RCPCH responds to Nuffield Council on Bioethics review of disagreements in the care of critically ill children

On Thursday 8 December, the Nuffield Council on Bioethics announced it has been commissioned by the Department for Health and Social Care to conduct an independent review of the disagreements that arise between families and healthcare teams in the care of critically ill children.
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The Nuffield Council on Bioethics has said the review will result in: 

  • evidence-based advice on the causes of protracted disagreements between healthcare professionals and parents or carers about the care and treatment of critically ill children, and the ethical issues these raise; 
  • recommendations for national or regional level interventions to help avoid such disagreements or resolve them more quickly in future; and  
  • the identification of any gaps in the evidence base.

The College recognises that conflict can arise rise between health professionals and the parents of children both in the context of disagreement on the withdrawal or withholding of life sustaining treatment and also in more general routine care. We are pleased to note that the review will build on previous work on this important area, including our own. 

Our Achieving Consensus work on preventing and managing conflict, aimed at paediatricians and other health professionals, sets out practices aimed at reducing disharmony. Earlier this year, we also published guidance to support healthcare professionals, service planners and families of children with complex medical needs to draw upon when requesting, providing and receiving an external second opinion. 

The review will start now and is expected to be completed by October 2023. 

In response to the Nuffield Council on Bioethics' announcement, Professor Steve Turner, RCPCH Registrar, said: 

The College welcomes the news that the Nuffield Council on Bioethics has been commissioned to conduct this important review into disagreements in the care of critically ill babies and children. 

The decisions paediatricians make always have the child’s best interests at heart.  We endeavour to make decisions alongside the family, but there will be cases where families and healthcare teams disagree. We recognise that disagreements in the care of critically ill children is distressing for all parties involved, including is the family and the healthcare team. Where disagreements arise, it is important that there is a process which allows for harmonious and collaborative relationships between families and healthcare teams wherever possible.