Theoretical Medicine and Bioethics

, Volume 25, Issue 4, pp 243-264

First online:

Parental refusals of medical treatment: the harm principle as threshold for state intervention

  • Douglas DiekemaAffiliated withDepartments of Pediatrics and Medical History and, Ethics University of Washington School of Medicine, Director of Medical Ethics, Children's Hospital and Regional Medical Center Seattle

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Minors are generally considered incompetent to provide legally binding decisions regarding their health care, and parents or guardians are empowered to make those decisions on their behalf. Parental authority is not absolute, however, and when a parent acts contrary to the best interests of a child, the state may intervene. The best interests standard is the threshold most frequently employed in challenging a parent's refusal to provide consent for a child's medical care. In this paper, I will argue that the best interest standard provides insufficient guidance for decision-making regarding children and does not reflect the actual standard used by medical providers and courts. Rather, I will suggest that the Harm Principle provides a more appropriate threshold for state intervention than the Best Interest standard. Finally, I will suggest a series of criteria that can be used in deciding whether the state should intervene in a parent's decision to refuse medical care on behalf of a child.

best interest children harm principle informed consent for minors medical neglect parental refusals proxy consent surrogate decision-making