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Physicians as healthcare surrogate for terminally ill children
  1. P Weisleder
  1. Dr Pedro Weisleder, Division of Nalionwide Children's Hospital and The Ohio Slate University, 700 Children's Drive, Columbus, OH 43205, USA; pedro.weisleder{at}


The parents of some terminally ill children have reported that being asked to authorise removal of life-sustaining measures is akin to being requested to sign a “death warrant”. This dilemma leaves families not only enduring the grief of losing a loved one, but also with feelings of ambivalence, anxiety and guilt. A straightforward method by which the parents of terminally ill children can entrust the role of healthcare surrogate to the treating physician is presented. The cornerstone of this paradigm is parental awareness that the physician will act in the child’s best interest, even if that means discontinuing life-sustaining measures. The goal is to mitigate parental guilt and fear of misperception, by self and others, of having given up on their child. From a moral standpoint this concept is an appealing option as it conforms to the four basic principles of medical ethics. While laws in the USA and several European nations prevent members of the medical team from taking on the responsibilities of healthcare surrogate for terminally ill patients, formal and informal precedence for this option already exists in France, The Netherlands, Norway, Sweden, Switzerland, and the Canadian province of Manitoba.

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  • Competing interests: None.

  • Funding: None.

  • Ethics approval: This work was deemed exempt from formal evaluation by Duke University Medical Center’s Office of Human Subject Protections.