Public Health Law Map - Beta 5 - Medical and Public Health Law Site

for adolescent boys often see families in which the boy feels compelled to compete
in sports to retain his father’s affection. As long as this does not interfere with the
child’s growth and development, it is not a problem for the physician. However,
parental enthusiasm becomes detrimental to the child if decisions about the care of
injuries are made on the basis of ability to play rather than what is best for the longterm
health of the child.
Physicians are increasingly pressured by parents to use medical treatments to alter
characteristics of normal healthy children. One of the most controversial therapies is
the use of human growth hormone to stimulate growth in children without intrinsic
growth hormone deficiency. In most cases, the child is short for his or her age.
Questions are being raised, however, about using growth hormone to help already
tall children gain the extra height and size that is a critical edge in professional
sports. Unlike the analogous problem of vanity surgery, the patient is not able to give
an informed, legally binding consent to the treatment. This raises profound ethical
questions about the role of the physician and the definition of health. [Lantos J,
Siegler M, Cuttler L. Ethical issues in growth hormone therapy. JAMA.
1989;261:1020–1024.]
a) Religious Objections to Medical Care
This is one of the most important areas of change in the law governing consent to
medical care for minors. Where the religious beliefs of the parents once were
paramount, the child’s right to life and health now takes precedence over the
parents’ right to freedom of religion. An adult Jehovah’s Witness, for instance, may
have the right to refuse transfusion, even if it means certain death. That same
person does not have the right to refuse transfusion for a child who will likely die. If
parents refuse necessary care for a child, the physician or hospital administrator
should immediately seek a court order for the care. If the care is needed urgently
and cannot await the court order, then the physician should proceed with the care
regardless of the parents’ objections. The court order should be sought at the same
time. The justification for this is the same as the emergency exception to consent. It
is reasonable to assume that the court will uphold the child’s right to life and health
and grant the order for care. If the court cannot be contacted in time, the physician
should go ahead with the care just as if it were the parents who are unavailable.
[Holder AR. Minors’ rights to consent to medical care. JAMA. 1987;257:3400–
3402.]
b) Specific Types of Care
Parents may have many reasons for refusing specific types of care. Refusing the
care offered by a particular physician or institution is not the same as neglecting the
medical needs of the child. Parents may refuse a particular type of care because
they do not believe it is in the child’s best interests. Courts generally defer to the
parents as the most appropriate judge of the child’s interests; however, if the
physician believes that the parents are not acting in the child’s best interest, this
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