This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
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.
CLINICAL ETHICS CASE REPORT: PART I
A 30-year-old woman presented to labor/delivery at term gestation after a failed home delivery with a lay midwife. Her membranes had ruptured 38 hours before delivery. One hour before presentation, she had developed a temperature to 102°F. The pregnancy had been uncomplicated. She had early prenatal care and a negative screen result for group B streptococcal infection 1 week before delivery. Her white blood cell count was 49 000/μL with 18% bands.
The woman and her husband refused fetal monitoring. They insisted on carrying out their plan for a natural birth and said that, right after delivery, they wanted to be discharged and take the child home. The obstetrician recommended that the mother receive intravenous antibiotics. She agreed to this treatment.
The pediatric service was consulted 1 hour before delivery. The parents were informed that …
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
Individual Login
Institutional Login
You may be able to gain access using your login credentials for your institution. Contact your librarian or administrator if you do not have a username and password.