Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.
Sidney Kidney Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
Pediatrics. 2019 Oct;144(4). doi: 10.1542/peds.2018-3939. Epub 2019 Sep 4.
Doctors are required to notify Child Protective Services (CPS) if parents do not provide appropriate medical care for their children. But criteria for reporting medical neglect are vague. Which treatments properly fall within the realm of shared decision-making in which parents can decide whether to accept doctors' recommendations? Which treatments are so clearly in the child's interest that it would be neglectful to refuse them? When to report medical neglect concerns to CPS may be controversial. It would seem inhumane to allow a child to suffer because of parental refusal to administer proper analgesia. In this ethics rounds, we present a case of an adolescent with chronic pain who is terminally ill. Her parents were not adherent to recommended analgesia regimens. Her palliative care team had to decide whether to report the case to CPS.
如果父母未能为子女提供适当的医疗护理，医生必须通知儿童保护服务机构 (CPS)。但报告医疗忽视的标准并不明确。哪些治疗方法确实属于共同决策的范畴，父母可以决定是否接受医生的建议？哪些治疗方法明显符合儿童的利益，拒绝治疗将构成忽视？何时向 CPS 报告医疗忽视可能存在争议。因为父母拒绝给予适当的镇痛而任由孩子受苦，这似乎是不人道的。在本次伦理讨论中，我们介绍了一名患有慢性疼痛且生命垂危的青少年患者。她的父母不遵守推荐的镇痛方案。她的姑息治疗团队必须决定是否向 CPS 报告此案。
