Responding to parental requests for life‐sustaining treatment – relational potential revisited

Fairness, severe intellectual disability, and the special case of transplantation

“…We have recently proposed a reformulation and expansion of Arras’ relational potential standard based upon recognition that in addition to interests and experiences, our relationships with others are part of the basic human goods that make life worth living. A relational potential standard broadens the moral focus of decision‐making to include the child and his or her parents, recognizing the moral value and meaning of the special relationship between parent and child . This remains true even if the child has limited ability to reciprocate and is consistent with other apparently one‐way relationships, such as that of the mother and her newborn, that are generally valued .…”

Highlights in this issue

“…Wightman et al. propose that clinicians should use a relational potential standard rather than a best interest standard when considering parental requests for life‐sustaining treatment for children with severe disabilities . However, Carter thinks that the standard proposed by Wightman et al.…”

Should we always honour parental requests?

“…And when a patient's best interests are unknowable, others’ interests rise to consideration. The paper by Wightman et al clearly gives one response to this confusion. Echoing American philosopher John Arras, these authors grasp fervently to the ‘relational potential standard’ and grant it, in my view, too broad an application.…”

“…How is it then, that Wightman et al hand us a portion of John Arras’ work, and bring us a snippet of another American philosopher, James Walter's, work as a new and better way (than the best interests standard) to approach the questions of continued life support simply at the request of parents? Neither Arras nor Walters endorse ‘apparently one‐way relationships such as that of the mother and her newborn’ when they address children with NDI. Walter's position employed proximate personhood arguments that were contingent upon an imperilled infant having a reasonable potential for minimal personal capacities that include becoming self‐aware (present in the vast majority of newborns – including those in the NICU) and who will derive a net physiologic benefit of treatment.…”

“…Further, in their discussion, Wightman et al note the potential for the power asymmetry between clinicians and parents to pose an impediment to providing compassionate care in support of the parent‐child relationship . While this is a long‐recognised reality when treating clinicians offer care to those who are vulnerable by nature (e.g., children) or made vulnerable by illness (e.g., all patients), on balance such an asymmetry is granted to clinicians by society with an expectation that they attend to their duties to be engaged in the discernment of right action and employ their clinical judgments towards a real benefit for the patient.…”