Drafting guidelines for the withholding or withdrawing of life sustaining treatment in critically ill children and neonates

In 1997, the Royal College of Paediatrics and Child Health (RCPCH) published a framework for practice on the withholding or withdrawing of life sustaining treatment. Based on sound ethical and legal principles, the purpose of the document was to oVer guidance for those faced with diYcult treatment decisions that could not be resolved by appeal to scientific fact alone. 1 Unsurprisingly, the RCPCH document has attracted both acclaim and some criticism for its general objectives and specific conclusions. 23 Any attempt to provide such guidance might be interpreted as applying unnecessary constraints to clinical practice. Furthermore,such documents can be criticised as being too general to be useful, stigmatising to some individuals or groups, and striking the wrong balance between law and morality. Although these criticisms have some validity, questions such as those dealt with by the RCPCH document and others cannot simply be left to the moral values of individual clinicians or their (possibly mistaken) interpretation of the law. 4 Some considered advice—informed by appropriate collective multidisciplinary deliberation—is imperative. It seems likely, therefore, that other groups will wish to provide guidance or advice on ethicolegal matters. Here, we examine some of the problems they may face by considering the kind of guidance that is required, the appropriateness of standards set, the role of the law, and the relation between guidelines and the law. Determining the kind of guidance that is required Many professionals want reasonably specific but not prescriptive guidance. Ethico-legal codes of professional practice, although emphasising communication skills, ethical behaviour, treating patients with dignity, and outlining legal boundaries of acceptable practice, 56