Ethics

Abstract

The three decades covered by this history saw profound changes in public and professional attitudes to severe disability and ‘end-of-life’ decisions. The paternalistic attitude of an earlier generation was replaced by a welcome move to a more consensual approach, key to which was open discussion with parents, children and young patients. Neil McIntosh, a distinguished neonatologist and professor of child health and health in Edinburgh, leads much of this change, and the principles established in the report of the College working party he chaired withholding and withdrawing life-sustaining medical treatment, criticised initially by the medical establishment, have been widely adopted in clinical practice. These form the basis of the present-day guidance, the evolution of which is reviewed by two great Ormond Street paediatricians, Vic Larcher and Joe Brierley.