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Title: Judging best interests in paediatric intensive care : the location, scope and basis of decision making
Author: Birchley, Giles
ISNI:       0000 0004 5923 6560
Awarding Body: University of Bristol
Current Institution: University of Bristol
Date of Award: 2015
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This thesis investigates how the "best interests" standard should be employed in decisions about critically ill young children with no antecedent wishes in the paediatric intensive care unit, focusing upon children in situations where life sustaining treatment may be withheld or withdrawn. Using an empirical ethics methodology, I review bioethical and legal sources and undertake empirical research into the experiences and values of four groups with practical decision making experience-parents, doctors, nurses and clinical ethics committee members. The literature conceives the best interests of the child naturalistically and so is attentive to the child's values and experiences. Parental proxies identify these values in children; the status of parental values per se is determined by one of several accounts of the value of the family. Empirical research participants informed their decision-making with principles that centred upon the validity of parental decision-making autonomy and the relevance of the family interests to the child's. They also identified processes, centring on parental contributions to decisions, the content and acceptability of clinicians' persuasive strategies and the utility of the courts in resolving conflict. Using a process of reflective equilibrium to produce justifiable conclusions from my intuitions, the literature and the empirical research, I argue that naturalistic conceptions of best interests are poorly suited to decision-making about children, and emphasis should be placed on positivistic aspects of the child's health and welfare, even if this gives clinicians' accounts greater influence. The focus on a shared-decision between doctor and parent, while practically defensible, places too great an emphasis on consensual agreement and too little on the significant costs to the child this can entail. I conclude that the process of decision-making should require parental assent, rather than consent, and that fresh mechanisms should be explored for expediting decisions where dissensus results in disproportionate cost to the child.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available