Withdrawal of Life Support Treatment
Refusal to Consent

 

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Ethical Issues

1. The Welfare of the Child and best interests of the Child are Paramount

Interpreted with respect to what a reasonable adult would choose for themselves.

2. The Role of the Parent; its Scope and Limitations

The Guardianship Act: parent's ability to consent to treatment of a child.

(a) Parents cannot choose against the best interests of the child where these are clear e.g. refusal of blood transfusion by Jehovah Witness parents.

(b) Discretionary role where parents are competent and the best interests of the child are in doubt.

(c) Parents cannot insist on treatment that is not in the child's best interests

(i) Futile treatment: where it would not produce an outcome beneficial to the child.

(ii) Treatment contrary to the child's best interests e.g. epidermolysis bullosa (Lethalis).

3. The Role of Medical Practitioners

Whether providing for or withholding treatment is in child's "best interests: physicians have a responsibility to prevent undue suffering including that from inhumane treatments and in the case of a dying child, allow "death with dignity" .

(a) There is no legal duty to provide futile treatment.

(b) Courts will not order treatment against clinical judgement if there is medical diagnostic and prognostic certainty.

(c) Courts will not lightly overrule parents.

(d) Family, clinical and ethical consensus is desirable.

(e) Clinicians/parental disagreement equals "alarm". In these cases, review legal issues by legal advisers and ethical issues by the Hospital Ethics Committee is recommended. It may be appropriate to obtain a Court Order approving the decision to withdraw.

References

1 Annas GJ. Asking the Courts to set the standards of emergency are -the case of Baby K.  N Engl J Med 1994; 330: 1542-5.
2 Biachi DW, van Mater LJ. An approach to ventilator dependent neonates with arthrogryposis. Paediatrics 1994; 94: 682-6.

These guidelines were initially developed  by Dr Andrew Howie, Ms Jane Bowden, and Associate Professor Tania Gunn - September 1997