Ethical Question

corona 247

SDN Angel
10+ Year Member
15+ Year Member
Feb 23, 2004
This question came up in my class and I wanted to ask practicing EM docs their opinion.

Parents come into the ER with their very sick child. The child's condition will some sort of invasive procedure. Problem is that the parent's religious beliefs state that to cut the skin is to excise the soul.

What would you do?

Thanks for any input!!
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Full Member
7+ Year Member
15+ Year Member
Oct 20, 2003
NYC--->San Francisco
  1. Attending Physician
this is never an easy question. I used to jump immediately to 'do whatever is necessary, screw the parents.' HOwever, like so many things in life, (and as a peds attending pointed out to me once as a premed) there are so many things to consider.

So, you do the procedure. You ahve now in effect, excised this childs soul. What exactly are you sending this child home to?
Will they be ostrasized from thier family? treated as cursed? If the child is old enough to understand its belief system, what have you done to that child emotionally?

its not to say that you in the end shouldn't still do what needs to be done. Its just something to think about.


Senior Member
15+ Year Member
Nov 22, 2002
  1. Attending Physician
Very similar to transfusing kids of Jehova's Witness. If it is life or limb saving, do what you need to do. You don't need a court order if it is an emergency. If the kid is a 17 yr old and is "mature" then this can get a little sticky. Still some states hold to the 18 yr old = adult only hard and true.

Right off the Sullivan's Group Physicians Law Review:

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.
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