SLU ethicists, leading scholars publish guidance for parents, physicians making medical decisions for children

Aug. 28, 2023
The recommendations published in Pediatrics.

How should others make decisions for pediatric patients?

For decades now, there has been debate in academic literature about the ethical principles that govern medical decision-making for children. In response to this, a group of leading scholars in pediatric ethics participated in a June 2022 symposium, “Best Interests and Beyond: Standards of Decision Making in Pediatrics,” at Saint Louis University. Over the course of three days, the 17 scholars debated one question – in the context of U.S. pediatric care, what moral precepts ought to guide parents and clinicians in medical decision-making for children?

The symposium and further discussions led to six recommendations for pediatric decision-making. Those findings, “Pediatric Decision Making: Consensus Recommendations,” appeared in Pediatrics on Aug. 9.


  1. Parents should be presumed to have wide, but not unlimited, discretion to make healthcare decisions for their children.
  2. Parents should protect and promote the health interests of their children while balancing practical constraints and/or other important obligations and interests.
  3. A clinician’s primary responsibility is to protect and promote their pediatric patients’ health interests. Clinicians’ recommendations should be informed by professional judgment and the best available evidence.
  4. To respect children and promote their well-being, clinicians and parents should inform pediatric patients of salient information and invite their perspective to the degree that it is developmentally appropriate.
  5. In addition to fulfilling state-mandated reporting requirements, clinicians should seek state intervention when all less-restrictive alternatives have failed and a parental decision places the child at significant risk of serious imminent harm or fails to meet the child’s best interests.
  6. Clinicians and parents should strive to collaborate in a shared decision-making process to promote the child’s interest.

St. Louis University Medical Center release on Newswise