Parental Refusal of the Best Treatment: Nudges and Trust in Pediatrics

More effective and less toxic therapies are welcomed by clinicians and families and are the rationale and raison d’être for well-designed clinical trials. This is especially true for life-threatening diseases like childhood cancer. When parents opt for an existing and good treatment, rather than accept a new and better treatment of a child with cancer, clinicians may struggle to accept the parents’ refusal. In considering such a refusal, should parental reasons matter? In this situation, should clinicians be more forceful in attempting to sway the parents to accept a novel and improved therapy? How does the sincerity of the therapeutic relationship, especially trust, factor into this calculus? In the following ethics rounds, stemming from a 2025 American Society for Bioethics and Humanities Meeting session, the commentators draw on their diverse background as pediatric clinicians, bioethicists, philosophers, and educators to navigate this challenging situation. They consider the intersection of evolving standards of care, parental authority, and clinician influence, with particular attention to communication and trust, emphasizing active listening and attending to what parents have to say.