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Commentary
Ethics of paediatric end-of-life decision making and consent for publication
  1. David Isaacs1,2
  1. 1Clinical Ethics Children's Hospital at Westmead, Sydney, New South Wales, Australia
  2. 2Discipline of Child Health, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Professor David Isaacs, Clinical Ethics Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW 2145, Australia; david.isaacs{at}health.nsw.gov.au

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In their interesting paper in this issue, De Vos et al1 consider the ethical issues when parents want treatment for their child to be withdrawn against the recommendations of the medical team. They discuss whether or not such end-of-life decisions should be shared with parents and whether or not physicians should protect parents from guilt or doubt in decision-making. De Vos et al1 conclude that the parents should be involved in decision-making, that it is not appropriate to exclude them from decision-making in order to protect them and that it should be hard to overrule parents’ decisions about terminating treatment. I should make it clear that they mean life-prolonging invasive treatment; they are not proposing euthanasia.

I agree wholeheartedly with De Vos et al about the need to involve parents and to be reluctant to overrule their wishes and I agree strongly that the continuity provided by having a single physician leading discussion, if possible, is invaluable. I would even state the case for parental primacy in decision-making more strongly. I attended an ethics meeting at which a panel of doctors demonstrated how they would assess a situation where doctors were debating late termination of a pregnancy involving a child with congenital malformations. The New York ethicist Nancy Dubler commented heatedly, “How dare you decide what will happen to this woman's baby?” Her comment brought …

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