When Parents Refuse a Septic Workup for a Newborn

Sometimes, parents refuse medical intervention for philosophical reasons. Pediatricians have an obligation to protect children from medical neglect on the part of their parents. Often, it is not clear where exactly to draw the line between parental rights and the best interest of the child. The law is clear, however. If the doctor suspects medical neglect, he or she has an obligation to notify child protective services (CPS). CPS, and eventually a judge, will then determine if the parental behavior is or is not legally acceptable. For doctors, however, there is often a trade-off between protecting the child and preserving a therapeutic alliance with the parents. We present here a case of a newborn at risk for sepsis whose parents do not want standard medical evaluation and treatment. Two general pediatricians, Elizabeth Simpson, MD, director of the general care nursery at Truman Medical Center, and Margaret Moon, MD, MPH, a bioethicist and pediatrician at Johns Hopkins School of Medicine, offer their responses to the case.

Address correspondence to John D. Lantos, MD, Children's Mercy Bioethics Center, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108. E-mail: jlantos{at}cmh.edu