J Med Ethics. 2009 Oct;35(10):635-7. doi: 10.1136/jme.2009.030510.
One of the basic tenets of paediatric ethics is that competent parents may render healthcare decisions for children who are too young or too incapacitated to make meaningful medical choices for themselves. In the USA, many jurisdictions have expanded this principle to include the right to terminate a child's life support, including nutrition and hydration, when that child enters a persistent vegetative state. However, this approach to the withdrawal of care in the paediatric setting has been put to the test by an increasing number of cases in which one or both parents are themselves accused of causing the child's life-threatening injuries. In such "mixed-motive" situations, parents may express a desire to keep a child on life support for religious or moral reasons; at the same time, forestalling the child's death may also prevent a murder charge against the accused parent. Principles need to be established for handling such tragic cases.
儿科伦理学的基本原则之一是，有能力的父母可以为年幼或无行为能力的孩子做出医疗决策，因为这些孩子无法为自己做出有意义的医疗选择。在美国，许多司法管辖区已经将这一原则扩大到包括在孩子进入持续植物人状态时终止孩子的生命支持，包括营养和水合作用。然而，这种在儿科环境中停止治疗的方法已经受到越来越多的案例的考验，在这些案例中，父母一方或双方都被指控造成孩子的危及生命的伤害。在这种“混合动机”的情况下，父母可能出于宗教或道德原因表达了让孩子继续接受生命支持的愿望；同时，阻止孩子死亡也可能防止对被告父母的谋杀指控。需要为处理此类悲剧案件制定原则。
