Intensive care treatment decisions: the roots of our confusion.
BACKGROUND
Decisions to withdraw or withhold treatment from infants and children are continuing concerns. Physicians voice confusion over perceived legal requirements. This confusion may lead to overtreatment of patients. Recent evidence suggests legal concerns still shape physician treatment decisions.


OBJECTIVE
This study was undertaken to determine if the legal standard governing these medical decisions was clearly stated.


METHODS
Conventional legal research was performed. Because the 1984 Federal Child Abuse Amendments require these issues to be resolved by state laws, statues of the 50 states and the District of Columbia were reviewed to ascertain if they would support a charge of child abuse for the inappropriate withdrawal of life-support from a child. An electronic legal database was queried for all cases involving withdrawal of life-support in children since 1984; the cases were analyzed to determine if judges were applying the federal legal standard.


RESULTS
Current child abuse reporting laws would support the federal standard in all 50 states and the District of Columbia. Six reported withdrawal cases were identified; none applied the federal standard. There is an emerging state legal standard that is flexible and subjective and allows a quality of life analysis because it is based on parental authority. This standard conflicts with the federal standard.


CONCLUSIONS
The current law is unclear because two competing legal standards coexist; physicians cannot simultaneously meet both standards. Choosing to apply the state legal standard in clinical medical practice should support families in times of stress and relieve physicians of the burden of considering who is potentially overtreated.
Clark
F I
FI
Department of Child Health, University of Missouri, Columbia 65212.
D002648:Child; D002649:Child Abuse / Q000331:legislation & jurisprudence; D003422:Critical Care / Q000331:legislation & jurisprudence*; D003657:Decision Making; D005066:Euthanasia, Passive / Q000331:legislation & jurisprudence*; D035082:Federal Government; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007258:Informed Consent / Q000331:legislation & jurisprudence; D033222:Judicial Role; D010290:Parents; D016079:Refusal to Treat / Q000331:legislation & jurisprudence; D016312:Treatment Refusal / Q000331:legislation & jurisprudence; D028761:Withholding Treatment