• Veronica Dussel, Steven Joffe, Joanne M Hilden, Jan Watterson-Schaeffer, Jane C Weeks, and Joanne Wolfe.
• Center for Outcomes and Policy Research and Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, 44 Binney St., Boston, MA 02115, USA. joanne_wolfe@dfci.harvard.edu
• Arch Pediatr Adolesc Med. 2010 Mar 1; 164 (3): 231-7.

ObjectivesTo estimate the frequency of hastening death discussions, describe current parental endorsement of hastening death and intensive symptom management, and explore whether children's pain influences these views in a sample of parents whose child died of cancer.DesignCross-sectional survey.SettingTwo tertiary-care US pediatric institutions.ParticipantsA total of 141 parents of children who died of cancer (response rate, 64%).Outcome MeasuresProportion of parents who (1) considered or (2) discussed hastening death during the child's end of life and who endorsed (3) hastening death or (4) intensive symptom management in vignettes portraying children with end-stage cancer.ResultsA total of 19 of 141 (13%; 95% confidence interval [CI], 8%-19%) parents considered requesting hastened death for their child and 9% (95% CI, 4%-14%) discussed hastening death; consideration of hastening death tended to increase with an increase in the child's suffering from pain. In retrospect, 34% (95% CI, 26%-42%) of parents reported that they would have considered hastening their child's death had the child been in uncontrollable pain, while 15% or less would consider hastening death for nonphysical suffering. In response to vignettes, 50% (95% CI, 42%-58%) of parents endorsed hastening death while 94% (95% CI, 90%-98%) endorsed intensive pain management. Parents were more likely to endorse hastening death if the vignette involved a child in pain compared with coma (odds ratio, 1.4; 95% CI, 1.1-1.8).ConclusionsMore than 10% of parents considered hastening their child's death; this was more likely if the child was in pain. Attention to pain and suffering and education about intensive symptom management may mitigate consideration of hastening death among parents of children with cancer.

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