Conflict about non-beneficial treatment — FFICM MCQ

Correct answer: D — Seek ethics support and legal review while continuing appropriate care

The correct answer is D, seek ethics support and legal review while continuing appropriate care. When disagreement between the treating team and parents about a child's best interests cannot be resolved through repeated family meetings, GMC guidance directs clinicians to seek second opinions, involve clinical ethics committees and, if necessary, obtain legal advice about applying to court, rather than unilaterally imposing a decision. Irreconcilable best interests disputes are ultimately for the court to adjudicate, not for either party to decide by default. Appropriate care must continue throughout this process (organ support without escalation beyond what is clinically indicated) to avoid harm from premature action in either direction. This staged approach protects the child, respects the parents' role, and protects clinicians legally and ethically. Why the other options are wrong: A. Withdraw ventilation immediately despite unresolved conflict: unilateral withdrawal before resolving the dispute or obtaining legal sanction breaches the requirement for independent determination in genuinely irreconcilable cases and exposes clinicians to legal challenge. B. Ask the parents to leave the hospital: this abandons the duty of ongoing communication and negotiation, is not a recognised conflict resolution step, and would worsen the relationship and any subsequent proceedings. E. Continue treatment indefinitely because parents request it: parental wishes alone do not override clinical judgement; continuing invasive treatment the team believes is not in the child's interests, without independent review, is not defensible. C. Transfer responsibility to nursing staff: nursing staff cannot resolve a best interests dispute of this nature; overall responsibility for escalating unresolved ethical and legal disagreements remains with the treating medical team. Key point: unresolved best interests disputes between clinicians and parents require escalation through ethics review and, if needed, the courts, with appropriate care continued throughout rather than unilateral action by either side.

Reference: GMC, 0-18 years: guidance for all doctors, Making decisions section, https://www.gmc-uk.org/professional-standards/the-professional-standards/0-18-years/making-decisions