonna D., Dudzinski, Denise M.·2013·Pediatrics
DOI 10.1542/peds.2012-0393
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Abstract

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.

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Metadata

Authors
Clark, J. D., & Dudzinski, D. M.
Affiliations
  • Seattle Children's Hospital (US)
  • University of Washington (US)
Corresponding author
Clark, Jonna D.
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
2013-03-01
Volume
131
Issue
3
Pages
572-580
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2012-0393
OpenAlex
W2149644506
Cited by
51
References
2
Citations by year
2026: 2 · 2025: 2 · 2024: 1 · 2023: 4 · 2022: 4 · 2021: 6 · 2020: 2 · 2019: 4 · 2018: 6 · 2017: 2 · 2016: 4 · 2015: 5 · 2014: 6 · 2013: 3
FWCI
6.14
Type
journal article
Language
en
Open access
closed
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Keywords
cardiopulmonary resuscitation, terminally ill children, pediatric end-of-life care, parental decision-making, informed consent, palliative care, parent-child relationship, physician responsibility
MeSH terms
Humans, Infant, Male, Parent-Child Relations, Physician's Role, Terminal Care, Resuscitation Orders, Cardiopulmonary Resuscitation, Terminally Ill

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