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Giving a voice to the voiceless: end of life second opinions
  1. Andy Bush1,2
  1. 1 Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
  2. 2 Centre for Paediatrics and Child Health, Imperial College, and Paediatric Respiratory Medicine, National Heart and Lung Institute, London, UK
  1. Correspondence to Professor Andy Bush, Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, Middlesex, UK; a.bush{at}

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As modern medicine can achieve greater than ever prolongation of life, the difficult issue of whether it is right as opposed to possible to continue with intensive treatment has become ever more important, not least in light of recent high-profile cases where professionals and parents have been unable to agree. The Royal College of Paediatrics and Child Health (RCPCH) has published an ethical framework setting out in rigorous, scholarly and humane documents the principles by which life-sustaining treatment may be withheld or withdrawn from a child,1 2 and important principles for giving a second opinion have also been published.3 This Viewpoint is set within the framework of previous guidance and relates to the practicalities of giving a second opinion when such a course of action is contemplated; it does not seek to challenge any aspect of the RCPCH principles, nor unfortunately does it provide a panacea for resolving disagreements in which usually both sides genuinely perceive themselves as having the best interests of the child at heart.

Almost invariably, the context is a child who has been looked after to the highest standards in an expert unit, by caring, expert and committed professionals, who have already obsessively explored every possible diagnostic and therapeutic option on multiple occasions. A formal mediation process, another valuable resource, may have been employed. …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.