Advance directives in pediatrics

Background. Advance directives (AD) are increasingly being used in Germany, and legal regulation is planned. In pediatrics, ADs are written by competent adolescent patients or by parents for their children. The aim of this study was to assess the acceptance of ADs by pediatricians. Methods. At the children's hospital of the University of Munich, special pediatric AD forms were developed. Two and a half years later, all physicians at the hospital were surveyed on their experiences and attitudes regarding pediatric ADs. Results. A total of 31% of the physicians reported having been confronted with ADs, 42% encountered the wish to write an AD. The hospital AD forms were known by 61% of the medical staff and 92% stated that the instrument makes sense in pediatrics. All physicians would follow ADs in principle, but only 27% or 23% would do so if it required limiting artificial nutrition or hydration, respectively. Conclusions. ADs appear to have a role in pediatrics. While they are generally regarded as helpful and binding, most physicians are wary of applying them if they involve the limitation of artificial nutrition and hydration.