ABSTRACT
SUMMARY. The Shaken Baby Syndrome can result in severe neurologic injury that leads to ethical challenges in medical care. This article addresses the perceived distinctions between withholding and withdrawing life-sustaining medical treatment, demonstrating that in a severely injured child the burdens of therapy may be disproportionate to the benefits. In this case, withdrawal of support could be in the child's best interest. The article then addresses the issue of who can participate in that best interest decision. While parents must be allowed to participate, there may be circumstances of conflicts of interest for a parent in the Shaken Baby Syndrome that don't allow the parent to make a choice in their child's best interest. In these situations, the health care team and the state services must use their parens patriae to act in the best interest of a child which could include withdrawal of support of life-sustaining therapy. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: <getir(o@haworthpressinc.com> Website: <https://www.HaworthPress.com>; © 2001 by The Haworth Press, Inc. All rights reserved.J
KEYWORDS. Withdrawing life support, self-realization, parens patriae, best interest
© 2001 by The Haworth Press, Inc. All rights reserved. 341
The American Academy of Pediatrics Policy Statement on Shaken Baby Syndrome reports that SBS is the leading cause of serious head injury in infants and has as high as a 60% severe morbidity or mortality rate (AAP, 1993). Although there are dramatized cases where the diagnosis of Shaken Baby Syndrome may be called into question, the great majority of these cases are easily diagnosed as child abuse. The simple presence of this form of child abuse challenges our ethical concepts of family, societal or community obligations and physician responsibilities. While it is beyond the scope of this chapter to review all ethical issues involving child abuse and neglect, there are two issues that are often mentioned which are pertinent to severely injured children from this syndrome. One is the issue of withholding and withdrawing support, and the other is who should be involved in making that decision.
