Fifteen-minute consultation: How to communicate with parents who have a child on life support with no hope of recovery

Arch Dis Child Educ Pract Ed. 2022 Jun 21;edpract-2021-322262. doi: 10.1136/archdischild-2021-322262. Online ahead of print.

Abstract

A child on life support with no hope of recovery is the worst nightmare for parents and for paediatricians. Unfortunately, some children have illnesses or injuries that are not compatible with life. Being in a vegetative state with no meaningful interaction does not safeguard children from feeling discomfort and pain. Letting nature take its course and allowing the child to die may well be the least worse option. However, this decision is fraught with difficulties for parents and for clinicians and can lead to unnecessary and painful conflict between them, even leading to court proceedings. In this paper, the impact of having a child on life support is discussed and recommendations are given in order to improve professional communication. It is hoped that an understanding of the impact on parents, cultural considerations, and the psychiatric concepts of 'denial', 'projection', the 'meta-level', 'transference', 'countertransference' and the techniques of 'motivational interviewing' will help clinicians prevent a breakdown of trust and improve doctor-parent relationships in these tragic cases.

Keywords: Child Psychiatry; Ethics; Palliative Care; Psychology.