Ethics for the Pediatrician: Caring for Abused Children

Abstract

1. Marilyn A. Fisher, MD, MS* 1. *Associate Professor of Pediatrics, Albany Medical Center, Albany, NY. After completing this article, readers should be able to: 1. Recognize the primary reason for parental conflict of interest regarding continuation versus withdrawal of life-sustaining medical treatment after severe child abuse. 2. Realize that brain death is ethically indistinguishable from cardiopulmonary death. 3. State ethical arguments for and against covert surveillance in suspected cases of factitious disorder by proxy. 4. Understand dilemmas encountered by health-care professionals regarding the reporting and conviction of perpetrators of violence affecting children. 5. Be aware of the difficulty in balancing beneficence and nonmaleficence to the child when determining whether he or she will be served best by foster care placement. Suspected or confirmed child abuse is devastating for families and their children. Treatment of children who are abused or exposed to violence may be distressing, but clinicians must be adept in dealing with the ethical dilemmas inherent in providing care to such children to make the best medical decisions on their behalf. In the wake of severe injury from child abuse, a child may require life-sustaining medical treatment (LSMT). The decision as to whether to continue LSMT must be determined for the abused child just as for any critically ill child. If the child will be severely and permanently disabled but is not brain-dead, a determination may need to be made about whether continuation of LSMT is in the child's best interest. Because a child has never possessed decision-making capacity to make advance directives, parents or guardians must decide on his or her behalf. Consideration of likely harms and benefits of acute and chronic treatment, degree and duration of pain and suffering, anticipated level of functioning, and expected duration of life are …