Paula Tironi, JD, LLM and Monique M. Karaganis, MD
While parents often have legal authority to make decisions regarding pediatric palliative care, federal and state statutory and case laws, like CAPTA, impose significant restrictions on that authority.
The current Medicare operation—reimbursing medical goods and services to a growing number of people without basing the reimbursement benefit on the actual cost of the services—is unsustainable, but there are some possible remedies.
Bioethicist Bruce Jennings examines the changing role of physicians in end-of-life care, from paternalistic decision maker to advisor-technician and half-way back.
Physicians who treat children with Down's syndrome should ensure that their parents fully understand the children's capabilities and long-term prognosis and counsel them on the appropriate actions to take regarding their children's care.
Physicians need to help surrogate decision makers to make treatment and end-of-life decisions for those with severe neurological damage by proving a realistic prognosis and maintain strong lines of communication.