Introduction

It has never been all plain sailing in paediatrics and the process of making a wise treatment decision in the best interest of a sick child will, from time to time, result in a conflict of views between the health professionals and the parents. Paediatricians who lead healthcare teams will usually have developed strategies to reach consensual agreement in the great majority of these disputes, often after several days of discussion with the parents and different members of the team. It would be foolish for any health professional to think that an intractable dispute only happens when a less-experienced colleague is lacking the requisite communication skills. To say “this could never happen to me” is to bury your head in the sand.

The most strongly expressed differences of view are likely to arise when there is a perceived rationing of resources or withdrawal or withholding of life-sustaining treatment, particularly when the issue concerns the likely duration and quality of the child's life. Therefore the majority of serious disputes are encountered in the fields of neonatology, respiratory intensive care, oncology, transplantation and palliative care. However, an intractable impasse can arise in any area of paediatric practice. How should paediatricians behave if they sense that they are getting into one of these situations? To seek a second medical opinion is often helpful, but it may not always be viewed as completely independent and, should …