Abstract

In this chapter, we consider how a commitment to acting in a child’s interestsChild's interests can be brought to bear on three specific ethical quandaries that face those caring for children at the end of lifeEnd-of-life, and how such a commitment might seem to cohere or be in tension with other principles such as autonomyAutonomy and justiceJustice. We examine the status of ‘do not resuscitateDo Not Resuscitate ’ orders in children and argue that they cannot exist in children in the same form as in adults. Since the standard of ethical permissibility is set by the interestsInterest of the child, rather than the preferencesPreferences of parentParents or doctor, there is no single person with authorityAuthority to agree an adult-style DNRDo Not Resuscitate. Looking at clinically-assisted feeding or hydrationHydration, we argue that withholding, withdrawing, commencing or continuing it each constitutes an intervention and needs to be carefully justified by considering its burdens and harmsHarm in the broadest sense reasonableReasonable. Finally, we consider ‘palliative sedationPalliative sedation’ and suggest that, while there are circumstances under which sedation is an inevitable result of adequate symptom controlSymptom control, impaired consciousness does not of itself represent a way to control symptoms and should not be deliberately induced.