Whose Child Is It Anyway? Resolving Parent-Physician Conflict in the NICU Setting

Jill Jasper; William D. Clark; Gerardo Cabrera-Meza; Carol Lynn Berseth; Caraciolo J. Fernandes

doi:10.1055/s-2003-45284

American Journal of Perinatology, Table of Contents

Am J Perinatol 2003; 20(7): 373-380
DOI: 10.1055/s-2003-45284

Whose Child Is It Anyway? Resolving Parent-Physician Conflict in the NICU Setting

Jill Jasper¹ , William D. Clark² , Gerardo Cabrera-Meza³ , Carol Lynn Berseth³ , Caraciolo J. Fernandes³

¹Pediatric Resident, Baylor College of Medicine, Houston, Texas
²Fellow in Neonatal-Perinatal Medicine, Baylor College of Medicine, Houston, Texas
³Attending Physician, Baylor College of Medicine, Houston, Texas

Abstract

ABSTRACT

Much has been written on parental involvement in decision making when dealing with critically ill children, but few articles have touched upon parental refusal of treatment in noncritically ill children. What steps should be taken when a parent refuses what is generally considered “standard of care” medicine for their hospitalized child? Does medical advice outweigh parental views or wishes, and what does one do when our role as physician turns from medical expert into one of medical negotiator? The following case and discussion deal with parental refusal of conventional medical care, and how one may find peaceful resolutions to challenging situations for the ultimate good of the child.

KEYWORDS

Neonate - refusal of treatment - conflict resolution

Full Text

References

REFERENCES

1 Steinberg A. Decision-making and the role of surrogacy in withdrawal or withholding of therapy in neonates. Clin Perinatol . 1998; 25 779-790
2 van der Heide A, van der Maas J P, van der Wall G, Kollee L A, de Leeuw R, Holl R A. The role of parents in end-of-life decisions in neonatology: physicians' views and practices. Pediatrics . 1998; 101 413-418
3 American Academy of Pediatrics Committee on Bioethics. Ethics and the care of critically ill infants and children. Pediatrics . 1996; 98 149-152
4 McHaffie H E, Laing I A, Parker M. et al . Deciding for imperilled newborns: medical authority or parental autonomy?. J Med Ethics . 2001; 27 104-109
5 McHaffie H E, Lyon A J, Hume R. Deciding on treatment limitation for neonates: the parents' perspective. Eur J Pediatr . 2001; 160 339-344
6 Hammerman C, Kornbluth E, Lavie O. et al . Decision-making in the critically ill neonate: cultural background v individual life experiences. J Med Ethics . 1997; 23 164-169
7 Campbell D E, Fleischman A R. Limits of viability: dilemmas, decisions, and decision makers. Am J Perinatol . 2001; 18 117-128
8 Affleck G, Tennen H. The effect of newborn intensive care on parents' psychological well-being. Child Health Care . 1991; 20 6-14
9 Harrison H. The principles for family-centered neonatal care. Pediatrics . 1993; 92 643-650
10 Hansen T, Corbet A. Disorders of transition. In: Taeusch HW, Ballard RA, eds. Avery's Diseases of the Newborn 7th ed. Philadelphia: WB Saunders Company 1998: 613-623
11 Hansen T, Corbet A. Neonatal pneumonias. In: Taeusch HW, Ballard RA, eds. Avery's Diseases of the Newborn 7th ed. Philadelphia: WB Saunders Company 1998: 648-658
12 Campbell J R. Neonatal pneumonia. Semin Respir Infect . 1996; 11 155-162
13 Engle W D, Jackson G L, Sendelbach D. et al . Neonatal pneumonia: comparison of 4 vs 7 days of antibiotic therapy in term and near-term infants. J Perinatol . 2000; 20 421-426
14 American Academy of Pediatrics. Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Provisional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia. Pediatrics . 1994; 94 558-565
15 Cauffield J S. The psychosocial aspects of complementary and alternative medicine. Pharmacotherapy . 2000; 20 1289-1294
16 Cohen J J. Reckoning with alternative medicine. Acad Med . 2000; 75 571
17 American Academy of Pediatrics Committee on Bioethics. Informed consent, parental permission, and assent in pediatric practice. Pediatrics . 1995; 95 314-317
18 Lantos J D. Treatment refusal, noncompliance, and the pediatrician's responsibilities. Pediatr Ann . 1989; 18 255-260
19 Zupancic J A, Kirpalani H, Barrett J. et al . Characterising doctor-parent communication in counselling for impending preterm delivery. Arch Dis Child Fetal Neonatal Ed . 2002; 87 F113-F117
20 Rice C. Making moral decisions: comparing two theories. Ment Retard . 2001; 39 155-157
21 Wocial L D. Life support decisions involving imperiled infants. J Perinat Neonatal Nurs . 2000; 14 73-86
22 O'Mara K. Communication and conflict resolution in emergency medicine. Emerg Med Clin North Am . 1999; 17 451-459
23 Becker P T, Grunwald P C. Contextual dynamics of ethical decision making in the NICU. J Perinat Neonatal Nurs . 2000; 14 58-72