Pediatric palliative care and pediatric medical ethics: opportunities and challenges


Pediatric palliative care and pediatric medical ethics: opportunities and challenges


Feudtner C; Nathanson PG






adolescent; Child; Humans; infant; Pediatrics; Withholding Treatment; Communication; Resuscitation Orders; Ethics; Medical; Palliative Care; 20th Century; History


The fields of pediatric palliative care (PPC) and pediatric medical ethics (PME) overlap substantially, owing to a variety of historical, cultural, and social factors. This entwined relationship provides opportunities for leveraging the strong communication skills of both sets of providers, as well as the potential for resource sharing and research collaboration. At the same time, the personal and professional relationships between PPC and PME present challenges, including potential conflict with colleagues, perceived or actual bias toward a palliative care perspective in resolving ethical problems, potential delay or underuse of PME services, and a potential undervaluing of the medical expertise required for PPC consultation. We recommend that these challenges be managed by: (1) clearly defining and communicating clinical roles of PPC and PME staff, (2) developing questions that may prompt PPC and PME teams to request consultation from the other service, (3) developing explicit recusal criteria for PPC providers who also provide PME consultation, (4) ensuring that PPC and PME services remain organizationally distinct, and (5) developing well-defined and broad scopes of practice. Overall, the rich relationship between PPC and PME offers substantial opportunities to better serve patients and families facing difficult decisions.


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Feudtner C; Nathanson PG, “Pediatric palliative care and pediatric medical ethics: opportunities and challenges,” Pediatric Palliative Care Library, accessed September 29, 2023,