title: Termination of life support after severe child abuse: the role of a guardian ad litem.
abstract: Discontinuation of life-sustaining interventions often raises ethical concerns. In cases of severe child abuse with poor prognosis for recovery, accused parents may have a conflict of interest regarding medical decision-making for their child, because the outcome of such decisions may impact legal charges filed against them. The recently issued American Academy of Pediatrics guidelines for addressing such cases recommended the appointment of a guardian ad litem for medical decision-making. We present the case of an 8-month-old infant who was abused severely by her father, resulting in a persistent vegetative state. We describe our experience with appointing a guardian ad litem and the ethical issues involved.
authors.affiliation: University of California, San Diego School of Medicine, San Diego, California 92123, USA.
authors.forename: Julie Akiko
authors.initials: JA
authors.lastname: Gladsjo
authors.forename: John
authors.initials: J
authors.lastname: Breding
authors.forename: David
authors.initials: D
authors.lastname: Sine
authors.forename: Robert
authors.initials: R
authors.lastname: Wells
authors.forename: Sharon
authors.initials: S
authors.lastname: Kalemkiarian
authors.forename: Joni
authors.initials: J
authors.lastname: Oak
authors.forename: Angela S
authors.initials: AS
authors.lastname: Vieira
authors.forename: Sheila Fallo
authors.initials: SF
authors.lastname: Friedlander
mesh_terms: D002140:California; D002649:Child Abuse / Q000941:ethics / Q000331:legislation & jurisprudence* / Q000628:therapy; D028741:Ethics Committees, Clinical; D005260:Female; D006801:Humans; D007223:Infant; D007872:Legal Guardians / Q000331:legislation & jurisprudence*; D008020:Life Support Care / Q000941:ethics / Q000331:legislation & jurisprudence*; D018447:Medical Futility / Q000941:ethics / Q000331:legislation & jurisprudence; D010290:Parents; D018458:Persistent Vegetative State; D011368:Professional-Family Relations; D011379:Prognosis; D028761:Withholding Treatment / Q000941:ethics* / Q000331:legislation & jurisprudence*