Paediatric end-of-life care and cardiopulmonary resuscitation

Every paediatrician's career includes the provision of care for children with life-limiting conditions. The College of Physicians and Surgeons of Ontario published a revised policy, "Decision-making for End-of-Life Care," in March 2023; in this commentary we explore the ramifications of this policy for community and acute care paediatricians in Ontario and highlight principles to contextualize this beyond provincial borders. In particular we discuss its impact upon clinicians' moral distress and the importance of: i) early and longitudinal engagement with patients and families, where possible, to contextualize the role of resuscitative measures (if any) in addition to the many other important considerations concerning high quality end-of-life care; and ii) preventing bias and calibrating decision-making with clinical colleagues (including Bioethics) to ensure CPR is never withheld because of a child's <i>protected characteristics</i> such as their race, age, or disability.