To present an ethical framework for responding to a child’s refusal of anesthesia induction, using urgency, decision-making ability, and potential harms of forced induction.
Approach:
Ethical foundations: The framework draws on the harm principle, the child’s best interests, and emerging autonomy.
Urgency: Assess the need and timing of intervention rather than relying only on an elective-versus-emergent classification.
Potential harms: Weigh physical, emotional, and psychological harms of forced induction against the benefits of proceeding.
Key Findings:
The article reports that a multicenter study found difficulty accepting the anesthesia mask in 20% of children.
For genuinely emergent, life-saving surgery, the authors state that postponement should seldom occur when intervention is clearly in the child’s best interests.
When there is no imminent risk, the child’s dissent and the harms of forced induction should be considered; these may support withholding anesthesia.
The authors advise clear communication with parents about potential harms and negotiation of their role during induction.
Interpretation:
The proposed framework organizes ethical considerations for last-minute refusal around urgency, the child’s decision-making ability, and the harms of forced induction.
Limitations:
The provided context ends during the section defining urgency, so later framework details and any further conclusions are unavailable.
The context describes a proposed ethical framework and does not provide outcome data evaluating its use.
Christopher Lindblade, MD, co-author of a 2026 Journal of the American Society of Echocardiography study, shares how factors seen on fetal echocardiography support the Phoenix Children’s model for performing urgent bedside balloon atrial septostomy for babies with neonatal hypoxia.
