TY  - JOUR
PY  - 2020//
TI  - End-of-life medical decision-making for children in custody: a collaborative, multi-stakeholder practical approach
JO  - Child abuse and neglect
A1  - Carroll, Ricki S.
A1  - Hirst, Eliza
A1  - Hudson, Mark
A1  - Shaw, Molly
A1  - Deutsch, Stephanie A.
SP  - e104441
EP  - e104441
VL  - 103
IS  - 
N2  - 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 "unfitness" including perpetration of egregious child abuse/neglect. Court intervention may be necessary to assert "parens patriae" 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>
LA  - en
SN  - 0145-2134
UR  - http://dx.doi.org/10.1016/j.chiabu.2020.104441
ID  - ref1
ER  -