Zone of parental discretion
When parents and healthcare professionals disagree about a particular treatment for a child and what constitutes the child’s best interests, the ‘zone of parental discretion’ can be a useful ethical tool to consider whether the parents’ preferences should be accepted1. Parents may refuse medically recommended treatment, or may request (or demand) treatment that is not recommended. The ‘zone of parental discretion’ focuses on whether the child would be harmed if the parents’ preferences were carried out.
If a treatment is expected to produce a very favourable outcome and the parents refuse the recommended treatment, it is likely that a court would mandate that the treatment be given; for example, providing a blood transfusion to a child who is bleeding and whose family are Jehovah’s Witnesses.
On the other hand, clinicians are not required to offer a treatment that is unlikely to be beneficial, particularly if it is also burdensome or the likelihood of adverse effects is high. For example, if parents ask for mechanical ventilation to be started in a child with a progressive advanced metabolic or neurological condition, a court would likely support the clinician’s view that this treatment should not be provided.
Between these 2 scenarios lies the ‘zone of parental discretion’, where decisions about a child’s best interests are uncertain or open to interpretation. For example, the use of complementary and alternative therapies at the end of life is within the ‘zone of parental discretion’. The boundary of this zone occurs at the point where the proposed treatment would cause significant harm to the child, rather than being potentially unhelpful or not optimal. When a decision is considered to fall into the ‘zone of parental discretion’ and the treatment (or nontreatment) requested by the parents is not likely to harm the child, healthcare professionals must respect the parents’ decision, unless doing so constitutes abuse, neglect or violates the child’s rights.