• Complex and end-of-life decisions about foregoing treatment and allowing natural death
• Use of invasive technology when the child will be permanently dependent
• Disagreements within a family about the right actions
• Rights and responsibilities of parents

• Disagreements between the physician, others on the health care team and family about the right actions
• Balance of harms and benefits for high-risk procedures
• Adolescent autonomy in decision making
• Balancing confidentiality and the best interest of the child

Plan of care

• There is no plan of care
• The patient has not been told/is not aware of the plan of care
• There is a plan, but it is not documented in the chart
• The patient in question has multiple co-morbidities
• There is prolonged decision-making
• There are concerns about the appropriateness of the plan of care

End of life

• Advance directives
• Assigned power of attorney for health care for 18+ year olds
• Allow Natural Death/Limited Therapy (AND/LT)
• Withdrawing or withholding treatments
• The continuation of life-sustaining treatments as opposed to comfort measures only

Communication

• Poor communication across providers
• Poor communication or persistent disagreement between family, providers and the patient
• Disruptive family
• Matters related to confidentiality or health information disclosure

Psychiatric

• Questions of uncertainty related to the patient’s cognitive capacity for 18+ year olds
• Patient is persistently, unreasonably in non-compliance with treatment plan
• Patient is persistently, unreasonably refuses medical intervention
• Patient is severely agitated or is displaying threatening behavior