Family continues to insist on the intervention Do you believe the intervention can achieve its physiological goal? (For example, will the patient survive CPR? Is intubation technically possible?) Intervention should not be offered. Compassionately explain why the intervention won’t work. No Possibly Discuss the benefits and burdens of the intervention with the family. Aim for a shared decision.* * Ultimately, the decision lies in the Zone of Parental Discretion. There is no absolute right and wrong. You might personally make a different decision to the family in this situation, but this does not make their decision wrong. The most important thing is to ensure the family is well-informed. Do you strongly believe the treatment is contrary to the best interests of the child (that is, it does not promote the goals of care or the burdens greatly outweigh the benefits)? No Yes In principle, the intervention should not be offered. Explain to the family that the treating team believes the intervention would be contrary to the child’s best interests Yes Family agrees Family continues to insist on the intervention Allow time for ongoing discussion.* It may not be possible to reach final resolution before deterioration occurs and decisions will need to be made at the time. Decide whether to provide the intervention during this time. You are not obliged to provide treatment that you believe will cause net harm to the child. (Seek institutional executive input if you believe you should withhold or withdraw treatment against parents’ wishes.) Seek a second opinion. Consult a bioethics service if available. *Refer to Thinking ahead discussion guide – Planning care for children with life-limiting conditions