Critical care decisions in fetal and neonatal medicine: ethical issues

Parents are generally considered to have the moral authority to make decisions in their child’s best interests in all the circumstances of life, though not as if they owned them. They are often best placed to know what is in the interests of their child because they share a special bond that begins during pregnancy and develops over time.

Legally, doctors must normally have the consent of parents before giving any treatment to a child. Doctors can only override parental wishes with a court order, except in an emergency.

Doctors have a responsibility to promote the best interests of the newborn baby and will be able to give a prediction of the outcome for the baby based on their knowledge and experience. Other people, such as family members, religious advisers or healthcare specialists may contribute advice. Nurses spend a great deal of time with the parents and their baby and are therefore well placed to provide additional insights into the best interests of both the child and his or her family.

We conclude

The Working Party considers that all participants in decision making should strive to reach agreement about what is best, and every effort should be made to secure consensus within the ‘partnership of care’ between the parents and the healthcare team.

This is more likely to be achieved if all the appropriate parties are fully involved in any discussion, properly understand the facts, appreciate their significance, and are given the opportunity to participate in the process of deciding. In some cases, agreement about what is best may not be reached, however hard and conscientiously it is sought.