Reactions of pediatricians to refusals of medical treatment for minors.
OBJECTIVE
Treatment refusals in pediatrics must balance parental decision-making authority and best interest. General pediatricians and subspecialists were surveyed to understand the factors that influence their responses to refusals including (1) prognosis, (2) concordance of parent-minor decision, and (3) minor autonomy.


METHODS
Of 1,120 eligible pediatricians, 421 (37.6%) randomly selected from the American Academy of Pediatrics Web-based Directory completed a survey about their reactions to refusals of treatment by parents, minors, or both in cancer scenarios with a 5-year expected overall survival of 80% or 15% for both an 11-year-old and a 16-year-old minor. Statistical analyses compared pediatrician willingness to respect a refusal and the relative importance of various factors to explain physician reasoning.


RESULTS
Pediatricians were less likely to respect refusals when prognosis was good. Pediatricians were most likely to respect a refusal when prognosis was poor and when parent and minor concurred in their decision (93%, n = 360/385 for the 16-year-old vs. 89%, n = 345/386 for the 11-year-old, p < .05). When parent-minor dyad disagreed, pediatricians were more likely to accept a refusal by a 16-year-old minor as compared with an 11-year-old (28%, n = 111/393 vs. 4%, n = 18/405 in good prognosis, p < .001; and 65%, n = 251/384 vs. 20%, n = 79/389 in poor prognosis, p < .05).


CONCLUSIONS
Pediatricians' decisions whether to respect treatment refusals for minor patients are multifactorial. When prognosis is good, best interest dominates. When prognosis is poor, parental authority is more important in younger minors, and minor autonomy is more important in older minors.
Talati
Erin D
ED
Department of Pediatrics, University of Chicago, Chicago, Illinois 60637, USA.
Lang
Colleen Walsh
CW
Ross
Lainie Friedman
LF
D000293:Adolescent; D000367:Age Factors; D001291:Attitude of Health Personnel; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D010290:Parents; D010372:Pediatrics; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D011379:Prognosis; D016312:Treatment Refusal; D014481:United States