Seriously Ill Children - Older Children

The American Academy of Pediatrics reports that not much has been written about life-sustaining treatments as they apply to older children. The courts generally have been lenient in allowing parents to act in the best interests of their children. The courts have been known to let the parents' decisions stand, even when court-appointed guardians disagreed with those decisions.

Religious Beliefs and Medical Treatment

During the 1970s, 1980s, and 1990s, there were documented cases of children who died because their parents chose, on the basis of their religious beliefs, not to seek or accept medical care. Several of these highly publicized childhood deaths occurred among children of Christian Scientists, who chose to receive care from religious rather than medical practitioners.

The courts have been somewhat inconsistent in their rulings about these cases. Two 1984 California cases involving Christian Scientists illustrate this point. In the first, seventeen-month-old Seth Ian Glazer died of bacterial meningitis after he was treated by a Christian Scientist healer. The child's mother was charged with manslaughter and child endangerment, but the court did not convict her. The same year, eight-month-old Natalie Rippberger also died of meningitis after her parents sought Christian Science care, which relies on prayer and Bible reading rather than medical treatment. Natalie's parents were charged with felony child endangerment and involuntary manslaughter and were convicted of the former charge. Although the verdicts differ in the two cases, in neither case were parents convicted of the more serious charge of involuntary manslaughter.

Adolescents

Historically, physicians have deferred to parents' wishes when considering decisions about an adolescent's health care treatment, but this is no longer the case. Robert F. Weir and Charles Peters, in "Affirming the Decisions Adolescents Make about Life and Death" (Hastings Center Report, vol. 27, no. 6, 1997), report that doctors and parents have been known to abide by decisions made by critically, chronically, and terminally ill adolescents rather than imposing their wishes on these adolescents.

Over the past twenty years, a number of studies have concluded that, by age fourteen, many adolescents are capable of making decisions about their own health care. In 1995 the AAP recommended that minors should have increasing influence in their health care as they mature.

While many laws concerning minors have changed, including the lowering of the legal age and allowing minors to seek medical treatments such as reproductive health and birth control services without parental consent, most states have no laws for end-of-life decisions by legal minors.

Weir and Peters observe that, due to their condition, chronically ill adolescents are frequently mature beyond their years. They have suffered physically and psychologically, have seen other patients die, and have considered the choices they would make should their conditions worsen. The authors suggest that adolescents may want to provide directions about their care if they become unable to communicate their decisions. Such an advance directive would help guide parents and physicians in carrying out adolescents' wishes.