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Child protection
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
It is possible to categorise the types of neglect in various ways. These are not fixed but can be a helpful framework within which to consider presenting features and extra considerations. Emotional neglect (emotional neglect is often described with emotional abuse and will be discussed later in this chapter).Abandonment; e.g. child found unattended in the home by a social worker.Medical neglect; e.g. failure of immunisation, missed clinic appointments, poor dentition.Nutritional neglect; e.g. inadequate growth.Educational neglect; e.g. poor school attendance.Physical neglect; e.g. unkempt and dirty appearance.Failure to provide supervision and guidance; e.g. recurrent accidents (falls, scalds, road traffic accidents).
Medical Abuse
Published in Marc D. Feldman, Gregory P. Yates, Dying to be Ill, 2018
Marc D. Feldman, Gregory P. Yates
According to Jenny and Roesler, medical abuse is the logical counterpart to a well-established concept in healthcare: medical neglect. Pediatricians document medical neglect when “a parent or other caretaker [is] not getting needed medical care for a child entrusted to his or her supervision.” There may be many reasons for this neglect, ranging from ignorance to poverty to careless disregard. Whatever the reason, the caregiver’s behavior is detrimental to the health of the child, and pediatricians are obliged to bring this to the attention of child protective services at the same time as they attend to the child’s immediate medical needs.
Children
Published in Yann Joly, Bartha Maria Knoppers, Routledge Handbook of Medical Law and Ethics, 2014
Things become more complex when clinicians reasonably believe that the parents’ failure to provide recommended care poses a threat of substantial harm to the child. All states have laws requiring that clinicians report such suspicions of ‘medical neglect.’4 If the state agency concludes that this level of harm will occur more probably than not, the state may go to court seeking an order to intervene to protect the child. If the court agrees, it has a variety of tools available, ranging from simply ordering treatment to removing the child from the home as a last resort. Issues of medical neglect most commonly arise when parents fail to deliver the ongoing care for a child with a chronic medical condition such as cancer (Jensen v. Cunningham 250 P.3d 465 (2011), diabetes (In re Shawndel M 824 NYS 2d. 335 (2006), or cystic fibrosis (In Re Stephen K 867 NE2 81 (2007). These cases are particularly challenging since ensuring treatment may require removing the child from the home, a disruption that may harm the child in other ways, as well as profoundly affecting the remaining family. Concerns about medical neglect also arise when parents fail to seek medical care for an acute illness or injury (see Walker v. Superior Court 763 P.2d 852 (1988) (failure to seek care for child with meningitis).
Beyond Mediation: A Toolkit Approach to Preventing and Managing Conflict with Patients and Families in Difficulty
Published in The American Journal of Bioethics, 2023
Liza-Marie Johnson, Andrew Elliott, Kimberly E. Sawyer, Katherine B. Steuer, Deena R. Levine
More significant ethical critiques in the article are that the agreements are coercive considering the power imbalance between hospitals and patients and lack of other health care facilities for many patients. This is an important ethical concern for organizations to keep in mind in thinking about the consequences, as well as how the agreements are both drafted and presented. Yet failure to protect staff or to protect patients from medical neglect pose their own significant ethical risks. Legitimate concerns about patient-provider contracts call for preventive strategies including anti-bias training and a trauma-informed approach, as well as thoughtful crafting when implemented. Bi-directional agreements to facilitate care may be a resource for alignment and support both staff and patients and families in difficulty.
Patient Abandonment in the Emergency Department?
Published in The American Journal of Bioethics, 2022
Gerardo R. Maradiaga, Nella Hendley, John C. Moskop
If, in contrast, the team judges that Benjamin’s care at home has been neglectful, the ethics consultants should advise that the team has a moral and legal responsibility to challenge his discharge home for continuing care. What form that challenge should take should depend on available options and their likely consequences. At one end of the spectrum, for example, if the team can identify significant home health services for Benjamin, and if Trudy accepts those services, the added services may satisfy Benjamin’s care needs. If, at the other end of the spectrum, the team diagnoses rapidly progressing, life-threatening sepsis, and Trudy refuses effective antibiotic treatment, the team may be justified in proceeding with emergent treatment on its own authority. Intermediate options may, depending on the specific situation, include seeking appointment of a legal guardian for Benjamin and reporting their suspicion of medical neglect of a dependent adult to the local adult protective services agency (Dyer et al. 2005).
Life-Saving Experimental Treatment for a Teenage Ward of the State
Published in The American Journal of Bioethics, 2022
Taken together, the lacuna in state legislation, the variability in IRB practices with respect to both the authority to consent and the degree of risk that may be accepted, and the Common Rule requirement of parental consent for research, leave this patient in a desperate medical situation with a regulatory morass to navigate. The teams involved need to investigate the legislation, policies, and procedures in the adolescent’s home state as well as the state where the treatment is to be administered. They also have to explore the treating institution’s IRB policies on consent for adolescents’ participation in research and the degree of risk that would be acceptable in research involving a minor. They may also have to deal with the home state’s court’s willingness to accept recommendations from the research team and the IRB. An additional complication might be the status of the mother who was accused of medical neglect. Until that issue is adjudicated, the mother’s consent may still be required. If the mother’s rights are terminated, a court-appointed advocate (or two) to review the pros and cons of participation in the trial and an on-site guardian may be required by the pediatric medical center.