Critical decisions for critically ill infants

Deciding what is best for a critically ill infant can be fraught, particularly if the question before the parent, healthcare professional or judge is ‘to treat or not to treat?’. We explore the courts’ dealings with cases in which this ethico-legal question has been posed, inspired by Margaret Brazier’s work in this context with the Nuffield Council on Bioethics. ¹ Specifically, we consider whether the clinical ethics committee (CEC) might improve the principles and processes by which resolution is achieved. The principle might appear straightforward: decisions must rest on the ‘best interests’ of the infant. ² Yet this cardinal legal principle can have diverse ethical interpretations, such that the best interests of an infant are neither self-evident nor incontestable. When deciding, doctors should apparently engage in shared decision-making with parents, with the courts stepping in if agreement fails to materialise. ³ Yet, how – or whether – consensus is achieved is also open to question, as is the role that the courts play when consensus cannot be found.