Ethical issues in parental decision-making. An interview study of mothers of children with hypoplastic left heart syndrome.

It is unclear how parents make life-and-death decisions on behalf of their children. To address this issue we interviewed 20 mothers whose children were born with hypoplastic left heart syndrome (HLHS), 10 whose child survived the operations and 10 mothers who chose comfort care. Semistructured interviews lasting from 1.5 to 3.5 h took place on median 4.6 (range 2.5-6) years after birth. The mothers who chose comfort care had more years of education (p = 0.03), reported a better childhood environment (p = 0.05) and had more often been employed in the healthcare services. The two groups described the information received in similar terms. The main motive for choosing surgery was that this was perceived to be the only acceptable choice. The motive for choosing non-treatment was to prevent the child from suffering. Lack of knowledge about long-term outcome, a state of shock and short time to deliberate limit the parents' possibilities for making autonomous choices. Autonomous decisions may be neither possible nor desirable for all parents. The care perspective, which highlights the parents' preferences resources and values, should represent ethical guidelines for care providers willing to dicide on behalf of the child.