Associate Prof Lynn Gillam, a specialist in health ethics
at the University of Melbourne, discusses 'the ethics of
decision-making' involving children, at a bioethics
conference in Dunedin yesterday. Photo by Gregor
Long-term effects on family relationships should be
considered before doctors seek a court order to override
parental wishes over a child's medical treatment.
That view was expressed on Friday by Associate Professor Lynn
Gillam, who is a clinical ethicist and academic director of
the Children's Bioethics Centre at the Royal Children's
Hospital, Melbourne and an associate professor in health
ethics at the University of Melbourne.
Prof Gillam was commenting during a plenary talk on ''When
parents and doctors disagree about medical treatment for a
child: the ethics of decision-making'' at the New Zealand
Bioethics Conference, hosted by the University of Otago
One key issue concerned the ''ethical weight to be given to
the views of parents'' when they and doctors disagreed about
treatment or management.
She also noted in an interview that ''the emotional tension
can be really high'' in such circumstances.
During a later question and answer session, a questioner
suggested there was a risk of parents removing their child
from the hospital and ''never seeing them again'', after such
a disagreement. Prof Gillam said the potentially adverse
long-term effect of tensions within a family and other
conflicts resulting from disagreements over treatment also
had to be taken into account.
Disagreement could take place over many different matters,
with parents who were Jehovah's Witnesses refusing to allow
their children to have blood transfusions ''perhaps the most
But parents could refuse '' all sorts of treatment'' for
children, including chemotherapy for cancer and insertion of
catheters or lines.
The first response by medical staff should always be ''to
understand and discuss, but agreement or compromise cannot
always be reached.''
She discussed using the concept of the ''Zone of Parental
Discretion'' as a tool in deciding what ethical weight to
give to parental views.
Parents were recognised legally and ethically as
decision-makers for their children, but ''the authority of
their decisions is not unlimited''.
Where serious harm, including loss of life, could result from
a parental decision, parental discretion should be resisted
or overridden, she said.