Legal basis for ethical withholding and withdrawing life-sustaining medical treatment from infants and children.

Withholding and withdrawing life-sustaining medical treatment is common in hospitals, particularly in intensive care unit environments. Usually, decisions regarding limitation of therapy are based on ethical considerations and derived by discussion and mutual agreement between parents and clinicians. However, disputes sometimes arise. When such disputes are settled in court, the judgements constitute common law and may serve as the basis for ethical decisions. All cases have been decided in the 'best interests' of the unfortunate child. Although each case has its own circumstances, a composite view reveals three legal criteria for withholding or withdrawing treatment. These are based on the present and future 'quality of life', 'futility' of present treatment and a comparison of 'burdens versus benefits' of present and future treatment and its discontinuance. These legal principles may facilitate difficult ethical decisions. This article identifies a number of common law cases which establishes these principles.