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Making decisions to limit treatment in life-limiting and life-threatening conditions in children: a framework for practice (DtLT)

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The current framework is available on the Archives on Disease in Childhood website. It was published in 2014 (and superseded a previous version in 2004) and provides guidance on one of the most ethically complex areas in paediatrics: when to withhold or withdraw life-sustaining treatment in children. We are updating this for expected publication in late 2026.

About the framework

The current framework reflects advances in paediatric care while acknowledging the growing role of children and families in decision-making. It emphasises shared decision-making, the child’s best interests and the importance of involving children and young people wherever feasible. It outlines legal and ethical considerations, including parental responsibility, the role of the courts and quality-of-life assessments. It also addresses the needs of children with disabilities and the importance of bereavement support for families.

The framework is a source of information for many areas involved with paediatric care, and has been referred to in judgements outside of the wider paediatric sphere.

Planned update

Status: Ongoing development; final scope available to download below

Estimated publication: Late 2026 

RCPCH is updating the framework to ensure it reflects the latest evidence and clinical practice. Please note its title will also be updated.

If you have any questions or concerns, please contact the Guidelines team on guidelines@rcpch.ac.uk and one of our team will be happy to get back to you on this subject.