The goal of pediatric health care is to promote the best interests of the child, and, in most cases, this carries a presumption in favor of treatment that supports sustaining life. In some circumstances, though, the medical team, family and, when possible, the patient, weighing the balance of benefits and burdens of a range of treatment choices, may decide that continuing life-sustaining treatment is no longer in the child's best interests.
The American Academy of Pediatrics (AAP), in its first update on the topic since 1994, has issued a policy statement, "Guidance on Forgoing Life-Sustaining Medical Treatment," to be published in the September 2017 Pediatrics (published online Aug. 28).
The AAP recommends a shared decision-making process with families that incorporates thorough communication within the health care team. The AAP also supports sharing information with children about their condition, treatment choices and opportunities to participate in decisions that affect their care, all in ways that are appropriate to their age and level of understanding, as recommended by the National Hospice and Palliative Care Organization. The AAP supports continuing palliative measures intended to manage pain or suffering in all instances.
