Volume 31, Issue 8 pp. 834-838

SPECIAL INTEREST ARTICLE

A practical and ethical toolkit for last-minute refusal of anesthetic in children

John Massie,

Corresponding Author

John Massie

[email protected]

orcid.org/0000-0003-1008-0967

Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia

Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Victoria, Australia

Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia

Murdoch Childrens Research Institute, Melbourne, Victoria, Australia

Correspondence

John Massie, Department of Respiratory Medicine and Children’s Bioethics Centre, Royal Children’s Hospital, 50 Flemington Road., Parkville 3052, Vic., Australia.

Email: [email protected]

Search for more papers by this author

Adam Skinner,

Adam Skinner

Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia

Search for more papers by this author

Ian McKenzie,

Ian McKenzie

orcid.org/0000-0002-3021-8049

Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia

Search for more papers by this author

Lynn Gillam,

Lynn Gillam

Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Victoria, Australia

School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia

Search for more papers by this author

John Massie,

Corresponding Author

John Massie

[email protected]

orcid.org/0000-0003-1008-0967

Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia

Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Victoria, Australia

Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia

Murdoch Childrens Research Institute, Melbourne, Victoria, Australia

Correspondence

John Massie, Department of Respiratory Medicine and Children’s Bioethics Centre, Royal Children’s Hospital, 50 Flemington Road., Parkville 3052, Vic., Australia.

Email: [email protected]

Search for more papers by this author

Adam Skinner,

Adam Skinner

Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia

Search for more papers by this author

Ian McKenzie,

Ian McKenzie

orcid.org/0000-0002-3021-8049

Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia

Search for more papers by this author

Lynn Gillam,

Lynn Gillam

Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Victoria, Australia

School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia

Search for more papers by this author

First published: 04 May 2021

https://doi.org/10.1111/pan.14201

Citations: 7

Share a link

Email
Wechat
Bluesky

Abstract

Children's fear of a procedure, including the anesthetic, is a common issue that operating theatre staff face. This fear is generally mitigated by preesthetic preparation and information sharing. Last-minute refusal of a procedure creates unique difficulties for the anesthetist and proceduralist. Refusal for a procedure raises issues of whether the dissent is binding, and if not, how best to get the child to theatre without creating moral injury. In this case review of a young adolescent who refuses to go to the operating theatre, we explore practical and ethical options to resolve the situation. We discuss respect for persons (including assent and consent), best interests, truth-telling, harm minimization, and restraint. The importance of a postevent debrief is discussed. We also assess the value of a clinical ethics service with team members embedded in clinical teams.

Open Research

DATA AVAILABILITY STATEMENT

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

REFERENCES

1Dahlquist LM, Gil KM, Armstrong FD, DeLawyer DD, Greene P, Wuori D. Preparing children for medical examinations: the importance of previous medical experience. Health Psychol. 1986; 5(3): 249-259.
10.1037/0278-6133.5.3.249
CAS PubMed Web of Science® Google Scholar
2Jaaniste T, Hayes B, von Baeyer CL. Effects of preparatory information and distraction on children's cold-pressor pain outcomes: a randomized controlled trial. Behav Res Ther. 2007; 45(11): 2789-2799.
10.1016/j.brat.2007.07.005
PubMed Web of Science® Google Scholar
3Navin MC, Wasserman JA. Capacity for preferences and pediatric assent implications for pediatric practice. Hastings Cent Rep. 2019; 49(1): 43-51.
10.1002/hast.980
PubMed Web of Science® Google Scholar
4Katz AL, Webb SA. Informed consent in decision-making in pediatric practice. Pediatrics. 2016; 138(2):e20161485.
10.1542/peds.2016-1485
PubMed Web of Science® Google Scholar
5De Lourdes LM, Larcher V, Kurz R. Informed consent/assent in children. Statement of the Ethics Working Group of the Confederation of European Specialists in Paediatrics (CESP). Eur J Pediatr. 2003; 162(9): 629-633.
10.1007/s00431-003-1193-z
PubMed Web of Science® Google Scholar
6Kuther TL. Medical decision-making and minors: issues of consent and assent. Adolescence. 2003; 38(150): 343-358.
PubMed Web of Science® Google Scholar
7Kopelman LM. Using the best interests standard in treatment decisions for young children. In: G Miller, ed. Pediatric Bioethics. New York: Cambridge University Press; 2009.
10.1017/CBO9780511642388.004
Google Scholar
8West N, Christopher N, Stratton K, Görges M, Brown Z. Reducing preoperative anxiety with Child Life preparation prior to intravenous induction of anesthesia: a randomized controlled trial. Paediatr Anaesth. 2020; 30(2): 168-180.
10.1111/pan.13802
PubMed Web of Science® Google Scholar
9Perry JN, Hooper VD, Masiongale J. Reduction of preoperative anxiety in pediatric surgery patients using age-appropriate teaching interventions. J Perianesth Nurs. 2012; 27(2): 69-81.
10.1016/j.jopan.2012.01.003
PubMed Web of Science® Google Scholar
10Chow CH, Van Lieshout RJ, Schmidt LA, Dobson KG, Buckley N. Systematic review: audiovisual interventions for reducing preoperative anxiety in children undergoing elective surgery. J Pediatr Psychol. 2016; 41(2): 182-203.
10.1093/jpepsy/jsv094
PubMed Web of Science® Google Scholar
11Pike NA, Evangelista LS, Doering LV, Koniak-Griffin D, Lewis AB, Child JS. Clinical profile of the adolescent/adult Fontan survivor. Congenit Heart Dis. 2011; 6(1): 9-17.
10.1111/j.1747-0803.2010.00475.x
CAS PubMed Web of Science® Google Scholar
12Beauchamp TL, Childress JF. Principles of Biomedical Ethics, 6th ed. New York: Oxford University Press; 2009.
Google Scholar
13Diekema DS. Taking children seriously: what’s so important about assent? Am J Bioeth. 2003; 3(4): 25-26.
10.1162/152651603322614481
PubMed Web of Science® Google Scholar
14Coyne I, Gallagher P. Participation in communication and decision-making: children and young people's experiences in a hospital setting. J Clin Nurs. 2011; 20(15–16): 2334-2343.
10.1111/j.1365-2702.2010.03582.x
PubMed Web of Science® Google Scholar
15Coyne I, Kirwan L. Ascertaining children's wishes and feelings about hospital life. J Child Health Care. 2012; 16(3): 293-304.
10.1177/1367493512443905
PubMed Web of Science® Google Scholar
16Hudson N, Spriggs M, Gillam L. Telling the truth to young children: ETHICAL reasons for information disclosure in paediatrics. J Paediatr Child Health. 2019; 55(1): 13-17.
10.1111/jpc.14209
PubMed Web of Science® Google Scholar
17Alexander E, Murphy C, Crowe S. What parents think about physical restraint of their child to facilitate induction of anesthesia. Paediatr Anaesth. 2010; 20(11): 1056-1058.
10.1111/j.1460-9592.2010.03434.x
CAS PubMed Web of Science® Google Scholar
18Kirwan L, Coyne I. Use of restraint with hospitalized children: a survey of nurses’ perceptions of practices. J Child Health Care. 2017; 21(1): 46-54.
10.1177/1367493516666730
PubMed Web of Science® Google Scholar
19Bray L, Snodin J, Carter B. Holding and restraining children for clinical procedures within an acute care setting: an ethical consideration of the evidence. Nursing inquiry. 2015; 22(2): 157-167.
10.1111/nin.12074
PubMed Web of Science® Google Scholar
20McDougall RJ, Notini L. What kinds of cases do paediatricians refer to clinical ethics? Insights from 184 case referrals at an Australian paediatric hospital. J Med Ethics. 2016; 42(9): 586-591.
10.1136/medethics-2015-103025
PubMed Web of Science® Google Scholar
21Gold H, Hall G, Gillam L Role and function of a paediatric clincial ethics service: Expereinces at the Royal Children’s Hopsital Melbourne. J Paediatr Child Health. 2011; 47: 632-636.
10.1111/j.1440-1754.2011.02171.x
CAS PubMed Web of Science® Google Scholar

Citing Literature

Volume31, Issue8

August 2021

Pages 834-838

A practical and ethical toolkit for last-minute refusal of anesthetic in children

Abstract

Open Research

DATA AVAILABILITY STATEMENT

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

A practical and ethical toolkit for last-minute refusal of anesthetic in children

Abstract

Open Research

DATA AVAILABILITY STATEMENT

REFERENCES

Citing Literature

References

Related

Information