Extensive guidance now at RCPCH.

Social media and access to Google mean families can find out about novel and unproven interventions/diagnoses. Some notorious cases where it has resulted in conflict between clinicians and families.

External second opinion (ESO) system requires “experts”, who have intimate knowledge of the case, without bias. All of which can be problematic.

Parents do NOT have a legal right to request a second opinion. Seeking an ESO could however been as within a doctor’s professional duty, if “in the best interests of the child”. A doctor does however need to to demonstrate they have provided appropriate care for their patients, which includes showing they have weighed risks against benefits, and made reasonable and logical decisions. These decisions must be in line with ‘a responsible body of medical opinion’.

GMC guidance specifically requires doctors to “respect the patient’s right to seek a second opinion”, as they have the right to make free, informed health care choices – to do that involves clarifying clinical facts and defining treatment options. So refusing a request for an ESO could breach a doctor’s obligation to respect patients’ rights and to provide the highest standard of care.

Courts will take account of professional and clinical guidance that it is good practice to request an ESO, as a way of determining what constitutes a responsible body of opinion. Of course it is not always feasible to obtain a second (or expert) opinion, particularly in situations where a decision must be made quickly.

Nuffield Council on bioethics review went to government – https://cdn.nuffieldbioethics.org/wp-content/uploads/NCOB-Disagreements-Critical-Care-Indepdent-Review-FINAL.pdf