Advance directives by children and parents - Advance care planning in pediatrics

作者：Jox R J^*; Fuehrer M; Borasio G D

来源：Monatsschrift Kinderheilkunde, 2009, 157(1): 26-32.

DOI：10.1007/s00112-008-1857-x

• Advance directives
• Competence
• Advance care planning
• End-of-life decisions
• Best interests

The prevalence and significance of advance directives (AD) is increasing both in adult medicine and pediatrics. Yet their role in pediatrics has almost never been addressed. There is a sharp difference between the AD of a competent child or adolescent and the AD of parents. The former is analogous to the AD of adult patients, and the problem lies in defining and assessing competence. The AD of parents is grounded in the constitutional right of parents to decide on behalf of their children. This right is, however, limited by the child's wellbeing, which is predefined by generally accepted values in society. For this reason, the AD of parents is more an instrument of communication than of confrontation. Both forms of anticipatory decision making should be part of an advance care planning process that is characterized by early and open communication.

• 出版日期2009-1