title: Ethical considerations in the management of analgesia in terminally ill pediatric patients.
abstract: Research has demonstrated the significant symptom burden present at the end of life of terminally ill children. Medicine has always viewed the relief of pain and suffering as a fundamental human right and a moral and ethical obligation. At the end of life, pain and dyspnea are symptoms commonly experienced by both adults and children. Opioids are the mainstay in treating the suffering associated with pain and dyspnea; however, there exist several barriers to the use of opioids. We describe a case in which parents prevent a young patient from receiving adequate pain management during the course of a terminal illness. We discuss the importance of recognizing the barriers to opioid use and the ethical ramifications of failing to find common ground with the family. We highlight parental responsibilities and limitations of parental authority in decision making for their child.
authors.affiliation: Division of Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. Electronic address: norbert.weidner@cchmc.org.
authors.forename: Norbert J
authors.initials: NJ
authors.lastname: Weidner
authors.affiliation: Children's Mercy Hospital, Kansas City, Missouri, USA.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Plantz
mesh_terms: D000698:Analgesia / Q000941:ethics* / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002648:Child; D003657:Decision Making; D005260:Female; D006801:Humans; D010146:Pain / Q000188:drug therapy; D010290:Parents / Q000523:psychology*; D011368:Professional-Family Relations; D013727:Terminal Care / Q000941:ethics* / Q000331:legislation & jurisprudence / Q000379:methods*; D019452:Terminally Ill; D016312:Treatment Refusal / Q000941:ethics* / Q000331:legislation & jurisprudence / Q000523:psychology; D014481:United States
chemical_list: D000701:Analgesics, Opioid
keywords: Right to pain relief; parental authority for decision making for a minor; parental refusal of treatment in a minor