title: Working with children in end-of-life decision making.
abstract: Traditionally, physicians and parents made decisions about children's health care based on western practices. More recently, with legal and ethical development of informed consent and recognition for decision making, children are becoming active participants in their care. The extent to which this is happening is however blurred by lack of clarity about what children - of diverse levels of cognitive development - are capable of understanding. Moreover, when there are multiple surrogate decision makers, parental and professional conflict can arise concerning children's 'best interest'. Giving children a voice and offering choice promotes their dignity and quality of life. Nevertheless, it also presents with many challenges. Case studies using pseudonyms and changed situational identities are used in this article to illuminate the complexity of ethical challenges facing nurses in end-of-life care with children and families.
authors.affiliation: School of Nursing, St Francis Xavier University, Antigonish, NS, Canada. jrogers@stfx.ca
authors.forename: Joanne
authors.initials: J
authors.lastname: Whitty-Rogers
authors.forename: Marion
authors.initials: M
authors.lastname: Alex
authors.forename: Cathy
authors.initials: C
authors.lastname: MacDonald
authors.forename: Donna
authors.initials: D
authors.lastname: Pierrynowski Gallant
authors.forename: Wendy
authors.initials: W
authors.lastname: Austin
mesh_terms: D002648:Child; D002651:Child Advocacy; D003657:Decision Making; D004993:Ethics, Nursing; D006801:Humans; D010290:Parents / Q000523:psychology; D010358:Patient Participation; D026684:Personal Autonomy; D013727:Terminal Care; D016312:Treatment Refusal