By Helen Turnham and Dominic Wilkinson

Following the release of the judgment in Abbasi and Haastrup [2023] EWCA Civ 331 Abbasi and another (Respondents) v Newcastle upon Tyne Hospitals NHS Foundation Trust (Appellant); Haastrup (Respondent) v King’s College Hospital NHS Foundation Trust (Appellant) – UK Supreme Court, April 2025, a ripple of conversation and concern flowed through the community of doctors who care for critically-ill children on the edge of life.  These are doctors who, on very rare occasions, seek assistance from the Courts when disagreements arise with families or their surrogates about what is the best course of treatment for a child – and who, until this ruling, had benefited from indefinite restrictions on naming them.

But why do doctors wish to remain anonymous, and what do they have to hide? Why were doctors afforded anonymity when the lawyers representing each side of contentious cases, and the Judges making the final decisions, were not?

Very few doctors involved in a Court case are worried about the facts of the case being aired, but instead may be concerned about untrue statements being made that they cannot defend, due to their need to protect the confidentiality of the child.  Doctors might even be worried about threats or harm to them and their own families.

A paediatric Intensive Care Unit (PICU) is a prime example of where such cases might originate.  Each day, parents around the United Kingdom place their trust in the doctors, nurses and allied health professionals around their child in PICU to care for them, act in their best interests in the hope that their child will recover.  In turn, those professionals take their duties seriously, careful to act in the best interests of the child placed in their care, to use their knowledge and experience alongside close teamwork to aid the child. Not all children who are admitted into intensive care are able to recover. Some reach the end of their lives there and they, their families and friends are supported by this same dedicated team of professionals to care for them at the end of their life.

Rarely, there are disagreements about what constitutes best interests of a particular child. It is highly unusual for doctors and the wider health team to disagree with parents about what is best for the child and be unable to work together towards an agreed plan of action. It is always a very last resort for a case to be presented to the Courts.

What might constitute such circumstances? Rarely there when there are no treatments available that will allow a child to recover, continued delivery of life-sustaining treatment might, in some circumstances, be painful and, or distressing for the child. Parents might hope for a miracle and a new treatment that might allow their child to live a healthy life and wish life sustaining treatment to continue. Doctors, nurses and other professionals might experience the phenomenon of moral distress, caring for some children. Delivering treatment that is painful or distressing for the child for hours, days and months at a time with little or no perceivable benefit to the child. Parents and doctors might disagree to what treatments are beneficial for the child and which are harmful. What is in their interests to continue and what should be stopped to allow the child to be comfortable and not in distress. There is no doubt in these challenging cases that all parties have the best interests of the child at heart. But what constitutes those interests might differ.

In the jurisdiction of England and Wales, by power of Parens Patrie, the Courts have final recourse to decide what is in the best interest of a child. When there is disagreement between medical teams and parents or surrogates about what is best for the child and the case is required to go to court an individual doctor pursues the case on behalf of the whole team. Rightly, this is a rigorous and difficult process, and it takes resilience, strength and tenacity on the part of that doctor. Few doctors who have experienced a court case have escaped unscathed. It is right that those doctors should be protected and supported.

The ruling is clear, doctors are not to be afforded protections greater than any other individual in the public (bar perhaps police informers and spies..). But they are still protected against threats and untruths. Importantly in the initial and fraught period when the doctors must focus on caring for the child, they are afforded anonymity if this is sought by the legal teams representing them. It is the continued anonymity in perpetuity that is now ruled to infringe the rights of others.  There might be circumstances where continued anonymity is required but this must be proven separately and not presumed as was the case previously.

There is no doubt that for doctors, pursuing a case in the interests of a named child is difficult and challenging, some doctors might continue to be concerned that if they are named they might be unable to defend themselves against publication of untruths or they might be subject to personal threats. But doctors do remain protected against these, as all citizens are.

There are steps that could be helpful to the doctors who find themselves pursuing cases to the courts.

1. Shared professional decision-making. In practice most medical teams such as those working in intensive care and other areas work closely as a team. An individual doctor retains the overall responsibility for care of a patient, but cases are closely discussed. Making this process more formal, so that complex and difficult cases where there is conflict of opinion are always discussed as a team and consensus of opinion taken into account for all decisions.
2. Routine and transparent access to independent second opinions from colleagues in other hospitals. It is important that both the professionals caring for a child and their family or surrogates of have confidence in the independence of second opinions. Those providing second opinions should undertake specialist training and it should be part of their professional job plan and reimbursed accordingly. A transparent process for appointing a second opinion should be in place nationally.
3. More routine discussion of difficult cases where there is conflict with Clinical Ethics Advice from clinical ethics advisory groups. With patient and parent views represented. Greater access to all doctors to experts in clinical ethics.
4. Greater access to Medical Mediation and professional conflict management where there are cases of disagreement between doctors and patients or parents and their surrogates.
5. Formal Media and communications training and support for medical professionals

Most importantly is a plea, that doctors, continue to take on this most difficult burden of applying to the courts to protect the interests of a child when it is absolutely needed. If we are deterred from bringing the very rare and most difficult cases to court, there is risk that children will suffer, we should keep the best interests of the child, first and always at the centre of all we do now as we have always.

Authors: Helen Turnham and Dominic Wilkinson

Affiliations: HT: Consultant in Paediatric Critical Care and Co-Chair Clinical Ethics Advisory Group, Oxford University Hospitals NHS Trust ; DW: Consultant in Newborn Care and Co-Chair Clinical Ethics Advisory Group, Professor of clinical Ethics, Oxford University Hospitals NHS Trust and Uherio Centre for Practical Ethics, University of Oxford

Competing Interests: None

Social Media Handles: X: @helenturnham