Witholding and Withdrawing Treatment UK


Key documents on withholding and withdrawing treatment. It is useful to be familiar with the legal and ethical framework, medical practitioners need to be working within. There is also guidance on the practical management of palliative care.

Making decisions to limit treatment in life threatening and life limiting conditions in children: a framework for practice (Larcher V et al) 2015
Guidance for medical professionals from the RCPCH on making decisions to limit treatment. Discusses the procedure to be followed. Note the following paragraph in particular if you are in disagreement:
"Good practice requires ongoing discussion between relevant parties to resolve disagreements. Clarification of the facts, by obtaining second medical opinions or clarification and analysis of the ethical issues involved by clinical ethics services and others, may be helpful, as may the use of mediation techniques. Wherever possible these should be used before referral to court is made. If a matter is referred to court, the court will wish to know what attempts have been made—and by whom—to resolve conflicts"
Also note that Trisomy 18 alone would be difficult to fit into any of the categories that suggest treatment should be withheld or withdrawn.

Practical guidance for the management of palliative care on neonatal units (Mancini A et al ) 2014
Does what it says: practical information on the management of palliative care. Also offers guidance on what to do if there is a conflict between parents and medical staff or between healthcare professionals themselves. Endorsed by the RCPCH

Treatment and care towards the end of life: good practice in decision making (GMC) 2010
Guidance for medical staff on managing palliative care decision making; sets out key principles and discusses practice. Excellent section on neonates, infants and children. Discusses role of parents and managing disagreements.

A reappraisal of the guidance and legal protection for medical practitioners in cases of medical futility (Cheetham S) 2008
 A useful summary of the available guidance and current case law on medical futility and witholding and withdrawing treatment. See the section on infants if arguing for post birth treatment.

Critical care decisions in fetal and neonatal medicine (Nuffield Council on Bioethics) 2006
An extremely long report discussing the ethics of treatment and witholding treatment from fetuses and neonates. Wide spanning document, discusses the legal background to decision making. Predominant focus on extremely preterm infants. Recommends parental choice is deferred to in the case of 22 and 23 week gestation infants. This was at a time when these infants had very poor outcomes with low survival rates. A short summary is available here 

Withholding or withdrawing life sustaining treatment in children (RCPCH) 2004 
Guidance on withholding or withdrawing treatment for medical professionals. replaced by Larcher et al 2015

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