Ethics challenge winner 2019/2020. Conflicting clinician and parental wishes

In 2019, the RCSIsmj introduced an ethical case challenge involving the conflicting clinician and parental wishes regarding the course of action for a newborn infant with hypoplastic left heart syndrome (HLHS). Per the case, the newborn is currently on life-sustaining prostaglandin therapy, and has an estimated 75% chance of survival at five years with surgical intervention. However, this intervention will be very intensive, requiring three separate operations and a lengthy hospital stay. There is also a risk of neurological disability, and a chance that the child will require a heart transplant later in life. Due to these factors, the child’s parents have requested that the prostaglandin infusion be stopped, and the child be allowed to die. This request is contrary to the recommendations of the staff in the cardiology service, who suggest that the surgery be performed. This article aims to discuss the ethical and legal issues involved with this case, and how the clinical team should proceed. Using existing research and guidelines on disagreements between parents and healthcare professionals (HCPs) within paediatric care, it asks: is the clinical team obligated to withdraw life-sustaining support, even though they do not believe that it is in the child’s best interests?