Ethics

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5. Best interests

Who decides what is in a child’s or young person’s best interests?

Where a child lacks competence there is a presumption that the child’s parents have the child’s best interests at heart. This is not always the case, however, and doctors should be alert to situations in which parents’ decisions appear to be contrary to their child’s interests.

Where a young person is competent, the young person’s views on what would be in his or her ‘best interests’ are of importance to the decision making process, although they may not always be determinative.

 

What needs to be taken into account when assessing a child’s or young person’s best interests?

A best interests judgement is as objective a test as possible of what would be in the child’s actual best interests, taking into account all relevant factors. It is customary to assume that a person’s interests are usually best served by measures that offer the hope of prolonging life or preventing damage to health, but this is not always the case.

A number of factors should be considered, including:

  • the patient’s own wishes, feelings and values (where these can be ascertained)
  • the patient’s ability to understand what is proposed and weigh up the alternatives
  • the patient’s potential to participate more in the decision, if provided with additional support or explanations
  • the patient’s physical and emotional needs
  • clinical judgment about the effectiveness of the proposed treatment, particularly in relation to other options
  • where there is more than one option, which option is least restrictive of the patient’s future choices
  • the likelihood and extent of any degree of improvement in the patient’s condition if treatment is provided
  • risks and side effects of the treatment or non-treatment
  • the views of parents and others who are close to the patient about what is likely to benefit the patient
  • relevant information about the patient’s religious or cultural background
  • the views of other health care professionals involved in providing care to the child or young person, and of any other professionals who have an interest in their welfare.

 

What if there is disagreement over what is in a child’s or young person’s best interests?

Where there is disagreement over what is in the best interests of a child or young person, further discussion should take place and a second opinion should be offered, but it may be necessary to seek legal advice. In the interim only emergency treatment that is essential to preserve life or prevent serious deterioration should be provided (see Cards 3 and 6 on parental responsibility and disputes).

 

Key advice

  • General Medical Council. 0-18 years: guidance for all doctors – sections 12 and 13. More information

 

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Card 5: Best interests