Paeds Vivas · professional-practice-and-evidence
Refusal of treatment and disagreement over care — branching viva
Viva on navigating a parental refusal, managing a blood-product refusal, escalating a goals-of-care dispute, and assessing an adolescent's competence to refuse.
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Opening (candidate)
My first move is to assess the risk of serious harm. This child is bleeding and deteriorating, so the refusal risks imminent death, which meets the harm-principle threshold. I would stabilise the child by treating in the child's best interests under the emergency doctrine, continue respectful engagement with the family alongside, escalate to my seniors and the ethics service, and seek a court determination for the ongoing dispute. [1] [3]
You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.
References6Show ledgerHide ledger
- [1]Diekema DS Parental refusals of medical treatment: the harm principle as threshold for state intervention Theor Med Bioeth, 2004.PMID 15637945
- [2]Diekema DS Revisiting the best interest standard: uses and misuses J Clin Ethics, 2011.PMID 21837884
- [3]Conti A Blood Transfusion in Children: The Refusal of Jehovah's Witness Parents' Open Med (Wars), 2018.PMID 29666843
- [4]Wheeler R Children of Jehovah's witnesses: a review of judicial responses to the refusal of blood transfusion Arch Dis Child, 2026.PMID 41443962
- [5]Schneiderman LJ Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial JAMA, 2003.PMID 12952998
- [6]Diekema DS Adolescent Brain Development and Medical Decision-making Pediatrics, 2020.PMID 32737228