During pediatric arrest, what should guide decisions about continuing resuscitation when directives exist?

• A. Proceed with full resuscitation regardless of family input.
• B. Honor advance directives and family wishes; discuss goals of care and consider stopping resuscitation per orders when appropriate.
• C. Never discuss goals and continue resuscitation indefinitely.
• D. Only allow the physician to decide.

Answer: (B)

In pediatric resuscitation, decisions about continuing or stopping life-sustaining efforts are guided by the patient’s advance directives and the family’s goals of care, with the medical team translating those directives into action in real time. When explicit orders exist, they should be honored if they are applicable and valid for the current situation, and the discussion with the family should clarify what outcomes are desired for the child. If there are no directives, a collaborative conversation about prognosis, potential for meaningful recovery, and the child’s quality of life helps determine whether continuing aggressive resuscitation aligns with the family’s values, with a plan to shift toward palliative or comfort-focused care if that alignment is appropriate.

This approach respects autonomy and legal/ethical obligations, reduces unnecessary or unwanted suffering, and maintains trust between families and clinicians. Choosing to proceed without family input, or to pursue indefinite resuscitation without discussing goals, undermines those values and can conflict with the patient’s or family’s preferences. Leaving the decision solely to the physician also omits essential context about the child’s and family’s priorities.