Specific Types of Care
Parents may have many reasons for refusing specific types of care. Refusing the care offered by a particular physician or institution is not the same as neglecting the medical needs of the child. Parents may refuse a particular type of care because they do not believe it is in the child’s best interests. Courts generally defer to the parents as the most appropriate judge of the child’s interests; however, if the physician believes that the parents are not acting in the child’s best interest, this should be reported to the child protection agency.
Physicians should be careful about the claims they make for the offered care. It is not unreasonable for parents to refuse medical care that is difficult or painful if it does not offer a substantial benefit to the child. Parents who refuse supportive care when there is little or no hope of cure are properly asserting the child’s right to refuse unnecessary care. This is also true for discontinuing care. If parents refuse treatment for the first presentation of acute lymphocytic leukemia because they do not believe in treating cancer, the physician should seek court intervention. If the parents refuse a repeat course of chemotherapy when there is little hope of remission because they want the child to die at home in comfortable surroundings, the physician should probably do what he or she can to assist them. Physicians should not try to enforce their personal beliefs about hope or dying on the parents or the afflicted child.