parents, it will often fall to a child patient's nurses to alert others to relevant issues
and concerns.
No doubt the most controversial case to feature conflict between parents and
health care professionals, was that involving the conjoined twins born in
Manchester on 8 August 2000 4Re A children) 2000)). The weaker twin only lived
because her circulation was sustained by her stronger sister. Unless a separation
was performed, the heart of the stronger twin would fail and both would die. The
health authority sought permission to separate the twins, which would allow the
stronger one to survive but kill the weaker one immediately. The parents refused to
sanction the death of one daughter, but they were overruled by the Court of
Appeal. Although the judges stressed that their decision `was authority for the
unique circumstances of the case' only, they did in effect sanction the active killing
of the weaker twin, albeit out of concern for the best interests of her stronger sister.
The ruling is difficult to reconcile with the protection for respect to life demanded
from the state by Article 2 of the European Convention.
10.1.5 Neglecting the child's medical needs
Where the medical needs of children are neglected by those with parental
responsibility, the latter forfeit their right to make treatment decisions. If time
permits, the case should be referred to the High Court. If there is no time for this,
the health care team should proceed to do what it thinks best for the child. This is
the basis on which the children of Jehovah's Witnesses are given blood products
against their parents' wishes. Nurses should be prepared for the difficulties
inherent in these painful situations. They should, before any emergency arises,
familiarise themselves with their employer's guidance on how to deal with the
parents in such circumstances.
10.1.6 Case study[9]
Adam, aged 5, has been out playing with his friends, and is discovered, completely
immersed, in a shallow pool. Despite attempts to resuscitate him, scans reveal
global brain damage. Four days later he starts to suffer whole body decorticate
extensor spasms, which, judging by his facial expressions and cries, cause him
great pain and distress. Anti-spasmodic drugs seem to help initially, but then
Adam develops a tolerance to them. Hypertension, tachycardia and difficulty with
the control of respiratory secretions, set in. Adam's deteriorating physical condi-
tion, and his suffering, persuade Adam's father to ask the health care team to
discontinue artificial nutrition and hydration.
Adam's health care team should primarily liaise with the people who have
parental responsibility for Adam. This may exclude Adam's father, if he was never
married to Adam's mother and took no steps to acquire parental responsibility.
Even if the father does have parental responsibility, Adam's mother's wishes
should be ascertained. If both parents have parental responsibility, but they
disagree over Adam's treatment, the safest course of action is to refer the case to
court. If Adam's mother shares the father's viewpoint, the health carers should
consider whether they too think that withdrawal of artificial nutrition and
The Critically Ill Patient 199