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Caruso Brown AE, Ciurria J. "Prix Fixe" or "À La Carte"? Pediatric Decision Making When the Goals of Care Lie in the Zone of Parental Discretion. J Clin Ethics. 2021;32(4):299-306
Caruso Brown, A. E., & Ciurria, J. (2021). "Prix Fixe" or "À La Carte"? Pediatric Decision Making When the Goals of Care Lie in the Zone of Parental Discretion. The Journal of clinical ethics, 32(4), 299-306.
Caruso Brown, Amy E, and Ciurria, Julia. ""Prix Fixe" or "À La Carte"? Pediatric Decision Making When the Goals of Care Lie in the Zone of Parental Discretion." The Journal of clinical ethics vol. 32,4 (2021): 299-306.
Caruso Brown AE, Ciurria J. "Prix Fixe" or "À La Carte"? Pediatric Decision Making When the Goals of Care Lie in the Zone of Parental Discretion. J Clin Ethics. 2021;32(4):299-306. PMID: 34928858.
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J Clin Ethics. 2021;32(4):299-306.

"Prix Fixe" or "À La Carte"? Pediatric Decision Making When the Goals of Care Lie in the Zone of Parental Discretion.

The Journal of clinical ethics

Amy E Caruso Brown, Julia Ciurria

Affiliations

  1. Interim Chair of the Center for Bioethics and Humanities and Associate Professor, Center for Bioethics and Humanities and Department of Pediatrics, Division of Pediatric Hematology/Oncology at State University of New York Upstate Medical University in Syracuse, New York USA. [email protected].
  2. Clinical Fellow in Pediatric Emergency Medicine at Washington University School of Medicine in St. Louis/St. Louis Children's Hospital in St. Louis, Missouri USA. [email protected].

PMID: 34928858

Abstract

For many children with complex medical conditions, decisions regarding their goals of care lie in the zone of parental discretion. That is, clinicians appropriately recognize that in many cases whether to prioritize quantity of life or quality of life is a deeply personal, values-laden decision best made by those who are most deeply invested in the outcome. Once a family has committed to a goal, however, there may be new or ongoing conflict between parents and clinicians regarding the specific interventions provided or not provided in support of that goal. To what extent is it ethically permissible for a seriously ill child's surrogate decision makers to reject individual interventions that support their desired goal of care? This question might be best described thus: is pediatric healthcare "prix fixe," in which clinicians help parents decide the best of one or more set combinations ("menus") of interventions, or is it "à la carte," in which parents are free to accept or reject each individual intervention? We argue that the concept of a "prix fixe" approach should be discussed with families early in the development of the clinical relationship, as an essential facet of shared decision making.

Copyright 2021 The Journal of Clinical Ethics. All rights reserved.

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