A comparative study of conflicts and decision making in the treatment of seriously ill children

  • Veronica Neefjes

Student thesis: Phd

Abstract

In this thesis I investigate possible approaches in order to settle or resolve conflicts between clinicians and parents about the medical treatment of seriously ill children, in particular in England & Wales. The first section of the thesis evaluates two proposals aimed at limiting litigation that have gained most traction in the last few years; the replacement of the best interests standard with a harm threshold and the resolution of clinician-parent conflicts by using mediation. I found that the replacement of the best interests standard with a harm threshold, either for triage or as standard for decision making is unlikely to have a measurable impact on the number of court applications except in specific circumstances. Similarly, mediation is unlikely to resolve conflicts prior to litigation as in court applications the conflicts often are wholly or partly about value judgments. Concluding that neither proposal is likely to prevent the majority of court applications, the second section of the thesis investigates the parental decision making process. The two papers combined found inter alia, that parents do thorough research before making a medical treatment decision and use ethical values for their decisions in a manner consistent with an Ethics of Care framework; the findings are at odds with the often voiced assumption that parental decision making is largely emotional. Moreover, two currently promoted policies; advance care planning and a government initiative to discourage the use of war metaphors in the treatment of seriously ill patients are shown not to be consistent with the parental decision making process. The findings confirm that any conflicts about medical treatment for the child are likely to be about differences in values, thus moral conflicts. The third section investigates the effects of a putative replacement of the judicial procedure as final arbiter in conflicts about withdrawal of life-sustaining treatment by a specialist committee in a process modelled after the one currently used in Texas, USA. This process offers the opportunity to respect both parental and clinician’s ethical decision making about the child’s treatment. Implementing such a specialist review committee in England & Wales will (unsurprisingly) prevent most of the current litigation. More importantly however, it may be more acceptable to parents and the wider public than the judiciary approach as the model implicitly accepts that parents also practice ethical decision making. As such, implementation of such a process may change the environment in which these conflicts are settled from adversarial to non-antagonistic.
Date of Award6 Jan 2025
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorSoren Holm (Supervisor) & Nicola Glover-Thomas (Supervisor)

Keywords

  • case law
  • parental decision making
  • mediation
  • Texas Advance Directives Act
  • metaphors
  • seriously ill children
  • comparative law
  • conflict resolution
  • clinician-parent conflict
  • litigation

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