# Christian Scientist scenario



## Nameless

Note: This is a hypothetical worst-case scenario I'm throwing out here. This never happened to me, and I hope this never happens to anyone. I just wanna know how the rest of you guys'd handle this!

Scenario:

You and your partner get called to a "sick person" in a fairly decent suburban neighborhood. The only information dispatch has given you is the patient is an 8-year-old male. The scene is secure. You arrive on scene and find out the neighbor has called. The neighbor, an elderly woman, tells you she was outside working in the garden in the afternoon and saw little Timmy (the patient) step outside. Not 5 seconds after he has been outside, he collapsed. She immediately called 911. You see the parents out in the back hovering over the boy, and head for the backyard. The father immediately orders you to leave. He states he and his wife and Timothy are Christian Scientists and they do not want you doing anything. You catch a glimpse of Timmy. You do not see notable chest rise and fall, nor do you see nasal flaring. He appears lifeless and is very pale. Cyanosis can be seen around the lips. He does not respond to his father's yelling. Your partner steps aside and attempts to call PD. Dispatch says there are no available units in the area. You attempt to get a signature from the father to not transport, and the father refuses to sign anything. 

What would you do?


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## STXmedic

Get the neighbor to sign as a witness and document. Would probably get a supervisor out there, too. Sucks for the kid, but people have a right to have their beliefs respected.


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## Handsome Robb

You request LE emergent.

An unresponsive, possible pediatric arrest will free up cops faster than you can blink your eyes.

Reason with the father, ask him I you can at least check to see if his son is alive. Let him know what you think is happening. Most parents will realize you're serious and change their attitude. "Sir your son is potentially dying, please let me at least check his pulse and if he's got one just breath for him until we can work something out."

Yea they can have their beliefs respected but at what point is it abuse and child endangerment? What lead up to this? If it's abuse the father doesn't have any say anyways.


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## STXmedic

Robb said:


> If it's abuse the father doesn't have any say anyways.



Very valid point.


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## wanderingmedic

1) I would not have even attempted to obtain a sig, this kiddo is going to receive treatment like it or not.

2) I would immediately get in contact with medical control and get permission to protective custody the child. I would reiterate the situation to dispatch and articulate that a non response from PD is unacceptable. From what it sounds my partner and I would be in physical danger from the "parents" if we attempted to treat, so PD needs to be put en route. When police hear kiddos are in trouble they come running just as fast. PD could also potentially PC the pt. 

3) How do I know those are actually that pt's parents and can legally decline treatment? Chances are they are not carrying proper Id for them and the child, as well as a birth cert to prove they are parents...sooooo for all I know these are crazy people trying to harm this child.

4) I am a PT ADVOCATE, not a parent's rights advocate. If I think this pt needs my help I will do everything in my power to advocate for their treatment regardless of what their parent's beliefs dictate. 

This happens in Phoenix because of the JW population. When I was last there PHX children's will PC the child and obtain a court order to transfer custody regarding treatment to a court appointed advocate.


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## wowmulewow

Have the neighbor sign as witness for refusal to sign and leave the premises (afterall, the father told you to leave).  LEOs cannot forcibly remove the parents from their child or their property.  At this point, you would be trespassing.  As for abuse or endangerment, it is neither.  A minor child in the eyes of the law does not have the ability to make an informed decision or have any legal presumptions in the matter.  The best you can do is respect the family's wishes/ beliefs.  As with most sudden pediatric deaths, there will be a LE Investigation, which would involve an autopsy, and rule out or support abuse, endangerment, medical history, etc.


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## VFlutter

azemtb255 said:


> 4) I am a PT ADVOCATE, not a parent's rights advocate. If I think this pt needs my help I will do everything in my power to advocate for their treatment regardless of what their parent's beliefs dictate.



To play the Devil's advocate, what makes you think that you know what is best for the patient more than the parents? Are you not imposing your own beliefs on the situation? What if you walk up to the kid, who is in obvious distress, and he says "Don't touch me, I don't want to go to Hell for taking medicine". Are you still going to force treatment? 

It is a complicated situation, and I am not saying nothing should be done, but your whole approach is a little brash. You are entering a situation where you are not wanted and may not have legal authority. Like it or not you can not just storm in, treat the patient, and then have the parents arrested for interfering.


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## wowmulewow

azemtb255 said:


> 3) How do I know those are actually that pt's parents and can legally decline treatment? Chances are they are not carrying proper Id for them and the child, as well as a birth cert to prove they are parents...sooooo for all I know these are crazy people trying to harm this child.
> 
> To play Devil's Advocate, Do you carry your minor child's birth certificate with you when you go to the grocery store, the park, or the movies?  Probably not.  Plus we have to remember the neighbor, she knows the child and the parents.  Granted, the Neighbor is not a State Issued ID card, but the neighbor will be able to identify the parents and the child as a family.  Also, they were at their house, so they probably do have proper ID somewhere inside.   Also, we have to remember this is occuring on private property, if the property owner orders you to vacate, you must do so.  LE would more than likely not be able to PC the child in this amount of time, especially over the parents claim of CS.  PC'ing a child because of his parents beliefs (which could be the child's as well) steps into the area of personal freedoms and liberties that we are granted as Americans.
> 
> Im not saying you should let the child lay there dying, but the law does somewhat tie our hands on this one.  Now what about determining whether the parents are capable of making the informed decision of their child? Are they possibly intoxicated, under the influence of an altering substance, or have any faculty that may prevent their decision making capability???


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## MonkeyArrow

azemtb255 said:


> 1) This happens in Phoenix because of the JW population. When I was last there PHX children's will PC the child and obtain a court order to transfer custody regarding treatment to a court appointed advocate.



Do the courts really grant PC (and subsequent treatment) all that often over the parent's wishes? I would think that the separation of State and Church with the 1st and all that other good stuff would prevent the courts from restricting the parent's religious wishes. I understand that hospitals have whole ethics panels and protocols for dealing with such stuff but would it happen all in time to save little Timmy "by the books"? Probably not.


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## medicsb

This is a classic ethics question.  General consensus is to treat the kid.  Nonetheless, you should contact medical command ASAP and await LEO arrival to remove the parents.

However there is not always one right answer when it comes to ethics, so this could be argued more than one way.

Questions like this is why college level ethics must be taught to all healthcare providers.


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## RebelAngel

Hum. Tough sitution. 

What is the law for medical neglect in your state? 

Sent from my XT557 using Tapatalk 2


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## mycrofft

I think local (state) laws and maybe even federal cases might need to be reviewed about legality.

In the instance, the child is apparently dead and that requires law enforcement. Tell dispatch you have a dead kid and the family won't let you approach.

PS: treatment whether the family wants it or not? And what if Dad or Mom smacks you with a hammer or stands in your way and you push them?


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## PotatoMedic

I kinda wish we had a lawyer on here...  oh wait.


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## wowmulewow

If you stand in the way of the family, not only are you still trespassing, but now you have committed assault, intimidation, disorderly conduct, etc.  You also are putting yourself and your partner at risk for injury from emotional parents, let alone a possible civil suit against you and your agency.  To me this is somewhat like a situation where you are presented with an invalid DNR, the family wants you to honor it, but because it's expired or missing a signature, it's no longer a legal document. except in this circumstance you cannt treat the minor without parental consent.  It's all a legality issue to be sorted out by LE and the courts, post incident.  No matter what we do in this particular situation, it opens us to possible civil and criminal suits.


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## Brevi

Religion and Medicine don't always play together so nicely.

Under the doctrine of 'parens patriae'  the state generally will not allow a child's health to be seriously jeopardized because of the parent's own limitations or convictions.

 "The right to practice religion freely does not include the liberty to expose... a child... to ill health or death. Parents may be free to become martyrs themselves. But it does not follow that they are free ... to make martyrs of their children..." Prince v Massachusetts

A parent does not have the authority to forbid saving their child's life. If it were me in this scenario, I would request PD, provide care and deal with the fall out after, but that's just me.


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## TheLocalMedic

Brevi said:


> Religion and Medicine don't always play together so nicely.
> 
> Under the doctrine of 'parens patriae'  the state generally will not allow a child's health to be seriously jeopardized because of the parent's own limitations or convictions.
> 
> "The right to practice religion freely does not include the liberty to expose... a child... to ill health or death. Parents may be free to become martyrs themselves. But it does not follow that they are free ... to make martyrs of their children..." Prince v Massachusetts
> 
> A parent does not have the authority to forbid saving their child's life. If it were me in this scenario, I would request PD, provide care and deal with the fall out after, but that's just me.



Bingo.  I was about to unleash a tirade against everyone who was advocating to just shrug and walk away.  ARE YOU SERIOUS???  If a child is in danger or dying, there is nothing that anyone can say that can legally prevent you from helping them.  And no amount of signatures or paperwork will save your behind from the litigation that will surely follow if you walk away and allow a child to die.  

For all I care, the parents can tell me they belong to the Flying Spaghetti Monster Cult and they believe their dying son will turn into meatballs.  Whatever the parents say, they cannot prevent their child from receiving life saving emergency treatment.  

The only thing that would hold me back is if I was in immediate physical danger, like if the parents had a gun.  Otherwise that kid is mine.


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## RebelAngel

I was searching Google for information about parents refusing treatment for minors in emergency situations and found this thread from here:
http://www.emtlife.com/archive/index.php/t-18352.html

I also bookmarked a few pages regarding laws in NYS, and will be asking the NYS Paramedics I know personally, my Captain, and my EMT course instructor.


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## medicsb

http://pediatrics.aappublications.org/content/128/2/427.full

From the American Academy of Pediatrics

Policy Statement:  Consent for Emergency Medical Services for Children and Adolescents

Committee on Pediatric Emergency Medicine and Committee on Bioethics

"When a legal guardian refuses to consent to medical care or transport that is necessary and likely to prevent death, disability, or serious harm to the child, law enforcement officers may intervene under local and state child abuse and neglect laws..."

"When faced with a guardian who refuses to allow the provision of necessary medical care or transport of a child when it is necessary to save a child's life or prevent serious harm, it might be necessary to notify the police and enlist their assistance in placing the child in temporary protective custody..."

"...a medical professional should provide medical treatment without consent only when the child has a medical condition that poses a risk of death or serious harm, when immediate treatment is necessary to prevent that harm, and when only those treatments necessary to prevent the harm are provided."


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## Rialaigh

I cannot place a child in temporary protective custody. I would get a doctor on the phone and LEO's en route to me while exiting the property. I am not going on this property to treat this child if the parents don't want it and are threatening without LEO's legally placing the child in protective custody, which whether they can place a "dead" child in protective custody is probably another legal issue altogether as in this scenario. 


A parent does have the authority to forbid saving a child's life. Numerous scenarios where children require surgery or blood transfusions for life extending/saving procedures and after the court of law has been brought into it the parents view stands legal in the eyes of the state.


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## wanderingmedic

Rialaigh said:


> A parent does have the authority to forbid saving a child's life. Numerous scenarios where children require surgery or blood transfusions for life extending/saving procedures and after the court of law has been brought into it the parents view stands legal in the eyes of the state.



Do you have any sources to cite? Evidence presented in this thread so far seems to discredit your statement.


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## Rialaigh

azemtb255 said:


> Do you have any sources to cite? Evidence presented in this thread so far seems to discredit your statement.



Thirty-eight states and the District of Columbia have religious exemptions in their civil codes on child abuse or neglect including decisions about healthcare.
Seventeen states have religious defenses to felony crimes against children including results from decisions about healthcare. 

Hospitals and ethics boards frequently label people "mature minors" and allow them to refuse medical care on the grounds of religion. Some as young as 12-14 can refuse life saving treatment for themselves. 

Take a look here and read through some cases and some of the legislation that is currently active

http://childrenshealthcare.org/


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## Nameless

I didn't think this would get as much input as it's getting! Awesome! I'm loving reading all of these answers. To those that mentioned ethics being important in the field, I wholeheartedly agree. 

If it were me in the situation, I'd perform care. If the father didn't have a weapon of any sort (gun, blunt weapon, knife, etc.). I'd load the kid up, meet ALS en route (or if we're an ALS unit, the medic would probably agree with me and be working him), nearest specialty center, and then take the fallout of essentially abducting the kid later on. Gather all of my objective statements and fill out the necessary paperwork. I don't think I could have it on my conscious that I walked away from something of this sort. 

I respect the parents' right to believe what they what, but I don't respect their decision to hinder their child's life based on their beliefs. That's just me, though. Gotta love philosophy.


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## bbmtnbb

robb said:


> you request le emergent.
> 
> An unresponsive, possible pediatric arrest will free up cops faster than you can blink your eyes.
> 
> .



this ^^^^^^


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## medicsb

[Deleted for expressing attitude to wrong poster.  Sorry, y'all.]


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## wanderingmedic

Redacted for above reason.


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## STXmedic

So these parent's beliefs prevent medical care for their child. They are obviously fairly convicted if they're willing to take the chance of their child dying. Weapon or not, do you seriously think they're going to let you walk up, take their kid from them, and drive away without intervening? (Hint: not likely). 

I understand the want to treat the child. I don't think it would be an easy thing to do, and would probably take a mental toll on me at some point. But who are we to force someone to violate their religious and spiritual beliefs.


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## medicsb

azemtb255 said:


> Yes...that comment was in response to Rialaigh's post which seemed to disagree with the stuff from the American Academy of Pediatrics.



HHhhmmm, yes, this was my folly.  My apologies.


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## bbmtnbb

Found on an attorney's web site-lots of court cases cited and scenarios but can't find one in the field-suggest MD on phone ASAP and PD en route for possibly dead/dying kid parents refuse to let you treat and let the MD give orders whereby HE/SHE took the child into protective custody and you are his/her arm in treatment. I FOR ONE WOULD NOT WALK AWAY!

https://www.thesullivangroup.com/risk_resources/refusal/refusal_2_refusal.asp


The courts have held that denying medical care to a child is not within the parents' First Amendment right of freedom of religion: "The right to practice religion freely does not include the liberty to expose... a child... to ill health or death. Parents may be free to become martyrs themselves. But it does not follow that they are free ... to make martyrs of their children..." State v. Perricone, N.J.Rep., Vol. 37, p. 463, Atlantic Reporter, 2d Series, Vol 181, p. 751, 1962.

Generally, state and federal courts support parental control over the basic matters affecting their children. However, when parental actions have resulted in inadequate medical care, courts in the United States have stepped in to decide between parent wishes and physician concerns. Under the doctrine of "parens patriae" (the state's paternalistic interest in children) the state will not allow a child's health to be seriously jeopardized because of the parent's limitations or convictions. A parent does not have the authority to forbid saving their child's life. Courts invariably rule in favor of a physician who claims that a parent is denying standard medical care to a child. 

Under the doctrine of parens patriae, the state represents the best interests of the child. The state also looks to the child abuse and neglect statutes, which provide for protective custody when the child has not received medically indicated treatment. 

Once again, the emergency physician is empowered by understanding the law. If parents withhold consent, and there is a life threat, the emergency physician should take temporary protective custody based on child neglect. It helps to explain to the parents that this is a medical obligation under the law, and you will immediately report to the hospital administrator, hospital attorney and the local child protection agency. The parents will typically stand down and allow you to proceed with your mission. Even in situations where the minor's life may not be threatened but severely impaired, the courts usually will order medical treatment over the parents objections. 


His Surmation:
1. Review of pediatric refusal of care issues:

a. In emergency situations, defined as conditions requiring prompt treatment, and not limited to potentially fatal or disabling conditions, any child may be treated without parental consent. 

b. Failure to provide treatment in these circumstances may constitute negligence. 

c. If treatment may entail risk, it is prudent to obtain a second opinion regarding the need for prompt treatment. Second opinions and attempts to contact the parents should be documented in the chart. 

d. "Emancipated" or minors living on their own who are self-supporting and not subject to parental control, a definition that includes college students and unmarried minor mothers, may provide their own consent for treatment. 

e. Statutes enacted by many states allow minors to give permission for treatment of venereal disease, or drug or alcohol problems without parental consent, and prohibit informing the parent regarding such treatment (including sending a bill) without the consent of the minor. 

f. The "mature minor" rule based on multiple court decisions, indicates that young people who are capable of providing appropriate informed consent may give valid consent for treatment which does not involve serious risks. Although minors have a corresponding right to refuse treatment, it appears to be doubtful the courts will uphold the rights of a minor to refuse treatment that may be life saving. 

g. It is noted that, in the past 30 years, no cases have been reported in which a parent has successfully sued a physician for the non-negligent care of an adolescent provided without parental consent.


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## VFlutter

Nevermind.


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## TheLocalMedic

STXmedic said:


> So these parent's beliefs prevent medical care for their child. They are obviously fairly convicted if they're willing to take the chance of their child dying. Weapon or not, do you seriously think they're going to let you walk up, take their kid from them, and drive away without intervening? (Hint: not likely).
> 
> I understand the want to treat the child. I don't think it would be an easy thing to do, and would probably take a mental toll on me at some point. But who are we to force someone to violate their religious and spiritual beliefs.



"Who are we to force someone to violate their religious and spiritual beliefs"???  I'm a paramedic, that's who.  Religious beliefs are all well and good, but ethically and legally I will not allow a parent to let their own child die.  

Again, the only thing stopping me from physically ripping that kid out of the parents' arms would be if they were willing and able to take me out.  And I'm a big guy, so I can hold my own in a fight.  

If I cannot reason with them (your child may die without immediate help) then they get pushed out of the way and that kid comes with me.  I'm more than happy to pick up an assault charge if it means getting that kid life saving care.  And I'd like to see any jury in the world convict me in that scenario.  

Maybe I'm hot headed, but this thread really struck something in me.  And I believe that anyone who says they'd walk away is full of it.  Walking away is not only ignorant, misguided and unethical, but will also find you on the pointy end of a prosecutor's interrogation for negligence.


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## STXmedic

TheLocalMedic said:


> "Who are we to force someone to violate their religious and spiritual beliefs"???  I'm a paramedic, that's who.  Religious beliefs are all well and good, but ethically and legally I will not allow a parent to let their own child die.
> 
> _Again, the only thing stopping me from physically ripping that kid out of the parents' arms would be if they were willing and able to take me out.  And I'm a big guy, so I can hold my own in a fight.  _
> 
> If I cannot reason with them (your child may die without immediate help) then they get pushed out of the way and that kid comes with me.  I'm more than happy to pick up an assault charge if it means getting that kid life saving care.  And I'd like to see any jury in the world convict me in that scenario.
> 
> Maybe *I'm hot headed*, but this thread really struck something in me.  And I believe that anyone who says they'd walk away is full of it.  Walking away is not only ignorant, misguided and unethical, but will also find you on the pointy end of a prosecutor's interrogation for negligence.



There are some very well-reasoned and well-argued posts on here that have already made me reconsider my position. I had a poor understanding of the extent of religious protection. I still have no intention of physically fighting parents off of their child, but I would certainly be more proactive than I'd have originally considered.

This is not one, nor are any of your previous posts in this thread. The only thing that stands out is the bolded, evidenced by the italicized (just one example).

The point is not to call you out, though. The point is that there is a good way to change beliefs, and a way that just demeans and pisses people off.*



*Any APs, please disregard the current irony...


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## TheLocalMedic

STXmedic said:


> The point is not to call you out, though. The point is that there is a good way to change beliefs, and a way that just demeans and pisses people off.



Granted, I may sound demeaning, and I may piss people off, but some of the reactions from people in this post made my blood absolutely boil.  It makes me question whether those people who say they'd just walk away have ever actually worked in the field and had to deal with tough ethical dilemmas.  Maybe they have, but the sense I got was that they were only conscious of a very classroom-based view of ethics.


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## Handsome Robb

I'm gonna ask a question.

How many people here have actually worked a pediatric arrest? I have. Multiple times. 

You can talk about what you'd do until you're blue in the face. When you really have to make decisions is when there's a dead kid in front of you.

I'm not fighting the parents. I'm not catching a charge. I will do everything in my power for that child but it's not my kid, I'm not sacrificing my livelihood by collecting a violent charge while on duty and potentially jeopardizing my livelihood.

Just another angle to consider.

What would your wife and kids day if you came home and told them you lost your job?


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## STXmedic

I've worked a few. Normally the child is being thrown at you, though, not pulled away. This scenario is one that most people will never see in their entire career. I do not envy the unfortunate medic faced with such a dilemma. If it were me, the only thing I'm sure of is that I'll be going home at the end of the day, and I will do nothing to jeopardize that.


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## TheLocalMedic

I've had several pediatric arrests, and never had I had anyone try and stop me from accessing the child.  But if there's a dying child in front of me with a parent between us saying that their religious beliefs won't allow me to help them, then I'm willing to do what it takes to get that child the care they need.  I can't imagine a parent wanting to stop me, but if they did, I would have an immediate problem with them.  And if they can't be reasoned with, then they're getting out of the way, one way or another.  

I don't consider it "jeopardizing my job" in that scenario.  I call it doing whatever it takes to try and save a child.  

If it's a kid with a skinned knee, that's a different story.  But this scenario calls for a collapse where the kid doesn't appear to be breathing.  You can call the cops, but that kid will be dead by the time they get there.  So unless there's significant risk to my life, I'm going in.  

Honestly, I'd rather risk an accusation of assault than stand by and watch a child die.  I'm sure that this particular predicament will never actually present itself, but that's where I stand on the issue.


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## Handsome Robb

That's what I was getting at. In a little over a year I've had 4 working and one obvious. 3 months, 18 months, 22 months, 24 months and 16 years. Obvious was a 8 month old. 

I have no doubt something like this has happened but I've never had a family try to interfere. Like Local and STX said the child is generally thrown at your as soon as you get out of the ambulance.

Telling the obvious one's parents was the most difficult thing I've had to do in my career. Hands down.

I have no doubt you'd run into resistance originally in a situation like this but even then once mommy and daddy realize little jimmy isn't coming back without help they'll change their minds. I've always wondered why communications isn't a prerequisite for EMS and/or included in the class...

Not a child but I had a 19 year old very devout Muslim woman with a severe neck injury. Had an extensive history of injuries and congenital problems. Present with severe generalize neuro deficits after yoga and feeling a pop in her high T low C spine. Other than requesting we remove our boots and meeting in the middle with disposable pillow cases as shoe covered they allowed us to treat her as we saw for provided we communicated what we wanted to do before we do it. 

Point of the story is communication skills can go a long way.


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## MonkeyArrow

TheLocalMedic said:


> I've had several pediatric arrests, and never had I had anyone try and stop me from accessing the child.  But if there's a dying child in front of me with a parent between us saying that their religious beliefs won't allow me to help them, then I'm willing to do what it takes to get that child the care they need.  I can't imagine a parent wanting to stop me, but if they did, I would have an immediate problem with them.  And if they can't be reasoned with, then they're getting out of the way, one way or another.
> 
> I don't consider it "jeopardizing my job" in that scenario.  I call it doing whatever it takes to try and save a child.
> 
> If it's a kid with a skinned knee, that's a different story.  But this scenario calls for a collapse where the kid doesn't appear to be breathing.  You can call the cops, but that kid will be dead by the time they get there.  So unless there's significant risk to my life, I'm going in.
> 
> Honestly, I'd rather risk an accusation of assault than stand by and watch a child die.  I'm sure that this particular predicament will never actually present itself, but that's where I stand on the issue.



The point that I have a problem with your actions is the point where you intervene against the parents wishes, in a not so nice way, and you still lose the child. Now where does that get you? You have obviously violated the parent's religious beliefs by pumping their child full of meds and doing all these ALS interventions and the child is still dead. I would say that you have doubled the hurt almost; you took away their child and their religion away in one action (of course assuming that for someone to prevent treatment of their dying child because of religion, they are truly devoted to said religion). We all know the statistics of arrest survivals, especially in peds where the cause is more likely going to be a congenital defect that may or may not go into VF/VT/Torsades. Now, you have a kid who is dead (who you might have never been ever to save), a severe religious issue with the parents, and legal issues (which the jury will not like since the kid is dead as opposed to being alive). I almost think that this situation is like the coach who decides to go for the game winning 2 pointer instead of the tying extra point. If the two point converts, he's a hero and everyone's good. But if they miss the two pointer, what a horrible call.

EDIT: Neither have I faced a situation like this nor do I hope I ever have to.


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## Av8or007

When ones religious beliefs prevent a child from ever being able to have their own beliefs or life then saving the child takes precedence.

Primium non nocere.


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## TheLocalMedic

MonkeyArrow said:


> We all know the statistics of arrest survivals, especially in peds where the cause is more likely going to be a congenital defect that may or may not go into VF/VT/Torsades. Now, you have a kid who is dead (who you might have never been ever to save), a severe religious issue with the parents, and legal issues (which the jury will not like since the kid is dead as opposed to being alive). I almost think that this situation is like the coach who decides to go for the game winning 2 pointer instead of the tying extra point. If the two point converts, he's a hero and everyone's good. But if they miss the two pointer, what a horrible call.



Just because the odds aren't in my favor doesn't mean that I'm not going to give it my all.  ESPECIALLY because it's a kid.  And if that means the parents' feelings get hurt, then so be it.  And as to the football reference, in this case there isn't an option to go for a field goal.  There is no second best in this situation.


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## Anonymous

Pretty much agree with everything TheLocalMedic has said. 

EMS is filled with ethical and legal questions like this. They used to drive me nuts, darned if you do, and darned if you don't. At the end of the day I am going to do what I believe to be right in my heart. No different than if I was not on duty. If I have to come home and tell my wife and kid I lost my job for trying to save a child then so be it, and I know they would;t think any less of me because of it. I am shocked that this issue is so divided. There goes the reasonable "prudent" man protection I used to find comfort in. I sure hope that the day a medic finds himself in a court room defending himself for something like this there is not one of you sitting across on the prosecution side saying "oh no I would have walked away and respected the parent's wishes."


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## mycrofft

Robb said:


> I'm gonna ask a question.
> 
> How many people here have actually worked a pediatric arrest? I have. Multiple times.
> 
> You can talk about what you'd do until you're blue in the face. When you really have to make decisions is when there's a dead kid in front of you.
> 
> I'm not fighting the parents. I'm not catching a charge. I will do everything in my power for that child but it's not my kid, I'm not sacrificing my livelihood by collecting a violent charge while on duty and potentially jeopardizing my livelihood.
> 
> Just another angle to consider.
> 
> What would your wife and kids day if you came home and told them you lost your job?



And the patient is still dead and you are waiting trial? I hear you.

There is an answer we don't often utilize here, which we were not taught, and that is to BE PERSUASIVE. Sweet talk the parents. Lie. In their presence actually call 911 and tell the operator who you are and that you need law enforcement because there is either a fresh or impending death about to occur. Beg. Whatever. But don't get into the macho armchair "I'd hit 'em with my E cylinder" routine.


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## DrParasite

Robb said:


> I'm gonna ask a question.
> 
> How many people here have actually worked a pediatric arrest? I have. Multiple times.


I have.... they suck.  usually they are drownings, or an expected death (kid had a medical condition, etc).  Never had a parent say don't help, usually it's hurry up and help my kid.





Robb said:


> I'm not fighting the parents. I'm not catching a charge. I will do everything in my power for that child but it's not my kid, I'm not sacrificing my livelihood by collecting a violent charge while on duty and potentially jeopardizing my livelihood.


I will.  I'll fight the parents.  I'll take the charge.  and I'll take that risk in a heartbeat, and you said why below





Robb said:


> What would your wife and kids day if you came home and told them you lost your job?


"Wife: what happened? me: I got fired/suspended/arrested today.  wife: omg why???? me: saw a kid who was dead/dying, thought of my own kids, how much I love them, and want them to succeed and have a nice long life, and couldn't live with myself if I just stood by and watch this kid die because the parents refused to let me help him.  So i did what I needed to in order to ensure this kid had as much of a chance as my own kids. "

I don't have any kids, but i could live with myself much easier doing that than standing around and letting the kid die.

And as much as I usually say people have the right do make thier own stupid medcial decisions, and have them sign the RMA form, this would be the exception.  Get LEO involved (I don't care if the desk Sgt himself needs to get in a car, or a white shirt police supervisor needs to come to the scene), a supervisor, in this case it's much easier to beg for forgiveness than wait for permission to be granted.


----------



## Brevi

DrParasite said:


> in this case it's much easier to beg for forgiveness than wait for permission to be granted.



Lol, Rob has the easier to ask forgiveness than get permission quote in his signature.

Guess he doesn't find it applicable here.


----------



## Brevi

I apologize if I come across as crass, but it seems that several of you are voicing that you would make patient care decisions based on avoiding punishment instead of what you believe is right or wrong.

It's a pre-conventional level of reasoning, which I find to be a terrifying imperative in a healthcare provider.


----------



## bbmtnbb

The basic underlying importance of this thread is to prep us for the inevitable that we will all encounter.   We NEED to know our limits and responsibilities legally as we know them in lur hearts ethically.  FIND OUT what you can and can't do in your county and do it. Again morally -which is not legally--I could NOT walk away easily-will I endanger myself in a fight with dad-probably not but will I leave NO. Use your words widely with EMS and POP and see where you get.  I am confident I could sway someone to make this work.  Get it worked out in your head and discuss this BEFORE it happens!!


----------



## Rialaigh

Brevi said:


> I apologize if I come across as crass, but *it seems that several of you are voicing that you would make patient care decisions based on avoiding punishment instead of what you believe is right or wrong.*
> 
> It's a pre-conventional level of reasoning, which I find to be a terrifying imperative in a healthcare provider.




erm...this is most of protocol based EMS. I put people in spinal all the time even though I think it is the "wrong" thing to do. We do tons of things in EMS that are widely thought among street level providers to be "Wrong" but we do it because it is the lesser of two evils...the worse one being losing your job or getting sued....

In area's that are not very up on evidence based medicine and treatment providers are required to treat people with outdated techniques that are frequently touted as "Wrong"


----------



## Household6

Brevi said:


> I apologize if I come across as crass, but it seems that several of you are voicing that you would make patient care decisions based on avoiding punishment instead of what you believe is right or wrong.
> 
> It's a pre-conventional level of reasoning, which I find to be a terrifying imperative in a healthcare provider.



My opinion of right and wrong are negated by my protocols. Rules I follow are in place to keep me out of jail, not appease my bleeding heart.


----------



## vcuemt

Protocols exist for a reason - to protect you, your agency, your patients, your community, and so on.  Parents have the right to make healthcare decisions for their children, just as they have the right to hold religious beliefs you and I might characterize as insane, stupid, etc etc. You don't get to take those rights away, and not only because people who were elected have passed laws and people who were appointed have written SOPs that say so, but also for larger, ethical reasons. Who are you to say what they are doing is incorrect? You approach the situation as a healthcare provider and you want to provide care, but your priorities are only one facet of the situation. The parents (in this made-up scenario) have priorities stemming from their religious beliefs. You are going to decide that your beliefs trump theirs when it pertains to _their _child? That's arrogant. 

We aren't out practicing vigilante medicine. Laws govern the police for a reason, even though criminals do go free after committing crimes. I'm sure there are many cops who'd rather shoot someone they "know" is a bad guy than face the possibility that he go free after a trial for any number of reasons, but they don't get to make those decisions. And that's a good thing, because we are a society of laws.

Of course that's easy for me to say sitting at a desk and typing this onto an online forum. If this was actually me in this scenario I'd respect the parents' wishes right up until the cops showed up and told me to go to work. I'd just hope it wasn't too late. 

"Person, personnel, patient" doesn't only apply when talking about scene safety. Your first allegiance on the back of the truck has to be to #1 - legally, too.


----------



## mycrofft

" 'Wife: what happened? me: I got fired/suspended/arrested today. wife: omg why???? me: saw a kid who was dead/dying, thought of my own kids, how much I love them, and want them to succeed and have a nice long life, and couldn't live with myself if I just stood by and watch this kid die because the parents refused to let me help him. So i did what I needed to in order to ensure this kid had as much of a chance as my own kids. '

_*I don't have any kids*_, but i could live with myself much easier doing that than standing around and letting the kid die."

ALTERNATE ENDING IN REAL WORLD:

EMT: "Wife, I pushed a grieving mother onto her butt and threatened her husband with my clipboard. I'm at County Jail, please tell the kids I'm sorry and get hold of a lawyer for me, and $10,000  for bail. PS the kid was dead already".

or 

EMT: "Wife, I'm at Memorial. We just brought in a kid who drowned, had a hard time getting his parents to let us in but they did. Just calling to give you and little JoJo and Akeesha a hug, I gotta go, be home the usual time".


----------



## jrm818

vcuemt said:


> Protocols exist for a reason - to protect you, your agency, your patients, your community, and so on.  Parents have the right to make healthcare decisions for their children, just as they have the right to hold religious beliefs you and I might characterize as insane, stupid, etc etc. You don't get to take those rights away, and not only because people who were elected have passed laws and people who were appointed have written SOPs that say so, but also for larger, ethical reasons. Who are you to say what they are doing is incorrect? You approach the situation as a healthcare provider and you want to provide care, but your priorities are only one facet of the situation. The parents (in this made-up scenario) have priorities stemming from their religious beliefs. You are going to decide that your beliefs trump theirs when it pertains to _their _child? That's arrogant.



Who am I (and who are you, too)?  I'm an educated medical professional, acting in place of a physician, and I'm rendering my educated medical opinion that the child in front of me is likely to die or be disabled if they fail to receive immediate care.  Our society says that children dying is "incorrect," and in this case we are the voice of society.  Its not an arrogant personal decision, its a societal decision that is necessary because children are generally unable to protect themselves from insane/stupid/abusive/foolish parents.

I don't really understand the basis of your opinion either.  I doubt it came from your training.  Nor does it seem to be based in the law.  Did you read the rest of the thread?  If not, read it, and read some of these too: 

http://pediatrics.aappublications.org/content/128/2/427.full.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528596/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726617/pdf/v022p00869.pdf
http://www.ncmedicaljournal.com/wp-content/uploads/NCMJ/sep-oct-07/brezina.pdf

I'll admit that there have been minimal test cases so the issue is a little complicated.  Additionally rules may change a bit state to state, but in general it seems pretty clear that the courts have held that the state has a substantial interest in protecting the lives of children, and that the state's interest outweighs the parental interests in exercising control over their children.  Parents have rights, but so do children.  In this case, the child has the right to grow to adulthood and make their own stupid decisions. TLDR:  *parents are non-omnipotent; they do not have the right to decide if their child lives or dies.*

I don't' really see how this is very hard - what would you do if you saw a parent beating their children with a whip and claim its was religious practice? In the process of sacrificing them at an alter?  If you say "walk away" or "watch until PD arrives" I think I would question either your honesty or your integrity.   This is little different  - a parent attempting to cause the death or injury of their child, the reason is irrelevant.


Obviously making contact with medical control ASAP, trying persuasion first (but quickly) and getting PD and supervisors to back you up absolutely ASAP is critical.  This scenario will likely never play out the way it is described.  But if it did, I have trouble respecting any person who would truly watch a child die, knowing they could help, due to fear of legal repercussions (which are doubtful anyways).


This reminds me of all the times people spout nonsense about how EMS is "just another job."  If you feel better by refusing to take accept the importance of the decisions you are paid to make every day, great, but that doesn't make you a Toyota technician.  Practicing medicine (even via protocols)sometimes  requires tough decisions and can have a profound impact on people's lives.  That requires some moral fortitude (and, of course, a working knowledge of your states laws and policies etc.) - you can't always just punt responsibility.


----------



## jrm818

Rialaigh said:


> Thirty-eight states and the District of Columbia have religious exemptions in their civil codes on child abuse or neglect including decisions about healthcare.
> Seventeen states have religious defenses to felony crimes against children including results from decisions about healthcare.
> 
> Hospitals and ethics boards frequently label people "mature minors" and allow them to refuse medical care on the grounds of religion. Some as young as 12-14 can refuse life saving treatment for themselves.
> 
> Take a look here and read through some cases and some of the legislation that is currently active
> 
> http://childrenshealthcare.org/



No clue where you wanted us to look on that website, but as to the top of the post: my understanding is that the laws you reference protect parents from criminal charges for failing to obtain medical care for their children.  Those laws do not prohibit medical personnel from overruling paretns to provide life saving care in an emergency


----------



## mycrofft

"  I'm an educated medical professional, acting in place of a physician ".

Paramedics are _*technicians*_ operation under protocols written _by MD's_, and supervised _by their medical controller_. They are not in lieu of a physician. Even PA's and FNP's are not in lieu of physicians.

Be that as it may, everyone including paramedics is responsible for reporting and preventing child abuse and endangerment. Point taken.


----------



## mycrofft

*Just because I can't let it alone….*

Would a responder be justified in using lethal force against a parent whose obstruction will cause a child's death? How about another adult's?


----------



## VFlutter

jrm818 said:


> TLDR:  *parents are non-omnipotent; they do not have the right to decide if their child lives or dies.*



But you do?


----------



## Av8or007

Yes. Withholding medical care for a child on the basis of religion when the child is  unable to consent to withhold the care themselves is no different then child abuse.

What happens if your religion involved starvation or beatings? Is that ok too?

Of course not.


----------



## TheLocalMedic

mycrofft said:


> Would a responder be justified in using lethal force against a parent whose obstruction will cause a child's death? How about another adult's?



No.  Lethal force is not acceptable.  But it is absolutely legal to use the "necessary" amount of force required to prevent them from killing or injuring another person.  "Necessary" is a pretty broad term, so interpret that as you may, but I envision that as restraining them rather than bashing them over the head with an O2 tank.


----------



## TheLocalMedic

Chase said:


> But you do?



Yes.  Preventing a child from receiving immediate, life-saving care is illegal, and I am ethically and legally obligated to act to save that child, even if it is against the parents wishes.


----------



## Carlos Danger

TheLocalMedic said:


> No.  Lethal force is not acceptable.  But it is absolutely legal to use the "necessary" amount of force required to prevent them from killing or injuring another person.  "Necessary" is a pretty broad term, so interpret that as you may, but *I envision that as restraining them* rather than bashing them over the head with an O2 tank.



I'm curious how you propose physically restraining 1 or both parents and simultaneously providing care to the child?


----------



## jrm818

Chase said:


> But you do?




x2 to localmedic's reply

I don't make any decision - society made the decision that ending a child's life because of parental beliefs is unacceptable.  And its not much of a complicated decision - kid gets every chance to live, period.  Seems pretty reasonable....freedom in this country is not without qualification.  

EMS providers may be the enforcers of that decision.  It is not a decision that I/we just made on our own, however.  That said, I make no apologies for being culturally normative when a _child's _life is on the line

Did you read any of the information that was posted?  This isn't a novel idea I cooked up....it's been established by common law, written law, and the courts.  This is also a concept that a healthcare professional should have some familiarity with.....


----------



## TheLocalMedic

Halothane said:


> I'm curious how you propose physically restraining 1 or both parents and simultaneously providing care to the child?



Restraining was just an example of the kind of force that may be considered.  In this case it may be that you wouldn't have to use much force, perhaps just initiating care and ignoring the parent's protests, or removing the child to the ambulance.  But if it gets physical I'm not adverse to protecting myself and the patient.  This is a more drastic scenario, but letting a potentially dying child just lay there isn't an option.  

1.  Call for code 3 law enforcement (and possibly an extra ambulance and a fire crew if there isn't one present)
2.  Quickly try to reason with the parents (probably less than a minute)
3.  Get access to the patient - if that means getting them out of there, great, and if the parents try to block you, then get them out of the way.  Stop only if there's a serious risk to yourself.


----------



## exodus

TheLocalMedic said:


> Restraining was just an example of the kind of force that may be considered.  In this case it may be that you wouldn't have to use much force, perhaps just initiating care and ignoring the parent's protests, or removing the child to the ambulance.  But if it gets physical I'm not adverse to protecting myself and the patient.  This is a more drastic scenario, but letting a potentially dying child just lay there isn't an option.
> 
> 1.  Call for code 3 law enforcement (and possibly an extra ambulance and a fire crew if there isn't one present)
> 2.  Quickly try to reason with the parents (probably less than a minute)
> 3.  Get access to the patient - if that means getting them out of there, great, and if the parents try to block you, then get them out of the way.  Stop only if there's a serious risk to yourself.



Have fun in prison.  My livelihood is not worth it.

Edit: And what charges?

Assault & Battery, kidnapping, kidnapping with force, false imprisonment. I'm sure the DA can find more. It's not YOUR child. It's their child. They have the right to choose what treatment the child gets.


----------



## Brevi

Granted this scenario is a bit extreme, but so are a lot of the responses here. You don't need to get a refusal and walk away, but you don't need to fight anyone either.

The Medical Director should be able to take the child into protective custody sight unseen. 

I'll talk to DCF and try to get some answers specific to this type of scenario for ya'll.


----------



## exodus

Brevi said:


> Granted this scenario is a bit extreme, but so are a lot of the responses here. You don't need to get a refusal and walk away, but you don't need to fight anyone either.
> 
> The Medical Director should be able to take the child into protective custody sight unseen.
> 
> I'll talk to DCF and try to get some answers specific to this type of scenario for ya'll.



Why would they take the child into protective custody? If there's no abuse, there is nothing wrong.


----------



## Brevi

exodus said:


> Why would they take the child into protective custody? If there's no abuse, there is nothing wrong.



A physician has the legal authority to  take temporary protective custody of a child without the consent of the parents or caretaker if certain conditions are met, such as refusing life saving treatments. A parent can not refuse treatment in a life threatening situation, even if for religious reasons.

And it's definitely a form of abuse. It may not be as obvious to some as beating or starving a child, but it is certainly abuse.


----------



## Brevi

Ask one of your ER docs the procedure they would use to take PC in your area.


----------



## exodus

Brevi said:


> A physician has the legal authority to  take temporary protective custody of a child without the consent of the parents or caretaker if certain conditions are met, such as refusing life saving treatments. *A parent can not refuse treatment in a life threatening situation, even if for religious reasons.*
> 
> And it's definitely a form of abuse. It may not be as obvious to some as beating or starving a child, but it is certainly abuse.



Cite this please.


----------



## VFlutter

jrm818 said:


> Did you read any of the information that was posted?  This isn't a novel idea I cooked up....it's been established by common law, written law, and the courts.  This is also a concept that a healthcare professional should have some familiarity with.....



Ya, Did you? All of those case studies except one took place outside the United States. They also all involved court orders prior to treatments. It is different circumstances then the original scenario. 

Can MDs and hospitals get court orders to force treatment on minors when parents refuse treatment? Yes. Do they forcibly provide treatment and physically remove parents? No. Especially without a court order or ethics committee involvement.   

I am not advocating just sitting around and letting kids die however I am against the fanatical mentality of "I am treating that kid and no one can stop, if those parents get in my way I will physically restrain them, etc". Take the emotion out of it. You may not have the medical or legal authority to make those decisions.

Call me heartless but I am not risking my career and livelihood for a patient, even a child. I didn't sacrifice 4+ years of school and assume 10s of thousands of debt to throw it away. And I will sleep just fine at night.


----------



## Brevi

google parental autonomy doctrine


----------



## fortsmithman

I would pull back at that point and stage a block from the scene and call for police and child welfare to go to the scene.  The moment they arrive I would go back in.  Because in all probability the child welfare officer would apprehend the child under the child welfare act.  Once that happens we would be able to attempt treatment.


----------



## TheLocalMedic

exodus said:


> Have fun in prison.  My livelihood is not worth it.
> 
> Edit: And what charges?
> 
> Assault & Battery, kidnapping, kidnapping with force, false imprisonment. I'm sure the DA can find more. It's not YOUR child. It's their child. They have the right to choose what treatment the child gets.



So if that kid collapsed and isn't breathing you would walk away just because the parents say so?  The parents in that case may be committing negligent homicide.  Are you saying that if you saw someone strangling a woman on the street you'd walk away because, God forbid, trying to help her might somehow get you a battery charge?  

In this case, the parents do not have the right to withhold care.  If it's something non-lifethreatening, that's a different story.  

Here's some great quotes from the Sullivan Group regarding patient AMA rights:

"Generally, state and federal courts support parental control over the basic matters affecting their children. However, when parental actions have resulted in inadequate medical care, courts in the United States have stepped in to decide between parent wishes and physician concerns. Under the doctrine of "parens patriae" (the state's paternalistic interest in children) the state will not allow a child's health to be seriously jeopardized because of the parent's limitations or convictions. A parent does not have the authority to forbid saving their child's life. Courts invariably rule in favor of a physician who claims that a parent is denying standard medical care to a child. One judge asserted that "The right to practice religion freely does not include the liberty to expose... a child... to ill health or death. Parents may be free to become martyrs themselves. But it does not follow that they are free ... to make martyrs of their children…"

"The parents will typically stand down and allow you to proceed with your mission."

"If there is no life threat, and no potential for serious impairment, the parent’s AMA request should be respected. "

"Remember that you are protected from civil and criminal liability under the child abuse and neglect statutes. You may be hesitant to take custody, but it should not be for fear of liability."


----------



## jrm818

Chase said:


> All of those case studies except one took place outside the United States.
> 
> _Not Quite, I posted 4 links, the first from the American Academy of Pediatrics speaking to US law, the next two from Canada and England because they did a good job of laying out the ethical issues (and in once case do reference the Massachusetts Prince case), and one from North Carolina illustrating some state specific issues. _
> 
> 
> They also all involved court orders prior to treatments. It is different circumstances then the original scenario.
> 
> _Emergencies are very different from situations allowing for time to obtain court orders, and that has historically been understood by the courts.  For example, from texas: (though it concerns withholding care due to disabilities rather than religious beliefs) : http://virtualmentor.ama-assn.org/2003/08/hlaw1-0308.html_
> 
> Can MDs and hospitals get court orders to force treatment on minors when parents refuse treatment? Yes. Do they forcibly provide treatment and physically remove parents? No. Especially without a court order or ethics committee involvement.
> 
> _Not accurate.  See Above.  That may be the way it tends to work on a hospital floor with conditions that don't need treatment immediately, but in an emergency situation it should be obvious to anyone that there is not time to obtain a court order or convene the ethics committee, and in this case treatment should begin parallel to LE, the courts, etc. becoming involved.  It is a well established legal principle that emergencies are treated differently in all sorts of ways.
> 
> You don't have to believe my ramblings.  Here's the guidance from the American Academy of Pediatrics, posted earlier....luckily they've written a position paper on just this issue - specific to emergencies and even to prehospital care._
> 
> 
> 
> "A particularly challenging situation occurs
> when the health care professional
> is faced with a legal guardian
> who refuses to give permission for
> treatment of a child in situations in
> which such treatment is considered
> essential to the child’s well-being.
> [...]parental permission
> is required before the evaluation and
> treatment of a child.* Parental authority
> is not absolute, however, and when a
> parental decision places a child at significant
> risk or serious harm compared
> with an alternative decision, the
> state may intervene to require intervention
> over the objections of the legal
> decision-maker.*
> As long as a child’s legal guardian possesses
> medical decision-making capacity,
> he or she has the right to refuse
> medical care for the child. However,
> the guardian is required to act in the
> best interest of the child. When a legal
> guardian refuses to consent to medical
> care or transport that is necessary
> 
> and likely to prevent death, disability,
> or serious harm to the child, law enforcement
> officers may intervene under
> local and state child abuse and neglect
> laws. It is always preferable to
> negotiate with the legal decisionmaker
> and attempt to achieve an
> agreeable plan for safely managing
> the child’s medical condition.
> When faced with a guardian who refuses
> to allow the provision of necessary
> medical care or transport of a
> child when it is necessary to save a
> child’s life or prevent serious harm, it
> might be necessary to notify the police
> and enlist their assistance in placing
> the child in temporary protective custody.
> *In a life-threatening emergency, it
> might be necessary to involve hospital
> security so that emergent evaluation
> and treatment can begin while child
> protective services and the police are
> notified. *Likewise, when a legal guardian
> appears to be intoxicated or otherwise
> impaired, involvement of law enforcement
> officers might be necessary
> to place a minor in temporary protective
> custody.[...] Under these
> circumstances, a medical professional
> should provide medical treatment
> without consent only when the child
> has a medical condition that poses a
> risk of death or serious harm, when
> immediate treatment is necessary to
> prevent that harm, and when only
> those treatments necessary to prevent
> the harm are provided.25"
> 
> 
> _They even wrote a bit for EMS:_
> 
> "If at all possible, an assessment
> should be performed to determine
> if there is a medical emergency,
> and medical consultation should be
> sought if the emergency medical technicians
> are unclear about whether a
> threat to life or limb exists. If parents
> are present or accessible and refuse
> care for their injured or ill child, they
> must be informed of the risk of not
> transporting a sick or injured pediatric
> patient, which might include death
> or permanent disability. *Regardless of
> religious beliefs or parental desires,
> every attempt should be made to treat
> and/or transport a child with a lifethreatening
> emergency or if providers
> suspect child abuse. *EMS providers
> should involve medical control early in
> these situations and use law enforcement
> resources as necessary to ensure
> that the patient receives the necessary
> emergency stabilization and
> transport."
> 
> 
> 
> I am not advocating just sitting around and letting kids die however I am against the fanatical mentality of "I am treating that kid and no one can stop, if those parents get in my way I will physically restrain them, etc". Take the emotion out of it. You may not have the medical or legal authority to make those decisions.
> 
> _In an emergency with no other resources immediately available I feel fairly confident that you do.  What evidence do you have suggesting the opposite?_
> 
> 
> Call me heartless but I am not risking my career and livelihood for a patient, even a child. I didn't sacrifice 4+ years of school and assume 10s of thousands of debt to throw it away. And I will sleep just fine at night.
> 
> _I disagree that loosing a job or being incarcerated is at all a likely outcome of treating over parental objections, and I'd love to see a single example where something similar happened.  Similarly, obeying parental wishes carries risks - and honestly legal problems seem much more likely to occur due to an untreated dead child than over a scorned religious zealot.   I admit I have no evidence for that particular claim._



Mine in blue

General comment: I am genuinely curious where everyone is getting the idea that parents can refuse lifesaving care in an emergent situation.  Not one shred of outside evidence has been posted supporting this notion.  The medical ethics books I've seen say the opposite.  Googling returns the opposite answer.  Were you taught this in school?  Is this just your general impression of how the American legal system works?  Does anyone with relevant qualifications agree with you (serious question, not snark)?


----------



## Rialaigh

jrm818 said:


> No clue where you wanted us to look on that website, but as to the top of the post: my understanding is that the laws you reference *protect parents from criminal charges for failing to obtain medical care for their children.  Those laws do not prohibit medical personnel from overruling paretns to provide life saving care in an emergency*



That's a mighty fine line to walk. Several of those laws specifically state that parents are legally covered from charges for refusing treatment for their child even in life saving circumstances. Hospitals with ethics boards and committees of doctors respect these parents wishes and their child's. why shouldn't EMS


----------



## Jim37F

My protocol basically says call the cops in this situation



> Department of Health Services
> County of Los Angeles
> Reference No. 832 Treatment/Transportation of Minors
> I. C. If Prehospital care personnel believe a parent or other legal representative of a minor is making a decision which appears to be endangering the health and welfare of the minor by refusing indicated immediate care or transport, law enforcement authorities should be involved.



So if I show up on a scene and the parents refuse care due to religious reasons, my first reaction would be to tell them "If you don't let me treat them, I will be forced to call the police. Please, let's keep that can of worms closed and just let me do my job and save your childs life".

If they relent, great, proceed to treat as normal. If not, get on the radio and request LEOs respond emergent.

While waiting for them to arrive, continue negotiating with the parents. I'm thinking something along the lines of "Look, I resect your religious beliefs, but please respect mine. I cannot simply just watch a child die and do nothing about it, especially if I have the tools to stop it. If you truly believe that God is calling your child to heaven right now then nothing I will do will matter anyway, so please, just let me try. Because if on the other hand it's NOT their time, we can prevent such a devastating loss to your family". Etc. 

If they relent, great, initiate treatment/transport. If not, wait for LEOs. Once they arrive they'll either a)do what they need to to detain the parents and allow you to do your job. In that case, forget about the parents and treat/transport the kid as their condition indicates. 
 I'll definitely be filling out a suspected child abuse form at this point. Otherwise that's the end of my involvement, let the state send people far more familiar with the intricacies of the law investigate.

Option b) is if the LEOs for whatever reason tell you no, you can't treat, the parents are within their rights to refuse treatment. After I'm through looking at said cop like he's got a d*** growing out of his forehead, I'd request supervisors from both your agency and the LE agency code 3 to the scene. If that ruling still stands, well, it'd suck royally, make me want to puke, but I'd no more initiate treatment than I would for a patient with a valid DNR.

But somehow I just don't see option B being the more likely scenario.


----------



## medicsb

Rialaigh said:


> Hospitals with ethics boards and committees of doctors respect these parents wishes and their child's. why shouldn't EMS



Where are you getting your information from?  In emergent situations it is not uncommon for physicians to have parents removed from the ED in order to care for a child against the objections of the parents.  In less emergent conditions, hospital and physicians can and do petition the court system for an order to provide care (e.g. cancer treatment).   It may not be an everyday occurrence, but it does happen.


----------



## TheLocalMedic

Rialaigh said:


> That's a mighty fine line to walk. Several of those laws specifically state that parents are legally covered from charges for refusing treatment for their child even in life saving circumstances. Hospitals with ethics boards and committees of doctors respect these parents wishes and their child's. why shouldn't EMS



I'm not sure why you believe this.  

"Natalie Rippberger, eight months, died December 9, 1984 in Santa Rosa, California, of h-flu meningitis. The parents, Mark and Susan Rippberger, had retained a Christian Science practitioner for spiritual "treatment" but would not get essential medical care for their daughter…  Natalie's parents, Mark and Susan Rippberger, were charged with felony child endangerment and involuntary manslaughter. Both were convicted of felony child endangerment."

"Shauntay Walker, age four, died March 8, 1984, in Sacramento, California, of h-flu meningitis. Shauntay was home sick from her pre-school for 17 days. She received no medical care, only Christian Science "care." ….  Laurie Walker was charged with involuntary manslaughter, and on June 21, 1990, over six years after her daughter's death, she pled guilty to that charge"

"Amy Hermanson, age seven, died September 30, 1986, in Sarasota, Florida, of untreated juvenile onset diabetes. Her parents refused to provide her with necessary medical care….  Amy's parents were charged with felony child abuse and third degree murder. Both were convicte on the charge of third degree murder."

"Loren Willliamson, age five, died June 1989, of lymphocytic leukemia in Loranger, Louisiana. Annetta Williamson, the mother, belongs to the Church of God; she prayed for divine healing instead of obtaining medical care….The mother was booked for negligent homicide."  

"Robyn Twitchell, age two, died in April, 1986, in Boston, Massachusetts, of a bowel obstruction. A simple operation to remove the twisting of the bowel would have most likely saved Robyn's life….In July, 1990, the Twitchells were convicted of manslaughter."

"Elizabeth Ashley King, age 12, died June 5, 1988, in Phoenix, Arizona, of bone cancer. She was out of school and sick at home from November 1987 to May 1988….Ashley told nurses and doctors: "I'm in so much pain...You don't know how I've suffered."…The parents, John and Catherine King, pleaded no contest to the felony of reckless endangerment in their daughter's death."

"Lisa Sheridan, age five, died in 1967 in Cape Cod, Massachusetts, after a three week battle with pneumonia without medical care. Lisa received Christian Science prayer treatment over the entire course of her illness. Lisa's mother was tried and convicted of involuntary manslaughter."

"Justin Barnhart, age two, died September 1981, in Beaver Valley, Pennsyslvania of a Wilm's tumor which grew larger than a volleyball in the child's abdomen. The parents, William and Linda Barnhart, withheld medical care from their son because of their religious beliefs. With early medical intervention, this form of childhood cancer has a better than 90 percent cure rate. The parents were convicted of involuntary manslaughter in 1982 by the county court. Although Pennsylvania had a religious exemption law in the code dealing with reporting of child abuse and neglect, the prosecution successfully argued that he law did not apply to criminal charges. In September 1988, the United States Supreme Court voted 9-0 against reviewing the state conviction of the parents."

And there are many many more...


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## MonkeyArrow

I'd like to cite the Dennis Lindberg case:
http://www.pediatricethics.org/news/noteworthy-stories/dennis-lindberg/
as evidence that the courts have held in certain situations that potentially life saving medical care can be withheld from minors leading to their deaths due to religious beliefs. I do understand that this case is not exactly the same as aforementioned scenario in this thread and that there are significant legal differences. However, there are also some similarities which could also be legally decisive.

Namely, a difference between this thread's scenario and the Lindberg case is that the boy was refusing treatment on his own behalf. His parents were actually urging him to get the treatment for which he refused. The judge basically declared that Dennis Lindberg has the right to refuse treatment as an emancipated minor and was thus mature enough to understand the consequences of not attaining the treatment he needed to survive. Even though the minor wanted to refuse treatment, he was still under the legal care of his aunt, an adult, until the judge ruled him an emancipated minor.

However, the precedent that this case sets may also be legally significant. The judge allowed a minor to die by refusing to seek medical care, something in which some of you have refused to say would let happen. However, the courts found in favor of letting Lindberg refuse treatment as a minor and die. Additionally, we must think what happens when the minor is not given an independent status as was given in this case. At that point, the minor is still under the care of the parents/legal guardian and the medical decision is their's to make. Since the judge allowed said minor to withhold treatment and die, you must assume that legal precedent MAY have been set and other minors could follow down the same path. If one minor is allowed to withhold treatment, why can't the other one's too (since the decision was/is being made by the appropriate legal entity)? How can you make a determination that the child wants to receive the treatment that is being forced upon him. Akin to this case, the minor may be old enough to understand and comprehend but not old enough to make legal decisions to withhold treatment. How does one get the legal power to remove a family member from life support? How is one tasked with the responsibility and legally allowed to choose when someone dies (legally is a whole different beast than real life. yes, the person is already brain dead in real life but legally still alive)?


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## jrm818

MonkeyArrow said:


> I'd like to cite the Dennis Lindberg case:
> http://www.pediatricethics.org/news/noteworthy-stories/dennis-lindberg/
> as evidence that the courts have held in certain situations that potentially life saving medical care can be withheld from minors leading to their deaths due to religious beliefs. I do understand that this case is not exactly the same as aforementioned scenario in this thread and that there are significant legal differences. However, there are also some similarities which could also be legally decisive.
> 
> Namely, a difference between this thread's scenario and the Lindberg case is that the boy was refusing treatment on his own behalf. His parents were actually urging him to get the treatment for which he refused. The judge basically declared that Dennis Lindberg has the right to refuse treatment as an emancipated minor and was thus mature enough to understand the consequences of not attaining the treatment he needed to survive. Even though the minor wanted to refuse treatment, he was still under the legal care of his aunt, an adult, until the judge ruled him an emancipated minor.
> 
> However, the precedent that this case sets may also be legally significant. The judge allowed a minor to die by refusing to seek medical care, something in which some of you have refused to say would let happen. However, the courts found in favor of letting Lindberg refuse treatment as a minor and die. Additionally, we must think what happens when the minor is not given an independent status as was given in this case. At that point, the minor is still under the care of the parents/legal guardian and the medical decision is their's to make. Since the judge allowed said minor to withhold treatment and die, you must assume that legal precedent MAY have been set and other minors could follow down the same path. If one minor is allowed to withhold treatment, why can't the other one's too (since the decision was/is being made by the appropriate legal entity)? How can you make a determination that the child wants to receive the treatment that is being forced upon him. Akin to this case, the minor may be old enough to understand and comprehend but not old enough to make legal decisions to withhold treatment. How does one get the legal power to remove a family member from life support? How is one tasked with the responsibility and legally allowed to choose when someone dies (legally is a whole different beast than real life. yes, the person is already brain dead in real life but legally still alive)?




so the argument is that since a court emancipated a conscious 14 year old based on his ability to articulate the implications of his decision regarding a non-emergent treatment;therefore a parent in a seconds-urgent situation can make the decision for their child to withhold life saving care, despite the fact that the child is unconscious, totally unable to participate in the decision, uninformed, possibly not mature enough to understand the implications of the decisions were he even conscious, and not able to voice any objections to his parents religion?

Come on - I refuse to believe you don't realize that those are so completely different as to make the case you posted totally irrelevant (never mind the much more on point references already posted establishing parental non-omnipotence).

It is already well established that an adult or emancipated minor can refuse their own care for any reason they want, provided their refusal is fully informed (just like informed consent).  The case you posted establishes that a 14 year old can be emancipated.  I would have spotted you that without the case in front of me.  The case has nothing to do with parental wishes -it's about individual autonomy not parental authority!

Similarly, the scenario in the OP has nothing to do with decisions about life support withdrawal in a non-acute situation, conscious patients able to participate in their own decisions, DNR's for terminal conditions, emancipation, etc.


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## MonkeyArrow

jrm818 said:


> so the argument is that since a court emancipated a conscious 14 year old based on his ability to articulate the implications of his decision regarding a non-emergent treatment;therefore a parent in a seconds-urgent situation can make the decision for their child to withhold life saving care, despite the fact that the child is unconscious, totally unable to participate in the decision, uninformed, possibly not mature enough to understand the implications of the decisions were he even conscious, and not able to voice any objections to his parents religion?
> 
> Come on - I refuse to believe you don't realize that those are so completely different as to make the case you posted totally irrelevant (never mind the much more on point references already posted establishing parental non-omnipotence).
> 
> It is already well established that an adult or emancipated minor can refuse their own care for any reason they want, provided their refusal is fully informed (just like informed consent).  The case you posted establishes that a 14 year old can be emancipated.  I would have spotted you that without the case in front of me.  The case has nothing to do with parental wishes -it's about individual autonomy not parental authority!
> 
> Similarly, the scenario in the OP has nothing to do with decisions about life support withdrawal in a non-acute situation, conscious patients able to participate in their own decisions, DNR's for terminal conditions, emancipation, etc.



What I'm saying is that the legal entity in charge of making the decision can…well… make the decision. In this case, the legal entity was the emancipated minor, and he was thus allowed to refuse treatment for a condition that was life-threatening (he died something like 14 hours after the ruling). Therefore, since justice is theoretically blind, any legal entity should theoretically be able to make that call to withhold treatment whether the parents have legal powers or the minor through emancipation. For the record, I did devote a whole paragraph to how this wasn't OP's scenarios and how it is different but potentially relatable.


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## jrm818

MonkeyArrow said:


> What I'm saying is that the legal entity in charge of making the decision can…well… make the decision. In this case, the legal entity was the emancipated minor, and he was thus allowed to refuse treatment for a condition that was life-threatening (he died something like 14 hours after the ruling). Therefore, since justice is theoretically blind, any legal entity should theoretically be able to make that call to withhold treatment whether the parents have legal powers or the minor through emancipation. For the record, I did devote a whole paragraph to how this wasn't OP's scenarios and how it is different but potentially relatable.



You are committing a logical error: you assume that parental authority is legally indecipherable from either individual autonomy or authority vested in another person e.g. by a durable power of attorney.  This is false.  Parental authority does not convey the same decision making power that individual autonomy does, it is more limited.  This is not just my opinion - it is the general opinion of ethicists and the courts.  See all the evidence above.

It's a concept that makes sense.  Children have not yet had the opportunity to make informed, well reasoned decisions about their priorities, beliefs, and wishes.  Our society has held that these children have the right to grow up safely until such time as they can make these decision on their own.




and just an FYI: even authority vested by a power of attorney, another situation where legal authority to make decisions rests in someone other than the patient, is limited.  The holder of the legal authority has a fiduciary responsibility to the patient (meaning they have to act in the patient's best interest, not their own interests).  The same is true of parents.  Courts do overrule POA's occasionally if the agent is not acting in the best interest of the patient.


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## MonkeyArrow

jrm818 said:


> You are committing a logical error: you assume that parental authority is legally indecipherable from either individual autonomy or authority vested in another person e.g. by a durable power of attorney.  This is false.  Parental authority does not convey the same decision making power that individual autonomy does, it is more limited.  This is not just my opinion - it is the general opinion of ethicists and the courts.  See all the evidence above.
> 
> It's a concept that makes sense.  Children have not yet had the opportunity to make informed, well reasoned decisions about their priorities, beliefs, and wishes.  Our society has held that these children have the right to grow up safely until such time as they can make these decision on their own.
> 
> 
> 
> 
> and just an FYI: even authority vested by a power of attorney, another situation where legal authority to make decisions rests in someone other than the patient, is limited.  The holder of the legal authority has a fiduciary responsibility to the patient (meaning they have to act in the patient's best interest, not their own interests).  The same is true of parents.  Courts do overrule POA's occasionally if the agent is not acting in the best interest of the patient.



I understand where you're coming from. Each person has the right to life, liberty, and the pursuit of happiness and thus children must be ensured that legally until they are mature enough to do it for themselves (which is also the argument for allowing/banning abortion). I guess that the issue now becomes even if there is a general consensus, we still see a lot of these cases going before judges and ethics panels. Therefore, relating back to OP's scenario, would it all fall in place fast enough to save a minor in pediatric arrest? I don't think so.


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## jrm818

MonkeyArrow said:


> I understand where you're coming from. Each person has the right to life, liberty, and the pursuit of happiness and thus children must be ensured that legally until they are mature enough to do it for themselves (which is also the argument for allowing/banning abortion). I guess that the issue now becomes even if there is a general consensus, we still see a lot of these cases going before judges and ethics panels. *Therefore, relating back to OP's scenario, would it all fall in place fast enough to save a minor in pediatric arrest? I don't think so.*



As has been stated multiple times, and as per the American Academy of Pediatrics recommendations for dealing with that _exact _scenario, emergencies are treated differently by the law, courts, and anyone with common sense.  In a life threatening time sensitive emergency nothing needs to be in place - you treat first, while in parallel obtaining LE/court assistance.


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## TheLocalMedic

jrm818 said:


> As has been stated multiple times, and as per the American Academy of Pediatrics recommendations for dealing with that _exact _scenario, emergencies are treated differently by the law, courts, and anyone with common sense.  In a life threatening time sensitive emergency nothing needs to be in place - you treat first, while in parallel obtaining LE/court assistance.



Seconded.  There is precedence for parents refusing or withdrawing care for their child, and even cases where a minor is granted the ability to make decisions about their own care, but those are not emergent scenarios.  The parens patriae policy holds that the state has a vested interest in the wellbeing of children, and as state-licensed paramedic or EMT you must also carry out that interest.  Which means that in an emergent situation, even if the parents try to prevent you, you have the obligation to provide life saving treatment until such time as the court allows you to stop.  

It's not as though the parent can say, "He's mine!  I'll do with him as I please!" and then allow their child to die.  Parents do not have the right to harm their child, and preventing their child from receiving care is harmful.  Q.E.D.


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## mycrofft

OK it seems in the OP scenario the parents are in the wrong, the responders are right legality speaking. (Precedent is also in place from cases where care was wrongfully withheld just because a parent or guardian was not to be found at the time, or they were dead).

I think the question is what will YOU or I do with real world constraints of time and the degree of resistance by the parents.

In any case, with the parents present, I'd want to be really sensitive about how aggressive I was versus the likelihood of successful resuscitation. What is done in the name of street EMS (even more so in the hospital) would be considered four types of horrendous felony if the circumstances are wrong and/_or_ the perp is not licensed.


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