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Published on: February 16, 2011
End-of-life decisions in abusive head trauma
Clifford C Ellingson1, Jared S Livingston, Jonathan M Fanaroff
1School of Medicine, Case Western Reserve University, Cleveland, OH 44121, USA. cce7@case.edu
Insights
Abusive head trauma in infants presents difficult end-of-life decisions. Accused parents may prioritize avoiding murder charges over a child's futile treatment, creating ethical and legal conflicts for healthcare providers.
Area of Science:
- Pediatrics
- Medical Ethics
- Legal Medicine
Background:
- Abusive head trauma (AHT) is a leading cause of infant mortality and morbidity.
- Decisions regarding life support for infants with AHT are complex.
- Accusations against parents for AHT create significant conflicts of interest.
Purpose of the Study:
- To examine the ethical and legal challenges faced by healthcare providers when parental interests conflict with a critically ill child's best interest.
- To explore how parental self-interest, driven by potential criminal charges, impacts end-of-life decisions in infant abuse cases.
- To propose solutions that balance parental rights with the protection of critically ill children.
Main Methods:
- Review of legal and ethical frameworks surrounding parental decision-making in pediatric critical care.
- Analysis of case scenarios where parental rights and child welfare are in conflict.
- Discussion of potential legal and ethical resolutions.
Main Results:
- Accused parents may opt to continue life support for infants with AHT to avoid murder charges, even when treatment is futile.
- This creates a conflict between parental rights and the child's best interest.
- Healthcare providers face ethical dilemmas in navigating these complex situations.
Conclusions:
- Existing legal and ethical frameworks may not adequately protect critically ill children when parents have conflicting interests.
- Solutions are needed to prioritize the child's welfare while respecting parental rights.
- Revising protocols for end-of-life decisions in suspected AHT cases is crucial.
Abstract:
Abusive head trauma is a significant and tragic cause of morbidity and mortality in infants and its victims often have a poor prognosis. With such high rates of morbidity and mortality, health care providers and parents are often faced with the decision to continue or discontinue life support for an affected child. Sadly, however, this decision becomes complicated when parents are accused of causing the victim-child's current state. In this situation, if life support is withdrawn, criminal charges for the accused may escalate from assault to murder. This escalation of legal charges creates a conflict of interest for accused parents. As a result, parents have a strong incentive to avoid murder charges by using their parental decision-making rights to keep the child alive, even when treatment is deemed futile or inhumane. In this article, we discuss the legal challenges health care providers may face when parents place their interest above their child's. We also propose solutions that give greater deference to the rights and interest of these critically ill children while still preserving protected parental rights.
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Assessment:
1. Clinical Evaluation:
History: