Advance directives in pediatrics Structured, law based advance directives for emergency treatment

Background: If a child's proxy is not available in an emergency, an advance directive can be a valuable tool to document treatment preferences in pediatrics.Objective: Development of pediatric advance directive forms, which comply with German law. Material and methods: The corresponding recommendations of German medical societies from 2009 were revised in a multistage process involving a user survey, expert round and legal guidance.Results: If several treatment options are justifiable in an anticipated emergency situation, the patient or the patient's representatives should be informed about this and the offer of an advance directive made. Forms (pedVVN) have been developed that comply with German law for three legally distinct scenarios and their use is explained in an accompanying text. A) Parents are the legal guardians of minors who are not competent to give their consent about medical treatment. B) Minors with the capacity and competence to give their consent should preferably decide together with their parents. C) For young adults with severe intellectual impairment, a legal guardian must be appointed by court and has to be involved in such treatment decisions. The discussion of advance directives should be part of an overarching advance care planning process.Conclusion: There are now uniform legally approved advance directive forms available for patients undergoing treatment in pediatrics.