A survey of parents who have lost children to cancer found that one in eight considered hastening their child's death, a consideration influenced by the amount of pain the child experienced during the last month of life, according to a new survey in the Archives of Pediatrics and Adolescent Medicine.

Researchers say the findings underscore the importance of managing patients' pain, and of communicating with parents about the tools available for easing progressive pain.

141 parents of children who had died of cancer were questioned about their behaviors and feelings leading up to their child's death and at the time the survey was conducted, which was a year or more after the death. The parents were also presented with hypothetical vignettes involving a terminally ill child with uncontrolled excruciating pain or who was in an irreversible coma.

One in eight (13 percent) of parents had considered asking caregivers about the possibility of ending their child's life, though only 9 percent reported having such a discussion. Five parents, or 4 percent, had requested that their child's death be hastened, and 3 parents said it had been carried out, using morphine. However, senior author Joanne Wolfe said that "this may not reflect what actually happened, because morphine is used in increasing doses to manage worsening pain without the intent or the effect of ending life."

In response to the hypothetical vignettes, 50 percent of parents said they endorsed hastening death in situations of uncontrollable pain or if the child was in an irreversible coma. Parents were 40 percent more likely to approve hastening death for a child experiencing extreme pain than for a terminally ill child in a coma.

Keeping the findings in perspective is important, the researchers say. Only five parents reported having talked about hastening their child's death, and 19 said they considered it. Wolfe said it is her experience that parents are comforted by having conversations about pain management and that most are reassured by knowing what will be done to ease their child's suffering.

"The problem is that conversations about these family worries may not always happen," said Wolfe. "Parents may not have the opportunity to express these feelings and considerations, and as clinicians, we may not be adequately enabling sufficient opportunity for them to talk about their concerns."

Citation: Dussel et al., 'Considerations About Hastening Death Among Parents of Children Who Die of Cancer', Arch Pediatr Adolesc Med., March 2010, 164(3), 231-237