Parent and medical team disagreements in the UK: universal lessons in the origins and resolution in conflict

In recent decades, there has been an increase in life expectancy in children with life-limiting conditions. Ideally, parents and clinicians would work together to ensure the best care for these children. Several cases have appeared in the media in recent years where conflict has risen between parents and healthcare professionals acting in the ‘best interests’ of children, which have resulted in court action. However, the legislation itself promotes conflict. Similar laws exist across Europe based on Article 24 of the UN Convention on the Rights of the Child. The aim of the Children’s Act 1989 in the UK was to place the ‘child’s welfare’ as the ‘paramount consideration’. It has prevented draconian care and supervision orders, which can only be made if the child is at risk of ‘significant harm’. This threshold does not apply to healthcare teams. Healthcare decisions are based on ‘best interests’, which are not explicitly defined. This sets the threshold for progression to court action much lower, and due to a lack of definitive definition of what ‘best interests’ are, this has unfortunately escalated conflict rather than resolve it. Healthcare institutions have been criticised for not utilising alternative approaches first, such as mediation. We propose an alternative approach based on collaboration, reasonableness and the threshold of significant harm, which we have explored in this review. Conflict management frameworks are a tool that can be used to recognise early signs of conflict and develop strategies to prevent escalation at ward level. They can be tailored to individual institutions and utilise content-oriented and empathetic communication strategies through designated clinicians. They should offer guidance on when to refer to the courts. Parental wishes should be assessed on whether they represent significant harm or not. If not, they cannot simply be wrong. Acknowledgement of the ‘reasonableness’ of parental requests can be a key factor which is diffusing conflict. Therefore, setting the threshold for state intervention at ‘significant harm’ rather than ‘best interests’ would help to reduce the number of these cases progressing to courts.