Seeking alignment of end-of-life goals within the Australian pediatric context.

In this article, we highlight the Australian pediatric palliative care context. We describe the way in which pediatricians may adopt 'directive' shared decision-making to align care plans with their perceptions of harm avoidance for the child. The degree to which 'directive alignment' is ethically appropriate or proportionate in the context of the clinical and social context of the child must be considered. Shared decision-making within palliative care continues to be a challenging dynamic to navigate for pediatricians.