Achieving consensus advice for paediatricians and other health professionals: on prevention, recognition and management of conflict in paediatric practice

• Published in: Archives of disease in childhood Vol. 104; no. 5; pp. 413 - 416
• Main Authors: Linney, Mike, Hain, Richard D W, Wilkinson, Dominic, Fortune, Peter-Marc, Barclay, Sarah, Larcher, Vic, Fitzgerald, Jacqueline, Arkell, Emily
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.05.2019; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Attitude of Health Personnel; Child; Child Health; Child Health Services - standards; Children; Children & youth; Clinical decision making; Communication; Communication (Thought Transfer); Consensus; Courts; Decision making; Dissent and Disputes; Ethics; Families & family life; Family (Sociological Unit); Guidance; Health Personnel; Health Personnel - psychology; Hospitals; Humans; Intensive care; Leading; Leading article; Legal Aid; Medical personnel; Medical treatment; multidisciplinary team-care; Negotiating - methods; Palliative care; Palliative Care - psychology; Palliative Care - standards; Parent Participation; Parent Responsibility; Parents & parenting; Pediatricians - psychology; Pediatrics; Physicians; Professional-Family Relations; Social networks; Terminal Care - psychology; Terminal Care - standards; United Kingdom; Young Adults; United Kingdom; multidisciplinary team-care; intensive care; ethics; palliative care
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2018-316485

Correspondence to Dr Mike Linney, Women And Childrens, Western Sussex Hospitals NHS Foundation Trust, Worthing PO19 6SE, UK; mike.linney@wsht.nhs.uk Introduction Conflict can arise between health professionals and the parents of children not only where there is disagreement on the withdrawal or withholding of life sustaining treatment, as seen in recent high-profile cases1 2 but also in more general routine care. In this document we have tried to summarise practical recommendations for those working with children and young people both to prevent and manage conflict, in effect to achieve consensus in decision making with families. Since evidence about the best ways of achieving consensus in healthcare is limited, these recommendations, endorsed by the RCPCH, are necessarily based on opinion and experience. Clinicians should be aware that courts cannot dictate treatment to be given to a child rather that the ‘choice of treatment is in some measure a joint decision of the doctors and court or parents’ as explained by Lord Donaldson.14 15 It is likely that where decisions are deemed by courts too difficult for either judges or clinicians to resolve, the choice should be one for those with parental responsibility, as per Lord Justice Waite.16 It is also recognised17 that the court’s clear respect for the sanctity of human life must impose a strong obligation in favour of taking all steps capable of preserving life, save in exceptional circumstances. Promoting the understanding that their role is not just ‘end of life’ care but part of the active support process for children and young people with life-limiting conditions to ensure their quality of life.