Children dependent upon life-prolonging medical technology are often subject to a constant background risk
of sudden death or catastrophic complications. Such children can be cared for in hospital, in an intensive care
environment with highly trained nurses and doctors able to deliver specialised, life-saving care immediately.
However, remaining in hospital, when life expectancy is limited can considered to be a harm in of itself.
Discharge home offers the possibility for an improved quality of life for the child and her family but comes with
significant medical risks.
When making decisions for children, two ethical models predominate, the promotion of the child's best
interests or the avoidance of harm. However, in some circumstances, particularly for children with life-limiting
and / or life-threatening illness, all options may be associated with risk. There are no good options, only
potentially harmful choices.
In this paper we explore decisions made by one family in such circumstances. We describe a model adopted
from risk management programmes beyond medicine, that offers a potential framework for identifying risks to
the child that are morally permissible. Some risks and harms to a child, not ordinarily permitted, may be
acceptable when undertaken in the pursuit of a specified desired good, so long as they are As Low as
Reasonably Practicable.
