Intended for healthcare professionals


Restoring balance to “best interests” disputes in children

BMJ 2017; 358 doi: (Published 02 August 2017) Cite this as: BMJ 2017;358:j3666
  1. Dominic Wilkinson, professor of medical ethics, consultant neonatologist12
  1. 1Oxford Uehiro Centre for Practical Ethics, faculty of philosophy, University of Oxford, UK
  2. 2John Radcliffe Hospital, Oxford, UK
  1. Correspondence: dominic.wilkinson{at}

The court of public opinion is surely the worst possible place for ethically complex decisions

Difficult and ethically challenging discussions about life prolonging treatment for a seriously ill child usually take place in quiet side rooms adjacent to medical wards. Sometimes, when parents and doctors have struggled to reach agreement, these discussions involve external mediation or take place in ethics committees. Rarely, unresolved dispute moves that discussion to a courtroom. In the recent Charlie Gard case, however, these discussions have taken place in public, on a wide global stage.

The Gard case raises ethical questions that are important to debate publicly.1 Yet much of the discussion about the case has been distinctly unbalanced. Commentators, politicians, and some supporters of the family attacked the hospital, the doctors, and the health system. Overseas medical and scientific experts, politicians, and religious leaders ventured opinions and offered treatment, apparently without knowledge of the full clinical circumstances.23

On the other side, the hospital and health professionals involved didn’t feel able to defend themselves in public out of concern for the confidentiality of the child and family and to protect staff …

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