Paeds Cases · pain-palliative-and-end-of-life-care
Hold the goals-of-care conversation for withholding and withdrawing life-sustaining treatment — OSCE
OSCE communication station for withholding and withdrawing life-sustaining treatment: open the conversation, explore understanding, make a clear recommendation, address fear of abandonment, and agree a documented plan.
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Study tools
Target exams
MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
A six-month-old infant with severe hypoxic-ischaemic encephalopathy remains ventilator-dependent after a catastrophic out-of-hospital arrest. The intensive-care team judges that continued invasive support is not in the child's best interests; the parents ask that "everything be done".
Candidate brief
You have eight minutes to open a goals-of-care conversation with the family in this scenario. Explore their understanding, hopes and worries; explain the clinical recommendation in plain language; address fear of abandonment; and agree next steps including documentation and support. [1][2]
References4ShowHide
- [1]Larcher V et al. Making decisions to limit treatment in life-limiting and life-threatening conditions in children: a framework for practice. Arch Dis Child, 2015.PMID 25802250
- [2]Himelstein BP et al. Pediatric palliative care. N Engl J Med, 2004.PMID 15103002
- [3]Dworetz AR et al. Withholding or withdrawing life-sustaining treatment in extremely low gestational age neonates. Arch Dis Child Fetal Neonatal Ed, 2021.PMID 33082153
- [4]Gillam L et al. How Could Parents' Reasons Shift a Refusal of Treatment into the Zone of Parental Discretion?. Am J Bioeth, 2025.PMID 41108243