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PEDIATRICS Vol. 113 No. 2 February 2004, pp. e141-e145

ELECTRONIC ARTICLE

Termination of Life Support After Severe Child Abuse: The Role of a Guardian ad Litem

Julie Akiko Gladsjo, PhD*, John Breding, MDiv{ddagger}, David Sine, MD{ddagger}, Robert Wells, PhD§, Sharon Kalemkiarian, JD, Joni Oak, RN, BSN{ddagger}, Angela S. Vieira, BSN, JD, MPH{ddagger}, Sheila Fallo Friedlander, MD*,{ddagger}

* University of California, San Diego School of Medicine, San Diego, California
{ddagger} Children’s Hospital and Health Center, San Diego, California
§ Children’s Hospital Central California, Madera, California

Discontinuation of life-sustaining interventions often raises ethical concerns. In cases of severe child abuse with poor prognosis for recovery, accused parents may have a conflict of interest regarding medical decision-making for their child, because the outcome of such decisions may impact legal charges filed against them. The recently issued American Academy of Pediatrics guidelines for addressing such cases recommended the appointment of a guardian ad litem for medical decision-making. We present the case of an 8-month-old infant who was abused severely by her father, resulting in a persistent vegetative state. We describe our experience with appointing a guardian ad litem and the ethical issues involved.

Key Words: child abuse • medical ethics • guardian ad litem

Abbreviations: AAP, American Academy of Pediatrics • CT, computed tomography • CPS, Child Protective Service

Received for publication Jan 9, 2003; Accepted Oct 20, 2003.


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