When Doctors and Parents Disagree

This book outlines an ethical conceptual tool - the zone of parental discretion (ZPD) that was developed through clinical ethics consultations. It is a framework to assist clinicians to assess parental decisions when parents and medical practitioners disagree on the proposed treatment plan. … For lawyers in medical law and child protection the book provides valuable insight into the issues and the decision-making frameworks used by clinicians and ethicists and why resort to the law is relatively rare in this context. Read full review… - Elizabeth Brophy, In_Print, Law Institute Journal Victoria, April 2017 [The] concept of the zone of parental discretion (ZPD) has compassionate aims: to offer a clearer way to avoid or resolve prolonged disputes between doctors and parents; to allow more scope for parents’ discretion; and to respect their moral weight and family harmony. Described as ‘an ethical tool that aims to balance children’s wellbeing and parents’ rights to make medical decisions for their children’, ZPD proposes that ‘parents are not ethically required to choose [in] the child’s best interests’. They may make ‘suboptimal’ choices that could favour the parents’ personal values or the interests of the whole family, as long as these do not harm the child. If decisions might be harmful, then ZPD ends and clinicians may intervene by refusing to provide requested treatment they see as unnecessary, or by trying to enforce treatment they deem clinically necessary, when they may refer families to the child protection services or the law courts. Read full review… - P Alderson, Clinical Ethics, March 2017 Ethical issues in health are common and paediatric health can be particularly complicated and challenging. Parents’ rights to make medical decisions for their children are widely acknowledged. But is this always the best for the child? How do we determine the appropriateness of this widely held belief? What do we do when there is a disagreement between the treating team and parents? “Doctors and Parents Disagree: Ethics, Paediatrics and the Zone of Parental Discretion” provides an interesting and informative look at the variety of ethical decisions facing health care professionals working in these areas. … The book aims to “assist doctors, nurses, allied health professionals and clinical ethics staff to deal with these ethically challenging situations”, which is exactly what it does. As a social worker within this area, I found the case scenarios allow for important ethical discussion and reflection, but perhaps of greatest benefit in the book is the very real and practical support the ZPD framework provides for clinicians working through these challenging scenarios. Read full review… - Katherine Dowson, Social Work Connect, November 2016 The past 60 years has seen enormous changes in the way in which decisions regarding the medical care of children are approached. From an era of medical paternalism where “doctor knew best”, decision making has emerged into an era where parent and care givers have become an integral part of the decision-making process and the internet has seriously eroded the doctor’s monopoly on information relevant to decisions whether or not to treat, or between various treatment options. … The way in which doctors are equipped to deal with these type of dilemmas traditionally involved resort to deceptively simplistic admonitions to “do no harm” or to do “what is best” for the child. However, in clinical practice, such phrases are apt to beg more questions than they answer. How does one determine what is “best” for the child? How should the harm which might result from the parents’ refusal to agree to treatment to be weighed against the harm which might result from the treatment if it were to proceed? Without a framework, questions of this type are apt to multiply and lead to inconsistent results even among similar clinical situations. This is the area in which the authors of When Doctors and Parents Disagree suggest a framework to enable clinicians to address treatment decision in an orderly way. For legal practitioners the approach is familiar: in determining whether to grant an interlocutory injunction, the court does not proceed by asking what is the “best” outcome but by asking a structured series of questions reaching an outcome that is one of many which are “good enough” rather than “best”. … The book is a useful resource in a difficult area of practice in both the medical and legal professions. It will also be of assistance to courts exercising statutory or parens patriae jurisdiction in disputes between parents and doctors over the treatment of children or even adults under an incapacity. Read full review… - Scott Aspinall, Australian Law Journal, 2016, 90 This small volume contains thirteen articles by medical professionals practising in various paediatric specialties. Its intended audience is the community of medical practitioners generally, and its stated aim is to raise an important ethical issue - in what instances should a medical practitioner override a parent’s decision about their child’s medical care - and to provide an ethical tool to doctors faced with such situations. Read full review… - Richard Weinstein, Bar News, NSW Bar Association, Summer 2016 Last week this publication reviewed the work of John Seymour, Children, Parents and the Courts; Legal Intervention in Family Life which concerned the intervention by the Courts in parenting. This week’s review considers a work on a closely related topic being the conflict which arises when parents and doctors disagree as to the appropriate medical treatment to provide to children. In particular, the work considers those occasions where medical treatment can be withdrawn from children. This work concentrates on the ethical rather than legal issues which arise when parents and medical practitioners disagree as to the medical treatment which is appropriate for a child. It seeks to develop an ethical tool which can be used to solve such issues when they arise; it is called the Zone of Parental Discretion. The tool seeks to balance the wellbeing of the child with the rights of parents to make medical decisions for their child. It is a collation of essays which are well ordered and interrelated and which are written by leading experienced clinical ethicists and paediatric clinicians. Its focus is on the resolution of ethical conflicts which arise when clinicians are faced with parents who require treatment for children which is not recommended by medical practitioners. It is a relatively short work which is easy to read and a useful reference for those engaged in the resolution of medical / legal issues. - Queensland Law Reporter - 2 September 2016 - [2016] 34 QLR

Rosalind McDougall is an ethicist at the Children’s Bioethics Centre, Royal Children’s Hospital Melbourne, and at the Centre for Health Equity, University of Melbourne. She studied philosophy, genetics and bioethics at the University of Melbourne and the University of Oxford, and has published widely on issues in clinical ethics and reproductive ethics. Her research focuses on paediatrics and parenthood. Rosalind has been involved in clinical ethics case consultation in Australian hospitals since 2008, and is currently a member of the Clinical Ethics Response Group at the Royal Children’s Hospital Melbourne.

Clare Delany worked for many years as a physiotherapist but now researches and practices in clinical ethics and clinical education. Clare is an Associate Professor in the Department of Medical Education, School of Medicine at the University of Melbourne and a Clinical Ethicist at the Royal Children’s Hospital Melbourne. At the University, Clare teaches in professional ethics, qualitative research and critical thinking and reasoning in health care. At the Children’s Bioethics Centre, Clare is a member of the Clinical Ethics Response Group and is involved in education, consultations and research in paediatric clinical ethics.

Lynn Gillam is an experienced ethicist, originally trained in philosophy (MA, 1988, Oxon) and bioethics (PhD, Monash, 2000). Lynn is the Academic Director of the Children’s Bioethics Centre at the Royal Children’s Hospital Melbourne. She is also Professor in Health Ethics at the University of Melbourne, in the Melbourne School of Population and Global Health. Lynn works in clinical ethics case consultation at the Royal Children’s Hospital, and has been involved in over 200 ethics consultations over the past 10 years. At the Royal Children’s Hospital, she also provides policy advice and leads research into a range of issues in paediatric clinical ethics.