The Nuffield Council on Bioethics is pleased to announce it has been commissioned by the Department of Health and Social Care to conduct an independent review of the disagreements that can arise between families and healthcare teams in the care of critically ill children in England.

Central to the review will be the perspectives of families and healthcare teams themselves, alongside research evidence and ethical analysis. We aim to further understand the causes of disagreements in the care of critically ill children, how they may be avoided, and how to sensitively handle their resolution.

High-profile court cases in the UK in recent years have highlighted the damaging effects that prolonged and deep disputes between a critically ill child’s family and their healthcare teams can have on everyone involved.

The Government committed in the Health and Social Care Act 2022 to arrange a review of the causes of disagreements. The review will inform a process of learning and improvement to support the development of good, collaborative relationships between families and healthcare teams.

The review will result in:

  • evidence-based advice on the causes of protracted disagreements between healthcare professionals and parents or carers about the care and treatment of critically ill children, and the ethical issues these raise;
  • recommendations for national or regional level interventions to help avoid such disagreements or resolve them more quickly in future; and
  • the identification of any gaps in the evidence base.

The Nuffield Council on Bioethics’ work in this area stems back to 2006, with an influential report on critical care decisions in neonatal medicine, and further research and engagement in 2018-19 focusing on disagreements between parents and healthcare teams. 

The independent review will build on this previous work and that of others working in this area. The review will start now and will be completed by October 2023.

Secretary of State for Health and Social Care Steve Barclay said:

“I recognise the extraordinary burden on parents and medical professionals when making decisions on what medical treatment is in the best interest of a critically ill child.

Every effort should be made for families and healthcare teams to reach agreement and I have commissioned the Nuffield Council on Bioethics - an independent body with experience in handling complex ethical and medical issues - to explore how best to achieve this.

I am committed to making sure the views of families, carers and clinicians are at the centre of this review designed to make the decision-making process clearer during the most difficult of times.”

Danielle Hamm, Director of the Nuffield Council on Bioethics, said:

“We are pleased to have been asked by the Secretary of State to undertake this important review of disagreements in the care of critically ill children.

We hope this will lead to better support for families and healthcare professionals facing these very distressing situations to work through disagreements sensitively and collaboratively, and to resolve matters as quickly and fairly as possible so that all involved feel like their voices have been heard.

Hearing from families and from clinicians who have been involved in disagreements relating to the care of critically ill children will be vital to this review and we are keen to hear a range of contributions”.

If you would like to find out more about this project, or would like to contribute to this work, please email

Related links

  1. Health and Social Care Act 2022 - Section: Review into disputes relating to treatment of critically ill children
  2. Previous Nuffield Council on Bioethics briefing (2019): Disagreements in the care of critically ill children