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Child Welfare. 1993 Jul-Aug;72(4):323-40.

Child welfare services for the catastrophically ill newborn: Part I--A confusion of responsibility.

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Institute for Human Services, Columbus, OH.


The majority of these difficult bioethical decisions should properly be made by parents with input from physician and health care workers, utilizing the resources and guidance of infant ethics committees within the involved hospitals. The child protective service system should have the final authority, however, to assure that the decisions of the "caregivers" do not constitute abuse or neglect. This will require that the child welfare system sometimes walk the razor's edge between protecting the child's best interests and preserving, facilitating, and empowering families in these difficult circumstances. But this is an ethical dilemma the child welfare system negotiates daily, and is perhaps the reason used to justify assigning the child welfare system this responsibility. It will also require that the child welfare field have a consensus bioethical paradigm for treatment decision-making for children born with catastrophic illness. Consistent treatment decisions in the best interests of our most vulnerable children cannot be assured, or even expected, without such standardized guidelines.

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