Presented by Janine Penfield Winters, M D

My experiences as a paediatric palliative care doctor exposed me to disagreements about high-stakes medical interventions for young children.

In this talk, I will first discuss the cases that sparked my passion for the topic. then I will review the evolution of thought about frameworks for decision-making for young children—from the Best Interest Standard to the newer (and better, in my opinion) Harm Principle and the recent addition of the Zone of Parental Discretion. Then I will narrow the topic to parental refusals of recommended treatment. Even when clinicians and arbiters have an appropriate (and flexible) ethical framework approach, it can continue to be difficult to decide what to do, especially in situations of complexity and uncertainty. Potential pitfalls including bias, errors of omission, and reductionism of complexity were observed in my clinical practice.

I will outline and defend a new decision-making tool that breaks the big picture into sub-steps to analyse and identify key questions. The tool is designed to assist those embroiled in complex disagreements to disentangle the issues and find a path to resolution.