Ethical Conflict: When Should the State Intervene? 

How should a physician proceed when a child’s medical treatment is opposed by his or her parents? This complex ethical problem is the topic of Parental Refusals of Medical Treatment: The Harm Principle as Threshold for State Intervention, by Douglas S. Diekema, MD, professor of bioethics and emergency medicine at the University of Washington. He presents eight conditions that must be met in order to justify seeking treatment for a child against a parent’s wishes. 


  1. By refusing to consent, are the parents placing their child at significant risk of serious harm?
  2. Is the harm imminent, requiring immediate action to prevent it?
  3. Is the intervention that has been refused necessary to prevent the serious harm?
  4. Is the intervention that has been refused of proven efficacy, and therefore likely to prevent the harm?
  5. Does the intervention that has been refused by the parents also not place the child at significant risk of serious harm, and do its projected benefits outweigh its projected burdens significantly more favorably than the option chosen by the parents?
  6. Would any other option prevent serious harm to the child in a way that is less intrusive to parental autonomy and more acceptable to the parents?
  7. Can the state intervention be generalized to all other similar situations?
  8. Would most parents agree that the state intervention was reasonable?