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Pediatrics. 2019 Oct;144(4). pii: e20183939. doi: 10.1542/peds.2018-3939. Epub 2019 Sep 4.

Failure to Provide Adequate Palliative Care May Be Medical Neglect.

Author information

1
Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.
2
Sidney Kidney Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
3
Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa; and.
4
Center for Bioethics, Children's Mercy Hospital, Kansas City, Missouri jlantos@cmh.edu.

Abstract

Doctors are required to notify Child Protective Services (CPS) if parents do not provide appropriate medical care for their children. But criteria for reporting medical neglect are vague. Which treatments properly fall within the realm of shared decision-making in which parents can decide whether to accept doctors' recommendations? Which treatments are so clearly in the child's interest that it would be neglectful to refuse them? When to report medical neglect concerns to CPS may be controversial. It would seem inhumane to allow a child to suffer because of parental refusal to administer proper analgesia. In this ethics rounds, we present a case of an adolescent with chronic pain who is terminally ill. Her parents were not adherent to recommended analgesia regimens. Her palliative care team had to decide whether to report the case to CPS.

PMID:
31484675
DOI:
10.1542/peds.2018-3939

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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