Stopping treatment for end-stage renal failure: the rights of children and adolescents.

Dialysis and transplantation have been of obvious benefit to children with renal failure. Yet this is not always so. End-stage treatment can also create physical and mental suffering, for both patients and their families. For this reason, the availability of life-saving treatment creates difficult ethical and legal dilemmas concerning when it can morally and lawfully be rejected. These dilemmas are explored through a general account of the doctrine of informed consent and its application to the refusal of such therapy. Clinical and parental duties of care are outlined for young and adolescent children. For young children, the rights of parents are evaluated, recognising the significance of parental involvement and support for treatment for renal failure to be successful. It is further argued that adolescents who are deemed to be competent to give informed consent have the moral right to choose to die rather than to continue treatment. To minimise this prospect, the importance of effective counselling and peer group support is made clear, along with a partnership model of clinical negotiation.