UK Paediatricians’ medical decision-making for severely disabled children: a socio-legal analysis
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Date
28/11/2018Author
Picton-Howell, Zoe
Metadata
Abstract
This thesis aims to illuminate how paediatricians in the United Kingdom (UK) make difficult
medical decisions when treating severely disabled children with complex health conditions. In
particular, it examines the part played, if any, by law, rights, and ethics in those decisions. After
drawing on jurisprudence of the English and European Human Rights Court, together with
existing scholarship, to analyse the doctors’ decision making, this thesis adopts a legal
consciousness theoretical approach. Using this it looks at how the paediatricians make sense of
and conceptualise law when making these decisions. It examines how decisions are, by the
paediatricians’ own accounts, commonly made at present and what the paediatricians say about
how they and their colleagues make such decisions.
This thesis addresses the following research questions:
i) Which decisions do UK paediatricians find particularly difficult when working with
disabled children and what makes those decisions particularly difficult?
ii) What factors do UK paediatricians take into consideration when making difficult
decisions for disabled children and what weight do they put on those factors?
iii) What formal education in law, rights, and ethics have the doctors received and to
what extent, if any, can we discern how this education impacts on their difficult
decisions for disabled children?
iv) How do UK paediatricians construct and understand the law, rights, and ethics
when making their difficult decisions?
This thesis makes an original contribution, being the first in-depth socio-legal study examining
UK paediatricians’ medical decision-making for severely disabled children, by identifying two
distinct styles paediatricians adopt when approaching best interest decisions, and by
recommending a new category of legal consciousness. It concludes by recommending
research and changes both in doctors’ training and approach to best interest decision-making to
address the current challenges paediatricians describe facing when deciding for severely
disabled children.