End-of-life decisions in abusive head trauma.
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 In this situation, if life support is withdrawn, criminal charges for the accused may escalate from assault to murder.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.
School of Medicine, Case Western Reserve University, Cleveland, OH 44121, USA. cce7@case.edu
Clifford C
CC
Ellingson
Jared S
JS
Livingston
Jonathan M
JM
Fanaroff
D001930:Brain Injuries / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D002649:Child Abuse / Q000401:mortality* / Q000706:statistics & numerical data; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D016365:Liability, Legal; D008020:Life Support Care / Q000592:standards* / Q000639:trends; D008297:Male; D020380:Needs Assessment; D013727:Terminal Care; D014481:United States; D028761:Withholding Treatment / Q000331:legislation & jurisprudence / Q000639:trends*