title: Challenges in reconciling best interest and parental exercise of autonomy in pediatric life-or-death situations.
abstract: OBJECTIVE
  To study attitudes regarding life-saving interventions.
  
  
  METHODS
  An Internet questionnaire describing 6 patients of different ages needing resuscitation was sent to members of the Norwegian Pediatric Association (n = 676): a 24-week gestational age infant, a term infant, a 2-month-old infant, a 7-year, a 50-year, and an 80-year-old individual. Neonates had similar or better described outcomes than older patients.
  
  
  RESULTS
  A total of 266 people responded (39.4%). The majority would resuscitate all the patients except the 80-year-old. The majority thought that resuscitation was in the best interest of the younger 5 patients, but fewer thought so for neonates (P < .05). Although the majority of the respondents thought that resuscitation was in the neonates' best interest (71% for 24-week-old and 75% for term infant), significantly more would accept comfort care at parental demand (62% for 24-week-old and 72% for term infant), unlike for other scenarios. Quality of life was used to justify decision making; 25% used the length of the life for neonates to motivate their answers. Patients were prioritized for resuscitation in the following order: 2-month-old infant, 7-year-old child with multiple disabilities, 50-year-old adult, the neonates, and lastly the 80-year-old individual.
  
  
  CONCLUSIONS
  There are challenges in reconciling best interest and parental exercise of autonomy in pediatric life-or-death situations. Neonates seem to be devalued.
authors.affiliation: Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Eirik M
authors.initials: EM
authors.lastname: Hagen
authors.forename: Øystein B
authors.initials: ØB
authors.lastname: Therkelsen
authors.forename: Reidun
authors.initials: R
authors.lastname: Førde
authors.forename: Olaf
authors.initials: O
authors.lastname: Aasland
authors.forename: Annie
authors.initials: A
authors.lastname: Janvier
authors.forename: Thor Willy Ruud
authors.initials: TW
authors.lastname: Hansen
mesh_terms: D000369:Aged, 80 and over; D001294:Attitude to Health; D002648:Child; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D026684:Personal Autonomy; D012151:Resuscitation; D011795:Surveys and Questionnaires