If Parent Refuses Treatment, Act in Child's Best Interest
If a parent objects to a medical evaluation or treatment of a child with a potentially life-threatening emergency, due to religious beliefs or any other reason, says Kevin M. Klauer, DO, EJD, FACEP, chief medical officer of Emergency Medicine Physicians in Canton, OH, the emergency physician (EP) can get a court order to get the child treated.
"The court may award temporary custody to a governmental agency or local authority to obtain the necessary care. The child will likely be brought back to the ED for treatment," he says.
If the EP has any bodily contact with the parents, or attempts to prevent the child or the parents from leaving the ED, however, he or she may face potential charges of assault and battery or false imprisonment.
"Although you are acting in the best interest of the child, you could run into trouble," says Klauer. "Unless it's an extreme case of abuse, you are going to be on less firm footing by physically removing the child from the parent."
Removing the child or detaining the parents is best deferred to law enforcement, he adds, once the appropriate authorization has been obtained.
If a delay in treatment is clearly harmful for a child, the EP should contact the local magistrate in order to have custody removed temporarily and the child brought back for treatment. "You have done all you could to provide good care, and you haven't exceeded your scope of practice or violated their rights in the process," Klauer says.
Do What's Reasonable
To reduce legal risks for the ED, Klauer says, "if it makes sense from a common sense standpoint, most of the time, you should go ahead and do it."
For life- or limb-threatening emergencies in children, "we as EPs are covered by doing the right thing for the patient, even if the parents are not present, including giving blood to Jehovah's witness patients," says Ghazala Q. Sharieff, MD, MBA, director of pediatric emergency medicine at Palomar-Pomerado Health System in San Diego.
Many states rely on the legal tenet of "implied consent," meaning that a patient came to the ED because he or she needed treatment, according to Michael Gerardi, MD, FAAP, FACEP, director of pediatric emergency medicine at Goryeb Children's Hospital in Morristown, NJ, and president of Superior Risk Retention Group in Livingston, NJ.
"If a parent doesn't want to consent to a life-saving study, states have usually ruled in favor of the physician," he says. "They do not want to recognize the parent's authority to deny care to a child."
Even if parents are refusing treatment for a child due to religious or other beliefs, says Gerardi, EPs should follow the standard of care and what a reasonable person would want in the situation.
"Think about this issue ahead of time, and be familiar with your obligations. People sometimes get caught up in the legal aspect instead of what is reasonable," says Gerardi, adding that if you have a child with a life- or limb-threatening condition, you should proceed as if they have consented.
"If the child was given a transfusion because he was in impending decompensated shock, you may end up in a court of law but you are going to win," says Gerardi. "You don't want to see yourself in a New York Times story with the headline, 'Doctor lets child bleed to death because parent refuses to give blood.'"
States will back whatever the EP does to protect the rights of the child in this scenario, he says.
If you sense reticence on the part of the consenting adult, Gerardi recommends documenting, "The risk/benefit analysis was not as apparent to the parent as it was to the medically treating team. Extensive discussion ensued about the proposed procedure and the negative consequences of lack of consent. The decision was made to proceed because of risk of loss of life."
"Involve another colleague in the case anytime you have a significant disagreement and you can't get them to see your logic," he adds.
Source
For more information, contact:
Michael Gerardi, MD, FAAP, FACEP, Director, Pediatric Emergency Medicine, Goryeb Children's Hospital, Morristown, NY. Phone: (973) 740-0607. Fax: (973) 740-9895. E-mail: [email protected].
If a parent objects to a medical evaluation or treatment of a child with a potentially life-threatening emergency, due to religious beliefs or any other reason, says Kevin M. Klauer, DO, EJD, FACEP, chief medical officer of Emergency Medicine Physicians in Canton, OH, the emergency physician (EP) can get a court order to get the child treated.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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