@article{ref1,
title="End-of-life medical decision-making for children in custody: a collaborative, multi-stakeholder practical approach",
journal="Child abuse and neglect",
year="2020",
author="Carroll, Ricki S. and Hirst, Eliza and Hudson, Mark and Shaw, Molly and Deutsch, Stephanie A.",
volume="103",
number="",
pages="e104441-e104441",
abstract="BACKGROUND: Parents have a constitutionally-protected, fundamental right to make decisions concerning the health and well-being of their children, afforded by the Due Process Clause of the Fourteenth Amendment. However, parental rights are not absolute, and may be curtailed after a finding of parental &quot;unfitness&quot; including perpetration of egregious child abuse/neglect. Court intervention may be necessary to assert &quot;parens patriae&quot; authority to protect a child's well-being. Disagreements over medical care for a child (particularly when parent maltreatment resulted in life-altering clinical conditions and parents are suspected of perpetrating abusive injuries) often pose conflicts of interest. End-of-life decision-making involving abuse perpetrators may be influenced by self-interest, due to potential for escalation of criminal charges. <br><br>OBJECTIVE: Discuss medico-legal decision-making for children in child welfare custody using a detailed case example involving a child near-fatally, abusively injured by his parents; review of relevant case law/national legal precedents; and clinical policy statements guiding end-of-life decision-making for pediatric patients. PARTICIPANTS/SETTING/METHODS: Using an exploratory, quasi-qualitative approach, perceived experiences of purposefully-selected taskforce members identified key themes that informed a care de-escalation protocol, implemented across the state. <br><br>RESULTS: Key themes included coordinated communication, expedited legal proceedings, and balancing child's best interest (the right not to suffer for a prolonged period of time or sustain complications) with parents' rights and due process concerns, and informed protocol development. <br><br>CONCLUSIONS: Practicable guidance established in the protocol can be theoretically adapted at the local level to address the complexity inherent in end-of-life decision-making for children in custody.<br><br>Copyright © 2020 Elsevier Ltd. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0145-2134",
doi="10.1016/j.chiabu.2020.104441",
url="http://dx.doi.org/10.1016/j.chiabu.2020.104441"
}