Independent review: Disagreements in the care of critically ill children

Literature review

To inform our discussions about the disagreements that can arise in the care of critically ill children, we commissioned a review of the literature and evidence relating to this area.

Disagreements in the Care of Critically Ill Children: Causes, Impact and Possible Resolution Mechanisms

By Dr Kirsty Moreton Associate Professor in Law, Birmingham Law School, University of Birmingham, UK

This thematic review examines the literature and evidence base between 2017-2023 relating to the causes, impact, and possible resolution processes in disagreements between parents and healthcare professionals about the care of critically ill children. The review focused on examining three questions:

1. What are the causes of disagreements in the care of critically ill children in England?
2. What is the impact that these disagreements can have on the child, their family, the healthcare professionals, the NHS and wider society?
3. What are the possible mechanisms for avoiding, recognising, managing and resolving disagreement?

Dr Kirsty Moreton is an Associate Professor of Law at the University of Birmingham and was previously the Director of the Medical Ethics and Law Programme at Keele University. She is a specialist in healthcare law, and has been researching the ethical, sociological, and legal dimensions of child healthcare decision-making for the last 10 years. Her recent work includes publications on adolescent decision-making in the palliative care and end-of-life context, and on transgender children's ability to consent to medical treatment. She was an invited speaker at the 2022 Annual Paediatric Critical Care Society conference, presenting on the ethical and legal perspectives of caring for children with medical complexity.

Any views expressed in the review are the author's own and not those of the Nuffield Council on Bioethics.