Parental involvement in treatment decisions regarding their critically ill child: a comparative study of France and Quebec.
OBJECTIVE
To examine whether physicians or parents assume responsibility for treatment decisions for critically ill children and how this relates to subsequent parental experience. A significant controversy has emerged regarding the role of parents, relative to physicians, in relation to treatment decisions for critically ill children. Anglo-American settings have adopted decision-making models where parents are regarded as responsible for such life-support decisions, while in France physicians are commonly considered the decision makers.


METHODS
Grounded theory qualitative methodology.


METHODS
Four pediatric intensive care units (two in France and two in Quebec, Canada).


METHODS
Thirty-one parents of critically ill children; nine physicians and 13 nurses who cared for their children.


METHODS
None.


RESULTS
Semistructured interviews were conducted. In France, physicians were predominantly the decision makers for treatment decisions. In Quebec, decisional authority practices were more varied; parents were the most common decision maker, but sometimes it was physicians, while for some decisional responsibility depended on the type of decision to be made. French parents appeared more satisfied with their communication and relationship experiences than Quebec parents. French parents referred primarily to the importance of the quality of communication rather than decisional authority. There was no relationship between parents' actual responsibility for decisions and their subsequent guilt experience.


CONCLUSIONS
It was remarkable that a certain degree of medical paternalism was unavoidable, regardless of the legal and ethical norms that were in place. This may not necessarily harm parents' moral experiences. Further research is required to examine parental decisional experience in other pediatric settings.
Carnevale
Franco A
FA
Montreal Children's Hospital, Montreal, Canada. franco.carnevale@mcgill.ca
Canoui
Pierre
P
Cremer
Robin
R
Farrell
Catherine
C
Doussau
Amélie
A
Seguin
Marie-Josée
MJ
Hubert
Philippe
P
Leclerc
Francis
F
Lacroix
Jacques
J
D002675:Child, Preschool; D003142:Communication; D003256:Community Participation / Q000523:psychology*; D003258:Consumer Behavior; D016638:Critical Illness / Q000628:therapy*; D003466:Cultural Characteristics; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration; D008297:Male; D024802:Nurse's Role / Q000523:psychology*; D010290:Parents / Q000523:psychology*; D026706:Paternalism; D010819:Physician's Role / Q000523:psychology*; D011368:Professional-Family Relations; D036301:Qualitative Research; D011792:Quebec