• Norbert J Weidner and Diane M Plantz.
• Division of Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. Electronic address: norbert.weidner@cchmc.org.
• J Pain Symptom Manage. 2014 Nov 1;48(5):998-1003.

AbstractResearch has demonstrated the significant symptom burden present at the end of life of terminally ill children. Medicine has always viewed the relief of pain and suffering as a fundamental human right and a moral and ethical obligation. At the end of life, pain and dyspnea are symptoms commonly experienced by both adults and children. Opioids are the mainstay in treating the suffering associated with pain and dyspnea; however, there exist several barriers to the use of opioids. We describe a case in which parents prevent a young patient from receiving adequate pain management during the course of a terminal illness. We discuss the importance of recognizing the barriers to opioid use and the ethical ramifications of failing to find common ground with the family. We highlight parental responsibilities and limitations of parental authority in decision making for their child.Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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