title: No child is an island: ethical considerations in end-of-life care for children and their families.
abstract: Ethical challenges are commonly encountered when caring for children with life-threatening conditions.
  
  
  
  Controversial end-of-life issues, such as physician-assisted death and medical futility, may also arise in children. The approach to these issues in children may be guided by the 'adult' medical literature; the age of the patient should not be a relevant factor in determining the morality of these acts. As such, the focus of this review is on ethical issues unique to children and adolescents by nature of their dependence on their parents. Appreciation that child well-being is best promoted when care aligns with parental beliefs, values and culture has given rise to the practice of family-centred care, which we prefer to call 'family-partnered' care. Occasionally, a family-partnered approach may challenge fundamental paediatric ethical principles, including best interests, developing autonomy, and the importance of honesty and truth-telling.
  
  
  
  This article explores the challenges that may arise when there is disagreement between the child, the parents, and the healthcare providers about care at the end-of-life and provides suggestions to clinicians about how to help resolve these conflicts.
authors.affiliation: aPaediatric Advanced Care Team, Hospital for Sick Children bEmily's House Children's Hospice cDepartments of Paediatrics and Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada dPediatric Advanced Care Team eDivision of Pediatric Critical Care, The Children's Hospital of Philadelphia fDepartment of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Rapoport
authors.forename: Wynne
authors.initials: W
authors.lastname: Morrison
mesh_terms: D000367:Age Factors; D003657:Decision Making; D005190:Family / Q000523:psychology; D006801:Humans; D018447:Medical Futility / Q000941:ethics; D010290:Parents / Q000523:psychology*; D010819:Physician's Role; D017236:Suicide, Assisted / Q000941:ethics; D013727:Terminal Care / Q000941:ethics*; D014342:Truth Disclosure