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Children’s doctors are familiar with balancing the risks and benefits of treatment, rarely seeking legal assistance. As a single illustration, those treating a child with sarcoma may agonise over the necessity for and roles played by excisional surgery, chemotherapy and radiotherapy. Each of these elements must be considered in terms both of their benefits and the risks of mutilation, immediate toxicity and long-term consequences, not least iatrogenic malignancy. But only rarely, or ever, will the balancing act for each mode of treatment, or the juggling of the alternative risks and benefits conferred by those modalities become the subject of litigation. Negotiation in this context is the raison d'etre for the multidisciplinary meeting. These details of clinical decision-making are not usually regarded as justiciable, liable to legal consideration.
A recent judgement gave a rare opportunity to observe how a court would perform what is usually an ‘MDT’ activity, when considering whether a young person should be sedated and ventilated to facilitate his renal transplant for end-stage renal failure.
William1 is 17, 6 feet tall. He had been found to lack capacity to make medical decisions due to his learning disability, autism and attention deficit hyperactivity disorder (ADHD). However, the judge had met William and was able to get a clear idea of his wishes, worries and fears. “It is very clear he (William) enjoys the life he leads, playing games, doing odd jobs, going to school and the respite centre and being with his family.” …
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.