Navigating Religious and Spiritual Factors that Impact Shared Decision-Making and Treatment Refusal in Pediatric Psychology

Objective: Religious and spiritual beliefs are important aspects of identity that can influence medical decision-making in pediatric healthcare, at times leading families to decline recommended treatment. Existing research has begun to highlight the bioethical dilemmas this can create for pediatric psychologists. However, the literature lacks a structured framework to inform their clinical reasoning and interdisciplinary contributions in these cases. This ethics-focused, practice-oriented analysis aims to address this gap. Methods: We review a targeted selection of legal, ethical, developmental, and clinical literature addressing religious and spiritual influences on pediatric medical decision-making. Relevant findings and resources are then synthesized into a unified, stepwise framework that incorporates ethical frameworks and facilitates clinical conceptualization, communication, and consultation in shared decision-making among care teams and families. Results: A seven-step integrative framework is presented, encompassing reflective preparation, risk and ethical clarification, cultural and religious formulation, evaluation of the Zone of Parental Discretion, assessment of the patient’s voice, communication and mediation, and systems-level collaboration. Two clinical vignettes illustrate framework application. Conclusions: Pediatric psychologists play a critical, nuanced role as advocates, cultural mediators, collaborators, and sources of support for children, families, and interdisciplinary teams when religious or spiritual beliefs conflict with medical recommendations. This analysis offers a clinically actionable, stepwise framework to promote culturally responsive, ethically grounded, and developmentally informed care.