Modern medicine has the power to enhance and prolong the lives of seriously ill children. This is clearly good news, but sometimes it leads to ethical dilemmas. If health professionals and parents cannot agree on what is in a child’s best interest, the decision may be taken to court. Recently, there have been several high-profile disputes, such as the one between the parents of Alfie Evans and Alder Hey Children’s Hospital in Liverpool, UK, over whether or not to withdraw life support.
Parents are right to fight for their children. They want what is best for them and health professionals understand that. However, the rise of the internet and social media has made conflict more likely by giving families in desperately sad situations quick and easy access to information about new treatments – some robustly tested and available in the UK and some not. This extends hope to families, which can be helpful. But it can also make matters worse when parents want their children to have treatments that doctors consider inappropriate or likely to cause more harm than good. It is, for instance, what led to a court battle in 2017 between Great Ormond Street Hospital for Children in London and the parents of Charlie Gard, who wanted to take their son to the US for treatment.
Where such conflicts occur, they can have profound mental and physical effects on all involved. In some cases, we have even seen protests on hospital sites and abusive messages directed at clinicians – actions that have sent shock waves through the medical community.
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In an attempt to address the problem, the Royal College of Paediatrics and Child Health has just published . Based on the experiences of health professionals and families, the document is the first to suggest best practices for the prevention, recognition and management of situations where conflict exists. Among other things, it recommends assigning a lead clinician to be responsible for overall care of the child and ensure communications with the family are clear, consistent and transparent, avoiding giving inappropriate expectations, making psychological support available for both families and health professionals, and recognising disagreements and communication failings early.
This advice aims to support families and health professionals during an emotionally charged period. Of course, it will not prevent every disagreement, but it is likely to de-escalate some. A hospital in Perth, UK, saw conflict incidents drop by 64 per cent when piloting a similar framework. Staff also reported increased confidence in managing conflict, and some reported increased morale.
Parents and clinicians won’t always see eye to eye, but Achieving Consensus ensures the child is at the centre of every decision. And that is what everybody wants.
