A practical and ethical toolkit for last-minute refusal of anesthetic in children.

This interesting case review by Massie and colleagues examines the practical and ethical issues relevant to last-minute anaesthetic refusal in children and adolescents.

The authors discuss in turn various possible practical responses beyond the essentials of maintaining the child’s comfort, dignity and privacy. These include deferring the case to later the same day, re-scheduling to another occasion, deception (even when suggested/ sanctioned by a parent), medication and restraint.

The second part of the paper identifies some of the ethical issues demanding of consideration; respect for person, best interests, truth telling and harm minimization.

Reference is also made to the role of clinical ethics support.

Nonetheless, some readers may be uncomfortable with the solution reached, a concern raised in subsequent correspondence1.

Wider consideration of the concepts of children’s decision-making capacity, consent and assent can be found in the non-anaesthetic literature2,3, and rewards attention for those interested.


  1. Wellesley H, Sogbodjor A, Martin R. When children refuse their anesthetic-restrain, deceive, or postpone?. Paediatr Anaesth. 2021;31(9):1016-1017. doi:10.1111/pan.14242
  2. Ruhe KM, Wangmo T, Badarau DO, Elger BS, Niggli F. Decision-making capacity of children and adolescents–suggestions for advancing the concept’s implementation in pediatric healthcare. Eur J Pediatr. 2015;174(6):775-782. doi:10.1007/s00431-014-2462-8
  3. Lansdown R. Listening to children: have we gone too far (or not far enough)?. J R Soc Med. 1998;91(9):457-461. doi:10.1177/014107689809100902

Reviewed by Dr Jon Stacey