When lifesaving treatment in children is not the answer

A set of guidelines that reflect clinical and emotional reality

Axioms in philosophy are not axioms till they are proved upon our pulses.—John Keats

Last month the Royal College of Paediatrics and Child Health produced guidelines on the withholding or withdrawing of lifesaving treatment in children.1 Such documents face the potential problem that in their attempt to achieve consensus the recommendations can become so vague as to say nothing. Any guidelines will find it difficult to achieve credibility in the face of the drama of a critically ill child, a drama in which the uneasy actors—parents; children; and nursing, medical, and allied health staff—so often find themselves painfully entrapped.2 When I first read the royal college's report I thought it a brave and dignified document which nevertheless stayed polite and superficial. But, with each rereading, I realised that in fact it is a remarkable report which does indeed make the leap to the bedside. It achieves sense and clarity without losing any connection with the emotions being played out in the theatre in which I and many others work.

The report's greatest contribution is in delineating “five …