Clinical dilemmas in children with life-limiting illnesses: decision making and the law.
Decision making about interventions for children and young people with life-limiting illnesses is fraught with difficulties but faced regularly by staff in children's hospices and paediatric wards. The perspectives of the child, various family members and professionals may all be different. The process of discussion and negotiation and the mechanism by which a decision is arrived at is complex. Various laws have recently changed in the UK that have an impact on this process. This article discusses several clinical scenarios to better understand these decisions and the effects of changes in the law. It also discusses how multidisciplinary teams in children's hospices (and other supportive clinical systems) can best support young people and families with and without recourse to the law.
Wright
B
B
Lime Trees Child and Family Unit, North Yorkshire and York Primary Care Trust, 31 Shipton Road, York. barry.wright@nyypct.nhs.uk
Aldridge
J
J
Wurr
K
K
Sloper
T
T
Tomlinson
H
H
Miller
M
M
D000293:Adolescent; D000367:Age Factors; D001291:Attitude of Health Personnel; D002648:Child; D002651:Child Advocacy; D002657:Child Development; D002675:Child, Preschool; D003142:Communication; D032882:Comprehension; D016638:Critical Illness / Q000628:therapy; D003657:Decision Making / Q000941:ethics*; D030881:Disclosure; D005192:Family Health; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006806:Human Rights; D006801:Humans; D007223:Infant; D007258:Informed Consent / Q000331:legislation & jurisprudence*; D007398:Interpersonal Relations; D007883:Legislation, Medical; D008297:Male; D016743:Mental Competency; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology; D013727:Terminal Care / Q000941:ethics / Q000331:legislation & jurisprudence* / Q000523:psychology; D006113:United Kingdom; D028761:Withholding Treatment