ETHICS IN ACTION
What to do When a Parent Discharges a Child Against Medical Advice SAEM PULSE | SEPTEMBER-OCTOBER 2019
By Andrea Wu, MD, MMM
10
In most cases, adults are free to make their own decisions as to how they want to treat an illness; however, when a patient is a minor and still legally under the care of parents or guardians, the issue can quickly become complicated and fraught with competing claims. The media is rife with stories of parents whose minor child was removed from them against their will because they withheld medical care for that child and were subsequently charged with endangering his or her life and/or health. Or, even more tragic, parents who were charged with involuntary manslaughter, or some other criminal offense, when their minor child died after they denied him or her lifesaving medical treatment.
State law determines whether denying a child medical care because of religious reasons is considered medical neglect. Most states require parents to provide a reasonable degree of medical care; however, 34 states and the District of Columbia offer legal protection for parents who refuse medical treatment for children on religious grounds. It is important to understand what laws are applicable in your state, as well as your local hospital’s risk management practice. With that in mind, below are some areas of guidance on this challenging situation.
Important Exceptions There are a couple instances for which one ought to consider refusing to allow a parent to take his or her child home against medical advice (AMA):
1) I f there is concern for non-accidental trauma (NAT) in the child’s home environment. 2) I f the child is critically ill or has a clearly diagnosed life threatening illness that is treatable In the first case (suspected NAT), it is important to determine whether the patient has ongoing contact with a possible perpetrator and whether or not the patient is safe to be discharged home and with whom. In addition to treating injuries sustained, one must assess the living situation and social interactions of the family. If available at your facility, social workers are excellent resources for gathering collateral information from family members and reporting the cases to Child Protective Services (CPS). You