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1
The framework evaluates last-minute pediatric refusal of anesthesia induction by considering intervention urgency, the child’s decision-making ability, and harms from forced induction.
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2
The harm principle supports overriding a child’s refusal when intervention is necessary to avert grave, imminent harm that cannot otherwise be prevented.
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3
When no imminent risk is present, providers should weigh the physical, emotional, and psychological harms of forced induction against the benefits of surgery.
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4
The best interests standard may require withholding anesthesia when harms associated with forced induction outweigh the benefits of proceeding.
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5
Emerging autonomy calls for considering children’s preferences, obtaining assent, and respecting refusal in nonurgent circumstances.
