Navigating healthcare decision-making for children requiring life-sustaining medical treatment in Ireland: exploring clinician perspectives through the lens of the Irish legal system

Abstract

Healthcare decision-making within the pediatric population is a complex area to navigate for clinicians, parents and/or legal guardians, and children, and is even more complicated when children require intensive life-sustaining medical treatment (LSMT). Literature has highlighted the key ethical and legal principles that clinicians involved in bioethics committees should follow when making complex clinical decisions for this population, however, it can be unclear exactly where and how these decisions are made in practice. This paper provides an insight into how healthcare decision-making for children requiring LSMT is navigated within the medical and legal environment in Ireland. It uses a unique methodology consisting of a combination of secondary qualitative analysis of interview data obtained from clinicians involved in bioethics committees, and an analysis of Irish case law. The results of this paper highlight how clinicians navigate bioethical pediatric healthcare decision-making in Ireland, in the context of decisions regarding LSMT. The findings illustrate the complex balancing act that clinicians face in recognising and respecting parental autonomy in shared decision-making whilst being responsible for medical care that prioritises the best interests of the child, particularly from a legal standpoint. In some instances, this creates a decisional discord, and further training and professional supports are needed within clinical practice to promote the needs of children and to reduce stakeholder conflict.

Keywords: Best interests of the child; Bioethics; Life-sustaining technology; Medical decision-making; Paediatrics; Rights of the child.