Parental authority and the weight of assent: Navigating moral dilemmas in adolescent end of life care

Parental authority and the weight of assent: Navigating moral dilemmas in adolescent end of life care
Journal of Bioethical Inquiry; by A. L. Heifner, M. M. Ortiz, T. L. Major-Kincade, C. O’Connor; 6/25
In the current era of moral pluralism, medical decisions must account for much more than clinical considerations: they must abide by legal standards of decision-making which usually prioritize parental preferences. Conflict abounds between the parent or other legal decision-maker and healthcare team in situations where the parent prefers not to disclose the severity of the adolescent’s illness or the healthcare team believes continuing lifesaving therapies are not in the adolescent’s best interest. These dilemmas challenge how we solicit adolescents’ preferences (assent) and their options for refusal (dissent). We explore the moral distress healthcare workers face navigating conflict amongst various stakeholders involved in the adolescent’s end-of-life care. Strategies to minimize moral distress are also provided.