Comment on the procedure for complex end-of-life cases

A paper authored by two Great Ormond Street Hospital doctors and one of the hospital's chaplains has been published in the Journal of Medical Ethics. This paper is based on a review of historical medical cases involving complex end-of-life decisions. The views presented in the paper are those of the authors themselves.

Great Ormond Street Hospital Foundation Trust explains the current legal framework for complex end-of-life cases:

"The legal and ethical basis of paediatric care is that treatment must be in the best interests of the child. Usually, difficult end-of-life cases are resolved between the parents and the professionals concerned. In a small number of cases, professionals believe treatment to be futile and burdensome and against the interest of the child, while parents do not. The parents’ position may be religiously based or otherwise. The desire of parents to do the right thing for their child is always understood.

There is a long established procedure to go to the courts for a declaration that treatment may be legally withdrawn. In recent times the process has typically taken about a week and has produced a clear declaration either way. If the courts do not concur, no doctor is required to continue treatment against their professional judgement. However, if another clinical team is willing to provide treatment, the child should be transferred to that team.

Whether the parents’ objections are religious in origin or not, whether the child is considered a follower of that faith, or not, whether the faith concerned is a ‘well known’ or ‘mainstream’ one or not, the focus of the court is upon what is in the best interests of the child."