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There are variations across Europe in provision of and organization of ethics consultation, as well as in the approach to ethical questions. However, one common thread is that the predominant ethical consideration for decision making for children should be the best interests of the child. The European Convention on Human Rights (ECHR) influences the ethics environment in the continent. The convention places greater weight on the interests of the child than on the wishes of the parents; parental ethical rights are understood to be the product of parental duties and the primary duty of a parent is to promote the interests of the child. The chapter explores how the concept of Best Interests (BI) has been understood and interpreted in Europe. The chapter also examines the European approach to two thorny ethical issues in pediatrics. Firstly, decision making at the end of life for children is examined. Variations between European nations have been marked in the past but there is some evidence of increasing standardization. Secondly, refusals of life saving medical treatments by minors are explored. Across Europe there is increasing emphasis on the child as an independent moral agent with rights to self-determination including potentially the right to refuse treatment.

Original publication





Book title

Philosophy and Medicine

Publication Date





209 - 216