Il miglior interesse del bambino al centro del triangolo pediatrico: una cifra del modo di intendere la genitorialità e l’esigenza di un sensus communis

The article takes its cue from two cases about end-life decisions regarding children, as examples of the eternal dilemma between the proprietary concept of parenthood as an absolute, unlimited authority and the concept of parenthood as a limited authority oriented on the best interests of the child. The Oviedo convention reflects the latter position, preferring to use the word authorisation instead of the common expression consent on behalf of the child. In fact, authorisation relates to the concept of a third authority, such as parental responsibility, which implies a different framework than that of informed consent. This is the concept of the child's best interests as the fundamental criterion of making decisions regarding children in conformity with the provision in the United Nations Convention on the Rights of the Child. Since informed consent can be seen as an expression of personal choice, it can only be given by the person who is to be provided with health care and only if this person is competent. Therefore, the word authorisation is preferable, because it evokes the idea that decision is made in the interests of the child and not as a personal choice of the parents. As a result, when treatment prove to be futile and may well cause pain, suffering and distress to the child, withdrawal of the treatment, although a life-sustaining one, can be done even if the parents deny their authorisation. In these cases, i.e. in the event of doubts as to the best decision in the patient’s best interests, hospital has the duty to approach the courts. However, decisions like this cannot be taken without respect and appropriate communication with the parents, reasonable attempts to let them participate and share the decision and offer of psychological help.