Provinces should recognize the wishes of children and youth with life-threatening illnesses, advise paediatricians

Wednesday, November 5 , 2008 -
Most jurisdictions in Canada do not have legislation that recognizes the formal wishes for care made by parents and minors who are very sick or dying. Consequently, there are no laws requiring third parties, such schools and emergency services, to respect them.  

In a new position statement published this week, the Canadian Paediatric Society (CPS) is calling on the provinces and territories to legally recognize advance care directives.

“It’s important for all voices to be heard when it comes to health care decision-making,” said Dr. Ellen Tsai, medical director of the paediatric intensive care service at Kingston General Hospital, chair of the CPS Bioethics Committee, and author of the new CPS position statement. “Advance directives are not recognized for children, either those made by the youth themselves or by their parents. Families have to rely on the good faith of the health care provider in order for their wishes to be followed.”

The goal of advance care planning is to optimize quality of life, comfort and well-being. Child and youth who are capable should have the right to participate in all aspects of health care decision-making.

By trying to protect children, adults sometimes avoid discussing difficult topics like serious illness and death. Even children and youth who are capable of understanding and coping with their condition are sometimes not included in discussions about how ill they are.

“Children who have experienced serious illness may have very strong feelings about their own health that shouldn’t be ignored. The legislative piece is important in that it supports their decisions,” said Dr. Tsai.

Published this week in Paediatrics & Child Health, the statement advises doctors to initiate advance care planning discussions early and regularly for paediatric patients with acute and chronic life-threatening conditions. Parents and mature minors should get the opportunity to be clear about their wishes regarding emergency and life-sustaining therapies such as cardiopulmonary resuscitation (CPR).

“The whole focus of this statement is about communication. Everyone involved should have a voice where it is appropriate,” adds Dr. Tsai. “These can be hard decisions for people to make in the first place. When families finally come to it, there is often a sense of relief. They know they have a plan and some idea of what is going to happen.”

To access full statement, please visit: Advance care planning for paediatric patients

For inquiries, contact:
Canadian Paediatric Society
Phone: 613-526-9397, ext. 247
Cell.: 613-850-4868