The Royal College of Paediatrics and Child Health (RCPCH) has just published a new framework to help doctors make tough decisions on end of life care for children and young people.
The new framework sets out an ethical and legal framework for when it can be considered no longer in the best interests of the child to give life sustaining treatment. Specifically, the framework provides three sets of circumstances when limiting treatment can be considered because it is no longer in the child’s best interests to continue:
- When life is limited in quantity: If treatment is unable or unlikely to prolong life significantly it may not be in the child’s best interests to provide it
- When life is limited in quality: This includes situations where treatment may be able to prolong life significantly but will not alleviate the burdens associated with illness or treatment itself
- Informed competent refusal of treatment: An older child with extensive experience of illness may repeatedly and competently consent to the withdrawal or withholding of LST. In these circumstances, and where the child is supported by his or her parents and by the clinical team, there is no ethical obligation to provide LST.
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