ABSTRACT
With the goal of protecting children from making unwise decisions, the
medico-legal model used in the United States traditionally has allowed
parents to make all health care decisions for their minor children. Children
are presumed to be incompetent to make their own decisions in all arenas,
including health care, due to cognitive limitations and immaturity. While
this legal presumption has been relaxed in recent decades as common law
and statute have created exceptions, the courts originally were quite strict in
their refusal to grant any rights, including constitutional rights, to children. This chapter addresses medical decision making in the pediatric population
with attention to important legal cases concerning the role of parents, chil-
dren, and the state in making treatment decisions. Historically, children
were considered chattel and states were reluctant to intervene in the parent-
child relationship. In an 1874 case, a young girl was discovered chained to a
bed, having been fed only bread and water by her parents. The American
Society for the Prevention of Cruelty to Animals succeeded in removing her
from her parents’ home ‘‘on the ground that she was a member of the animal kingdom and that therefore her case could be included under the
laws against animal cruelty.’’1 The law had to resort to animal protection
laws as no child protection laws existed at the time.
