An editorial in this week's issue of THE LANCET discusses the complex issues surrounding decisions to withhold medical treatment for profoundly ill patients, recently highlighted by the UK cases of 11-month-old Charlotte Wyatt and 9-month-old Luke Winston-Jones.
The editorial comments: 'These are rare cases. Difficult decisions are made, daily, about when to withhold life-prolonging medical treatment. Usually, parents and the medical teams reach agreement in the confines of hospitals or homes, with the help of current guidelines, and without any media coverage. What is clear from these two complex, difficult, and emotionally involving cases is that legal recourse was sought because agreement between parents and medical teams could not be reached. But are the courts the best place to resolve such conflict? As a last resort, perhaps, but courts, by their very nature, encourage confrontation not negotiation. Despite the sensitivity displayed by Justice Hedley in his summing up, and his own admission of his limitations, such momentous decisions are surely best kept outside the courts. In the rare cases where parents and doctors continue to disagree, arbitration in a more comforting and appropriate setting than a court of law is needed. The Nuffield Council of Bioethics has set up a working party to examine issues around prolonging life in fetuses and newborn babies. Aiding decision making outside the courts should be one of their terms of reference.'
The Lancet