Best-interests decisions and treatment limitation — OSCE

OSCE station: leading a goals-of-care and treatment-limitation conversation with the family of a child with a progressive life-limiting condition, applying the best-interests balance and avoiding an isolated resuscitation decision.

osce communication and management station2 min readVerification in progress

Prompt

An 8-year-old with a progressive neurodegenerative disease is admitted with respiratory failure that will not reverse; the team agrees intensive care can no longer help, and the candidate must lead a goals-of-care conversation with the parents.

Objectives

Apply the best-interests balance of benefits against burdens to a treatment-limitation recommendation. [1]
Run an honest, structured goals-of-care conversation using a recognised framework. [10]
Avoid the error of an isolated resuscitation decision and build an overall limitation and comfort plan. [4]
Identify the escalation pathway to ethics and the courts for a genuine value dispute. [1] [12]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References5Show ledger

[1]Larcher V, Craig F, Bhogal K, Wilkinson D, Brierley J Making decisions to limit treatment in life-limiting and life-threatening conditions in children: a framework for practice. Arch Dis Child, 2015.PMID 25802250
[4]Truog RD, Campbell ML, Curtis JR, Haas CE, Luce JM, Rubenfeld GD Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College of Critical Care Medicine. Crit Care Med, 2008.PMID 18431285
[9]Himelstein BP Palliative care for infants, children, adolescents, and their families. J Palliat Med, 2006.PMID 16430356
[10]Morrison W, Clark JD, Lewis-Newby M, et al. Titrating Clinician Directiveness in Serious Pediatric Illness. Pediatrics, 2018.PMID 30385625
[12]Freckelton I, McGregor S Refusal of potentially life-saving treatment for minors: The emerging international consensus by courts. J Law Med, 2016.PMID 30136557

Best-interests decisions and treatment limitation — OSCE

osce communication and management station2 min readVerification in progress

Objectives

Apply the best-interests balance of benefits against burdens to a treatment-limitation recommendation. [1]

Run an honest, structured goals-of-care conversation using a recognised framework. [10]

Avoid the error of an isolated resuscitation decision and build an overall limitation and comfort plan. [4]

Identify the escalation pathway to ethics and the courts for a genuine value dispute. [1] [12]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References5Show ledger

[1]Larcher V, Craig F, Bhogal K, Wilkinson D, Brierley J Making decisions to limit treatment in life-limiting and life-threatening conditions in children: a framework for practice. Arch Dis Child, 2015.PMID 25802250
[4]Truog RD, Campbell ML, Curtis JR, Haas CE, Luce JM, Rubenfeld GD Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College of Critical Care Medicine. Crit Care Med, 2008.PMID 18431285
[9]Himelstein BP Palliative care for infants, children, adolescents, and their families. J Palliat Med, 2006.PMID 16430356
[10]Morrison W, Clark JD, Lewis-Newby M, et al. Titrating Clinician Directiveness in Serious Pediatric Illness. Pediatrics, 2018.PMID 30385625
[12]Freckelton I, McGregor S Refusal of potentially life-saving treatment for minors: The emerging international consensus by courts. J Law Med, 2016.PMID 30136557