Intended for healthcare professionals


Who decides?

BMJ 2006; 333 doi: (Published 27 July 2006) Cite this as: BMJ 2006;333:240
  1. Jasveer Singh Mangat (, specialist registrar in paediatric cardiology,
  2. Priya Kumar, specialist registrar in paediatrics
  1. Guy's and St Thomas' NHS Trust, London
  2. Guy's and St Thomas' NHS Trust, London

    Tom had been an active child, enjoying school and playing football. More importantly, he was a central part of his family. He was born with an atrioventricular septal defect and trisomy 21. At that time, intervention had been thought to be too risky and, as a result, he had frequent hospital admissions and poor exercise tolerance. Outcomes and perceptions changed, and, at 7 years old, he underwent surgical repair (pulmonary vascular resistance was low). This led to four fun years of walking and playing.

    We met him when he was 13 years old, and he was six months …

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