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The do-not-resuscitate order is a cornerstone of end-of-life medical care, signalling to doctors not to treat a near-death patient after a severe crisis. Your ill grandfather might have had one. But does your 13-year-old ill son have the right to one?

A group representing Canadian pediatricians thinks he may indeed have the right, along with the right to direct his own medical care or choose palliative care instead of an ongoing treatment, such as chemotherapy.

In a new position paper published today in the journal Paediatrics and Child Health, the Canadian Paediatric Society has stepped into ethically thorny territory by suggesting that some chronically or terminally ill children deserve the same rights as adults to choose the nature of their deaths.

"There's always a tension between protecting children as much as possible and also recognizing they also have views and values about themselves," says Ellen Tsai, the lead author of the paper and a pediatrician at Kingston General Hospital.

The new position paper expands on the group's current policy urging pediatricians to discuss medical treatments with minors, not just their parents.

For the terminally ill child, just as with terminally ill adults, there are options besides exhausting all treatments to the point at which the patient dies in hospital in the intensive care unit, Dr. Tsai says.

The aim of pediatricians, Dr. Tsai writes, should be "to add life to the child's years, not simply years to the child's life."

And some children are mature enough to process information on how to accomplish this goal, she says. Even very young children can understand some aspects of their care.

But both doctors and parents can be loath to discuss the possibility of death with each other, let alone with their children. Parents may want to preserve the innocence of the child and not burden them with upsetting facts.

Dr. Tsai, who has treated seriously ill teenagers who had very strong feelings about the type of treatment they wanted to receive, says she and her colleagues should feel compelled to kick-start the discussion.

"We assume people are afraid to talk about it. I think we're sometimes more afraid to talk about it than they are. Parents might be afraid to talk about it because we never mention it."

In the paper, Dr. Tsai also urges provinces to update the current patchwork of laws to address the issue in a consistent manner.

Some provincial laws allow teens to authorize an "advance directive," a document outlining the acceptable and unacceptable course of their end-of-life care, from the age of 16, even if it's below the age of consent in that province. Some allow for medical decision-making for patients as young as 14, but make no mention of advance directives. Still others merely have an age of consent in place, from 16 to 19, with presumably no health-care decision-making rights attached.

The issue is especially critical for children known legally as "mature minors," who may be mentally mature enough to make major decisions about their future. The wishes of these children, usually aged 12 to 16, are not legally binding and can be vetoed by parents.

Some children, regardless of age, will have no interest in speaking with a doctor privately, and will be comforted by their parents leading the way, says Christine Harrison, the director of bioethics at the Hospital for Sick Children in Toronto. But for those who do, "we're getting data now that to not include children in these discussions can be psychologically harmful to them," she says.

Dr. Harrison is addressing this very issue in a talk next week, using a theoretical case study of a 15-year-old girl suffering from cystic fibrosis. The girl has written a DNR order. She goes into cardiac arrest. Her parents want the doctors to perform CPR. In Ontario, a DNR order is only legally binding if she is 16.

Dr. Harrison will ask her colleagues what they would do.

"It's a challenge because everyone gets protective of a child who is dying," Dr. Harrison says.