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  • 1.  Parents refusing standard of care

    Posted 08-12-2026 10:41

    Hi all,

    We're doing a lot of work on how to approach situations in which parents refuse what we consider standard-of-care treatment, for example, steroids for status asthmaticus.

    Do any of your institutions have policies, guidelines, or established practices for managing these cases?

    We're finding that many refusals of standard-of-care treatment do not meet Diekema's harm principle threshold, making it difficult to justify involving the Department of Children's Services. I'd be interested to hear how others navigate these situations.

    Thank you!



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    Jessica Turnbull
    Pediatric Intensivist, Clinical Ethicist
    Vanderbilt University
    Nashville, TN
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  • 2.  RE: Parents refusing standard of care

    Posted 30 days ago

    When our oncologists encountered this and could not reach a solution through typical means they'd consult the ethics committee, and I feel like this is the area of pediatric medicine with the most literature on refusal of treatment. Our PICU division wrestled with refusal of care recently in a complicated situation and we don't really have an established protocol when this arises. Something akin to the white paper on parental requests for potentially nonbeneficial treatment in Pediatrics early this year would be great. Would love to talk more offline about this.



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    Madhura Hallman MD, MPH
    Associate Professor of Pediatrics, Division of Pediatric Critical Care Medicine
    University of Alabama at Birmingham (UAB)
    Birmingham, AL
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