A Practical and Ethical Toolkit for Last-Minute Refusal of Anaesthetic in Children.

Children's fear of a procedure, including the anaesthetic is a common issue that operating theatre staff face. This fear is generally mitigated by pre-aesthetic preparation and information sharing. Last minute refusal of a procedure creates unique difficulties for the anaesthetist and proceduralist. Refusal for a procedure raises issues of whether the dissent is binding, and if not, how best to get the child to theatre without creating moral injury. In this case review of a young adolescent who refuses to go to the operating theatre, we explore practical and ethical options to resolve the situation. We discuss respect for persons (including assent and consent), best interests, truth telling, harm minimisation and restraint. The importance of a post-event debrief is discussed. We also assess the value of a clinical ethics service with team members embedded in clinical teams.