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Bol Med Hosp Infant Mex. 2015 Jul - Aug;72(4):284-289. doi: 10.1016/j.bmhimx.2015.07.002. Epub 2015 Sep 8.

[Informed consent and parental refusal for medical treatment in childhood. The threshold of medical and social tolerance. Part II].

[Article in Spanish]

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Servicio de la Dirección de Investigación, Hospital Infantil de México Federico Gómez, México D.F., México. Electronic address:
Subdireccción de Gestión de la Investigación, Hospital Infantil de México Federico Gómez, México D.F., México.
Unidad de Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez, México D.F., México.
Departamento de Historia y Filosofía de la Medicina, Facultad de Medicina, Universidad Nacional Autónoma de México, México D.F., México.


Medical care in pediatric patients is conditional to parental consent. Parents decide the time and type of treatment they want their children to receive when they are ill. The physician should request parental consent before carrying out the most appropriate therapy. When parents refuse the treatment offered, the physician should seek alternative therapies that may be better accepted by parents and find the most beneficial treatment for children and their families. If physicians and parents are unable to agree on the best therapeutic methods, then the physician becomes involved in an ethical conflict related to the best interests of the child and parental choices. From the above posture, the following questions arise: What should the physician do when faced with this situation? Should the physician use legal measures to force parents to accept treatment? Under what conditions is it justified to force parents and when should the decision be tolerated? What is the role of the Hospital Bioethics Committee concerning this issue? This second part focuses on proposing four practical criteria to be used by the physician and Hospital Bioethics Committee when all alternative therapies and conciliatory options have been exhausted with parents and they continue to refuse treatment. The physician then has to make a decision because the child is placed at risk of harm. This decision focuses on whether there is danger to the minor arising from the decisions of parents and if such harm is avoidable.


Bioethics; Bioética; Comités de Ética Clínica; Consentimiento informado; Ethical and Clinical Committees; Informed consent; Menores de edad; Minors

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