Expounding on Shared Decision-Making in Pediatrics

Abstract

Although the term “shared decision-making” would not be officially coined until the 1983 President’s Commission report on Deciding to Forego Life-Sustaining Treatment, the concept was described 10 years earlier by Duff and Campbell in their highly controversial 1973 publication in the New England Journal of Medicine. 1 United States President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Deciding to Forego Life-Sustaining Treatment. Washington DC: US Government Printing office. https://repository.library.georgetown.edu/bitstream/handle/10822/559344/deciding_to_forego_tx.pdf?sequence=1&isAllowed=yDate: 1983 Date accessed: September 11, 2022 Google Scholar ,2 Duff R.S. Campbell A.G.M. Moral and ethical dilemmas in the special-care nursery. N Engl J Med. 1973; 289: 890-894 Crossref PubMed Scopus (335) Google Scholar In discussing 299 consecutive deaths that occurring in a special care nursery (what is now known as a neonatal intensive care unit), Duff and Campbell spoke the unspeakable by acknowledging that 43 of the deaths (14%) were related to withholding treatment: “After careful consideration of each of these 43 infants, parents and physicians in a group decision concluded that prognosis for meaningful life was extremely poor or hopeless, and therefore rejected further treatment [italics added].” 2 Duff R.S. Campbell A.G.M. Moral and ethical dilemmas in the special-care nursery. N Engl J Med. 1973; 289: 890-894 Crossref PubMed Scopus (335) Google Scholar p.890 The group decision was a decision made by parents and physicians together. Duff and Campbell acknowledged the tension that their manuscript would create, “Perhaps more than anything else, the public and professional silence on a major social taboo and some common practices has been broken further. That seems appropriate, for out of the ensuing dialogue perhaps better choices for patients and families can be made.” 2 Duff R.S. Campbell A.G.M. Moral and ethical dilemmas in the special-care nursery. N Engl J Med. 1973; 289: 890-894 Crossref PubMed Scopus (335) Google Scholar p.894