This thesis aims to illuminate how paediatricians in the United Kingdom (UK) make difficult medical decisions when treating severely disabled children with complex health conditions. In particular, it examines the part played, if any, by law, rights, and ethics in those decisions. After drawing on jurisprudence of the English and European Human Rights Court, together with existing scholarship, to analyse the doctors' decision making, this thesis adopts a legal consciousness theoretical approach. Using this it looks at how the paediatricians make sense of and conceptualise law when making these decisions. It examines how decisions are, by the paediatricians' own accounts, commonly made at present and what the paediatricians say about how they and their colleagues make such decisions. This thesis addresses the following research questions: i) Which decisions do UK paediatricians find particularly difficult when working with disabled children and what makes those decisions particularly difficult? ii) What factors do UK paediatricians take into consideration when making difficult decisions for disabled children and what weight do they put on those factors? iii) What formal education in law, rights, and ethics have the doctors received and to what extent, if any, can we discern how this education impacts on their difficult decisions for disabled children? iv) How do UK paediatricians construct and understand the law, rights, and ethics when making their difficult decisions? This thesis makes an original contribution, being the first in-depth socio-legal study examining UK paediatricians' medical decision-making for severely disabled children, by identifying two distinct styles paediatricians adopt when approaching best interest decisions, and by recommending a new category of legal consciousness. It concludes by recommending research and changes both in doctors' training and approach to best interest decision-making to address the current challenges paediatricians describe facing when deciding for severely disabled children.

Text in Afrikaans / lnternasionale erkenning van die konsep van kinderregte skep die grondslag vir state om op nasionale vlak inisiatiewe te loads wat op die kweek van 'n kinderregtekultuur gerig is, wat sal meebring dat 'n sensitiwiteit vir kinderregte ontwikkel en prioriteit aan die beskerming van daardie regte verleen word. Dit is 'n omvattende taak wat grondwetlike bepalings raak en wetgewing en administratiewe programme vereis ten einde 'n balans te vind tussen ouers se aansprake op gesinsoutonomie en die strewe om in gepaste gevalle aan kinders die bevoegdheid te verleen om self besluite oar hul lewens te neem. Die belangeatweging vind plaas teen die agtergrond van die primere oorweging van die beste belange van kinders ten opsigte van aspekte wat hulle raak . . / International recognition of the concept of children's rights lays the foundation for states to launch initiatives on national level which are aimed at developing a culture of children's rights. This will lead to an increased sensitivity to children's rights and the fact that priority will be given to the protection of those rights. It is a wide·ranging task which affects constitutional provisions and requires legislation and administrative programmes in order to strike a balance between parents' claims to the autonomy of the family and the attempt to enable children, in suitable instances, to make decisions about their lives themselves. This weighing up of interests takes place against the background of the primary consideration of the best interests of children with respect to aspects which affect them. / Constitutional, International and Indigenous Law / (LL.M)

Text in Afrikaans / lnternasionale erkenning van die konsep van kinderregte skep die grondslag vir state om op nasionale vlak inisiatiewe te loads wat op die kweek van 'n kinderregtekultuur gerig is, wat sal meebring dat 'n sensitiwiteit vir kinderregte ontwikkel en prioriteit aan die beskerming van daardie regte verleen word. Dit is 'n omvattende taak wat grondwetlike bepalings raak en wetgewing en administratiewe programme vereis ten einde 'n balans te vind tussen ouers se aansprake op gesinsoutonomie en die strewe om in gepaste gevalle aan kinders die bevoegdheid te verleen om self besluite oar hul lewens te neem. Die belangeatweging vind plaas teen die agtergrond van die primere oorweging van die beste belange van kinders ten opsigte van aspekte wat hulle raak . . / International recognition of the concept of children's rights lays the foundation for states to launch initiatives on national level which are aimed at developing a culture of children's rights. This will lead to an increased sensitivity to children's rights and the fact that priority will be given to the protection of those rights. It is a wide·ranging task which affects constitutional provisions and requires legislation and administrative programmes in order to strike a balance between parents' claims to the autonomy of the family and the attempt to enable children, in suitable instances, to make decisions about their lives themselves. This weighing up of interests takes place against the background of the primary consideration of the best interests of children with respect to aspects which affect them. / Constitutional, International and Indigenous Law / (LL.M)

Le rapport traditionnel entre responsabilité pénale et secret sacramentel a laissé place à un nouveau rapport controversé. La modernisation, la laïcisation des sociétés, la nécessité d’adapter la justice au besoin grandissant de la société en sécurité, les implications de membres du clergé dans les scandales de pédophilie, le silence longtemps gardé par l’Église sur ces implications et sa gestion à l’interne de ces scandales et enfin le pluralisme et l’intégrisme religieux sont autant de facteurs qui ont contribué à changer le discours du droit étatique sur le secret sacramentel. Autrefois la divulgation du secret sacramentel était sujette à la poursuite en justice. Aujourd’hui, c’est plutôt la rétention de l’information criminelle qui est susceptible d’engager la responsabilité pénale du confesseur. Ce nouveau rapport qui s’est établi entre la responsabilité pénale et le secret sacramentel ne s’accorde pas au discours de l’Église catholique pour qui le secret sacramentel doit demeurer un droit absolu, passible d’excommunication en cas de violation. Le conflit est évident et la recherche de solution impérieuse. Comment résoudre l’énigme du secret sacramentel dans une société à double vitesse qui cherche à concilier transparence absolue et dignité humaine : la première appelant à la divulgation de l’information au détriment de la dignité humaine et la seconde, sa rétention, au préjudice de la sécurité du citoyen? Le cas des agressions sexuelles commises sur mineurs est celui qui, actuellement, alarme au plus haut point la société. Cette problématique du secret sacramentel aux prises avec les nouvelles exigences légales de dénonciation est commune à plusieurs aires géographiques, mais les approches de solutions ne sont pas pareilles. La recherche d’un rapport plus conciliant entre ledit secret et la responsabilité pénale pourrait passer par la comparaison de plusieurs droits positifs. Le modèle de droit français paraît moins attentatoire au droit à la liberté de religion du pénitent et du prêtre catholique en l’occurrence. Et c’est à la lumière de celui-ci que nous proposons une réforme du modèle québécois dont le droit à la protection de la jeunesse pénalise le secret sacramentel. C’est sur les théories de « gouvernance conjointe » dont l’accommodement transformatif est le corollaire, de « relevance juridique » et de pluralisme de « coopération » développées respectivement par Ayelet Shachar, Santi Romano et Mireille Delmas-Marty, que s’appuie cette thèse pour modéliser une nouvelle relation entre le droit positif québécois et le droit canonique au sujet de ce qui les oppose. Il est un impératif pour l’Église de préserver la confiance des pénitents qui se présentent au sacrement de pénitence pour éviter de faire du confesseur un agent pénal ou un délateur. Mais la sécurité des enfants au sein des communautés ecclésiales et leur confiance en une Église qui les protège et les défend en est aussi un. L’aggiornamento juridique en cours dans l’Église et qui s’appuie sur une sauvegarde du droit du délinquant, une préservation du droit de l’Église à son identité, mais aussi et surtout sur un renforcement du droit de la victime, est une contribution substantielle de l’Église à la répression et à la lutte contre l’abus sexuel des enfants et constitue une preuve de sa bonne foi. / The traditional relationship between criminal responsibility and sacramental secrecy has given way to a controversial new report. Modernization, the secularization of societies, the need to adapt justice to the growing need of society in security, the implications of members of the clergy in pedophilia scandals, the Church's long silence on these implications and its internal management of these scandals, and finally religious pluralism and religious fundamentalism have all contributed to changing the discourse of state law on Sacramental secret. Formerly the disclosure of sacramental secrecy was subject to prosecution. Today, it is rather the retention of criminal information which is liable to incur the criminal responsibility of the confessor. This new relationship between penal responsibility and sacramental secrecy does not agree with the language of the Catholic Church, for whom sacramental secrecy must remain an absolute right subject to excommunication in case of violation. The controversy is obvious and the search for a compelling solution is imperious. How to solve the enigma of sacramental secrecy in a two-speed society that seeks to conciliate absolute transparency and human dignity: the first calling for the disclosure of information to the detriment of human dignity and the second, retention, to the detriment of the safety of the citizen. The case of sexual assaults committed against minors is the one that, currently, alarm society at the highest level. This issue of sacramental secrecy facing the new legal requirements of denunciation is common to several geographical areas, but the approaches of solutions are not the same. The search for a more conciliatory relationship between the secrecy and criminal responsibility could go through the comparison of several positive rights. The model of French law appears to be less intrusive to the right to freedom of religion of the penitent and the Catholic priest in this case. And it is in light of this law that we propose a reform of the Quebec model whose right to the protection of youth penalizes the sacramental secrecy. It is on the theories of "joint governance" whose transformative accommodation is the corollary, of "legal relevance" and pluralism of cooperation respectively developed by Ayelet Shachar, Santi Romano and Mireille Delmas-Marty, that this thesis is based on modeling a new relationship between the positive law of Quebec and canon law about what is opposed to them. It is an imperative for the Church to preserve the confidence of the penitents who present themselves to the sacrament of penance in order to avoid making the confessor a criminal agent or an informer. But the safety of children in ecclesial communities and their confidence in a Church that protects and defends them is also one. The legal aggiornamento in the Church, based on a safeguarding of the right of the offender, preservation of the right of the Church to its identity, but also and above all on strengthening the right of the victim, is a substantial contribution of the Church to the repression and the fight against the sexual abuse of children and constitutes proof of its good faith.