Independent review: Disagreements in the care of critically ill children

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, alongside reviewing the causes of disputes between parents/carers of a critically ill child and the healthcare teams responsible for the provision of care or medical treatment for the child, and assess how these disagreements can be avoided, and how we can sensitively handle their resolution.

The following definition of a dispute, disagreement or conflict situation will be used¹:

A breakdown in trust and/or communication between health professionals and a patient, parent/carer or family member which has an impact on any or all involved and/or affects the ability of a treating team to provide the care they deem optimal for the patient concerned.

The review will be completed by October 2023 and 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.

¹ Barclay S (2016) Recognizing and managing conflict between patients, parents and health professionals. Paediatrics and Child Health 26 (7): 314-315.