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3 - Parental refusals of recommended medical interventions

from Section 1 - Core issues in clinical pediatric ethics

Published online by Cambridge University Press:  07 October 2011

Douglas S. Diekema
Affiliation:
Seattle Children's Research Institute
Mark R. Mercurio
Affiliation:
Yale University School of Medicine
Mary B. Adam
Affiliation:
Department of Pediatrics, University of Arizona School of Medicine, Tucson
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Summary

Case narrative

A 3-year-old child is brought to the emergency department by his parents who have concerns about a head injury. The day before, the child had been playing on the monkey bars when he fell about 4 feet and hit his head on the ground. He did not lose consciousness, and after about 15 minutes of crying, appeared to be fine. Today, however, he has been complaining that his head hurts and has been vomiting. He has vomited three times since arriving in the emergency department and continues to complain of a headache. The emergency department physician tells the parents that he is concerned about the possibility of intracranial bleeding and feels a CT scan of the head is essential to make a timely diagnosis and intervene if necessary. The parents are convinced that previous X-rays gave their son some learning problems, and refuse to consent to the CT scan.

Introduction

Responding to a parent who has refused a recommended diagnostic study or treatment modality presents a difficult challenge for clinicians. Clinicians must balance their assessment of the child’s well-being with respect for the parent’s wishes and legal rights. What are the limitations on a parent’s right to refuse diagnostic testing or treatment for a child? How does a clinician resolve conflicts between the parent’s values and his or her own as a medical professional? At what point should a clinician consider interfering with a parental decision to ignore the clinician’s recommended course of diagnosis and/or treatment? What are the steps a clinician must take in order to justify involving state agencies to compel testing or treatment over parental objections?

Type
Chapter
Information
Clinical Ethics in Pediatrics
A Case-Based Textbook
, pp. 14 - 17
Publisher: Cambridge University Press
Print publication year: 2011

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References

Committee on Bioethics, American Academy of Pediatrics 1997 Religious objections to medical carePediatrics 99 279Google Scholar
Diekema, D.S. 2004 Parental refusals of medical treatment: the harm principle as threshold for state interventionTheoretical Medicine and Bioethics 25 243Google Scholar
Dworkin, G. 1982 Who Speaks for the Child: The Problems of Proxy ConsentGaylin, W.Macklin, R.New YorkPlenum Press
Feinberg, J. 1984 Harm to Others: The Moral Limits of the Criminal LawNew YorkOxford University Press
Hanisco, C.M. 2000 Acknowledging the hypocrisy: granting minors the right to choose their medical treatmentNew York Law School Journal of Human Rights 16 899Google Scholar
Miller, R.B. 2003 Children, Ethics, and Modern MedicineBloomington, INIndiana University Press
Ross, L.F. 1998 Children, Families, and Health Care Decision-MakingNew YorkOxford University Press

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