What should happen when doctors and parents disagree about what would be best for a child? When should courts become involved? Should life support be stopped against parents’ wishes? The case of Charlie Gard, reached global attention in 2017. It led to widespread debate about the ethics of disagreements between doctors and parents, about the place of the law in such disputes, and about the variation in approach between different parts of the world. In this book, medical ethicists Dominic Wilkinson and Julian Savulescu critically examine the ethical questions at the heart of disputes about medical treatment for children. They use the Gard case as a springboard to a wider discussion about the rights of parents, the harms of treatment, and the vital issue of limited resources. They discuss other prominent UK and international cases of disagreement and conflict. From opposite sides of the debate Wilkinson and Savulescu provocatively outline the strongest arguments in favour of and against treatment. They analyse some of the distinctive and challenging features of treatment disputes in the 21st century and argue that disagreement about controversial ethical questions is both inevitable and desirable. They outline a series of lessons from the Gard case and propose a radical new ‘dissensus’ framework for future cases of disagreement. This new book critically examines the core ethical questions at the heart of disputes about medical treatment for children. The contents review prominent cases of disagreement from the UK and internationally and analyse some of the distinctive and challenging features around treatment disputes in the 21st century. The book proposes a radical new framework for future cases of disagreement around the care of gravely ill people.

What should happen when doctors and parents disagree about what would be best for a child? When should courts become involved? Should life support be stopped against parents' wishes? The case of Charlie Gard, reached global attention in 2017. It led to widespread debate about the ethics of disagreements between doctors and parents, about the place of the law in such disputes, and about the variation in approach between different parts of the world. In this book, medical ethicists Dominic Wilkinson and Julian Savulescu critically examine the ethical questions at the heart of disputes about medical treatment for children. They use the Gard case as a springboard to a wider discussion about the rights of parents, the harms of treatment, and the vital issue of limited resources. They discuss other prominent UK and international cases of disagreement and conflict. From opposite sides of the debate Wilkinson and Savulescu provocatively outline the strongest arguments in favour of and against treatment. They analyse some of the distinctive and challenging features of treatment disputes in the 21st century and argue that disagreement about controversial ethical questions is both inevitable and desirable. They outline a series of lessons from the Gard case and propose a radical new 'dissensus' framework for future cases of disagreement. . This new book critically examines the core ethical questions at the heart of disputes about medical treatment for children. The contents review prominent cases of disagreement from the UK and internationally and analyse some of the distinctive and challenging features around treatment disputes in the 21st century. The book proposes a radical new framework for future cases of disagreement around the care of gravely ill people.

"Because the discipline of medical ethics has developed with autonomy as its foundation, the field has ignored pediatric ethics. The book is resoundingly successful in its effort to rectify this problem.... [A] pleasure to read." -- Eric D. Kodish, M.D., Director, Rainbow Center for Pediatric Ethics, Case Western Reserve University Using a form of medical ethnography to investigate a variety of pediatric contexts, Richard B. Miller tests the fit of different ethical approaches in various medical settings to arrive at a new paradigm for how best to care for children. Miller contends that the principle of beneficence must take priority over autonomy in the treatment of children. Yet what is best for the child is a decision that doctors cannot make alone. In making and implementing such decisions, Miller argues, doctors must become part of a "therapeutic alliance" with families and the child undergoing medical care to come up with the best solution. Children, Ethics, and Modern Medicine combines strong philosophical argumentation with firsthand knowledge of the issues facing children and families in pediatric care. This book will be an invaluable asset to medical ethicists and practitioners in pediatric care, as well as parents struggling with ethical issues in the care of their children.

In recent decades, advances in biomedical research have helped save or lengthen the lives of children around the world. With improved therapies, child and adolescent mortality rates have decreased significantly in the last half century. Despite these advances, pediatricians and others argue that children have not shared equally with adults in biomedical advances. Even though we want children to benefit from the dramatic and accelerating rate of progress in medical care that has been fueled by scientific research, we do not want to place children at risk of being harmed by participating in clinical studies. Ethical Conduct of Clinical Research Involving Children considers the necessities and challenges of this type of research and reviews the ethical and legal standards for conducting it. It also considers problems with the interpretation and application of these standards and conduct, concluding that while children should not be excluded from potentially beneficial clinical studies, some research that is ethically permissible for adults is not acceptable for children, who usually do not have the legal capacity or maturity to make informed decisions about research participation. The book looks at the need for appropriate pediatric expertise at all stages of the design, review, and conduct of a research project to effectively implement policies to protect children. It argues persuasively that a robust system for protecting human research participants in general is a necessary foundation for protecting child research participants in particular.

"The question of whether and how decisions are made in respect of a child's medical treatment has become a matter of significant public controversy following the highly publicised cases of Charlie Gard (Great Ormond Street Hospital v Yates [2017]) and Alfie Evans (Alder Hey Children's NHS Foundation Trust v Evans et al [2018]). In light of this background, this timely collection brings together commentators from law, medical ethics and clinical medicine, actively drawing on the view from the clinic as well as philosophical, legal and sociological perspectives on the crucial question of who should decide about the fate of a child suffering from a serious illness. In particular, the collection looks at whether the current 'best interests' threshold is the appropriate boundary for legal intervention, or whether it is appropriate to adopt the 'risk of significant harm' approach proposed in Yates. Moreover, it explores the respective roles of parents, doctors and the courts and the possible risks of inappropriate state intrusion in parental decision-making, and how we might address them"--

The Best Pharmaceuticals for Children Act (BPCA) and the Pediatric Research Equity Act (PREA) were designed to encourage more pediatric studies of drugs used for children. The FDA asked the IOM to review aspects of pediatric studies and changes in product labeling that resulted from BPCA and PREA and their predecessor policies, as well as assess the incentives for pediatric studies of biologics and the extent to which biologics have been studied in children. The IOM committee concludes that these policies have helped provide clinicians who care for children with better information about the efficacy, safety, and appropriate prescribing of drugs. The IOM suggests that more can be done to increase knowledge about drugs used by children and thereby improve the clinical care, health, and well-being of the nation's children.

Pediatric medical ethics are very different from any other clinical setting. This collection presents possible cases and scenarios to help caregivers be better-prepared for complicated ethical questions.