Should religious beliefs be allowed to stonewall a secular approach to withdrawing and withholding treatment in children?
- 1Paediatric and Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK
- 2Department of Chaplaincy, Great Ormond St Hospital for Children, London, UK
- Correspondence to Dr Joe Brierley, Paediatric and Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children, Great Ormond St, London WC1 3JH, UK;
Contributors JB collected the cases and analysed the interactions. All three authors reviewed the cases and contributed equally to the final manuscript.
- Received 11 July 2011
- Revised 27 October 2011
- Accepted 30 January 2012
- Published Online First 30 March 2012
Religion is an important element of end-of-life care on the paediatric intensive care unit with religious belief providing support for many families and for some staff. However, religious claims used by families to challenge cessation of aggressive therapies considered futile and burdensome by a wide range of medical and lay people can cause considerable problems and be very difficult to resolve. While it is vital to support families in such difficult times, we are increasingly concerned that deeply held belief in religion can lead to children being potentially subjected to burdensome care in expectation of ‘miraculous’ intervention. We reviewed cases involving end-of-life decisions over a 3-year period. In 186 of 203 cases in which withdrawal or limitation of invasive therapy was recommended, agreement was achieved. However, in the 17 remaining cases extended discussions with medical teams and local support mechanisms did not lead to resolution. Of these cases, 11 (65%) involved explicit religious claims that intensive care should not be stopped due to expectation of divine intervention and complete cure together with conviction that overly pessimistic medical predictions were wrong. The distribution of the religions included Protestant, Muslim, Jewish and Roman Catholic groups. Five of the 11 cases were resolved after meeting religious community leaders; one child had intensive care withdrawn following a High Court order, and in the remaining five, all Christian, no resolution was possible due to expressed expectations that a ‘miracle’ would happen.
- care of dying minors
- religious ethics
- minors/parental consent
- clinical ethics
- definition/determination of death
- ethics committees/consultation
Disclaimer Thanks to the Rev Dorothy Moore-Brooks for her help with preparing this manuscript. The views expressed in this manuscript are entirely those of the authors and not of the institution in which they work.
Competing interests None.
Ethics approval Not really a ‘study’ but a review of cases referred, and no identifiable clinical details provided.
Provenance and peer review Not commissioned; externally peer reviewed.