Alta Fixsler: Medico-legal Paternalism in UK Paediatric Best Interest Decisions

April 1, 2022
Edition: Spring 2022
Volume: 37
Issue: 1
Article: 3

Table of Contents


The case of Alta Fixsler, where a judge ruled that withdrawing life sustaining care was in her best interest rather than transferring her to Israel, as her parents wanted, is the latest in a series of controversial paediatric best interest decisions. Using this case, as well as some other recent cases, I argue that the UK exhibits a high degree of medico-legal paternalism in best interest decisions, even though paternalism seems to be ubiquitously negatively perceived in medical ethics. Firstly, I explain what I mean by medico-legal paternalism and defend my claim that this phenomenon is present in the UK. I then argue that at least philosophically (rather than legally) such a situation is impossible to justify in a secular state and that how we treat paediatric best interest decisions is very different from other areas of medical law. Lastly, I discuss proposals that aim to rectify this situation.

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About the Authors

Affiliation: Department of Medical Physics and Clinical Engineering, Cardiff and Vale University Health Board, Cardiff, Wales, United Kingdom; The author wishes to extend his thanks to James E. Hurford, Bruce P. Blackshaw, Nicholas Colgrove and the anonymous reviewer for suggestions and constructive comments on drafts of this manuscript, as well as Louise Pruski for proofreading.