The Experts below are selected from a list of 6594 Experts worldwide ranked by ideXlab platform
John Stirling - One of the best experts on this subject based on the ideXlab platform.
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Understanding Medical Neglect: When Needed Care Is Delayed or Refused
Journal of Child & Adolescent Trauma, 2019Co-Authors: John StirlingAbstract:Though the most common form of child maltreatment, Neglect can prove among the hardest to diagnose, and intervention is equally difficult. In considering Neglect of a child’s Medical needs, a number of factors play important roles. Diagnosis should be motivated foremost by the intent of providing the best ongoing care for the patient, supplying what the child has not been able to receive from the caregiver. Characteristics peculiar to the patient, the parents, the pathologic condition, its possible treatments, and the mutual understanding between the child’s caregivers and the treating professionals all help determine why the therapeutic relationship has failed and which interventions will be most effective. Religious and cultural considerations may lead a family to refuse Medical treatments, occasionally to the child’s detriment. The caregivers’ wishes must be taken into account, but legal precedent has affirmed that the patient’s welfare remains the paramount concern. Sorting through the opinions and providing clarity can be a challenge. Finally, good Medical care can help prevent Medical Neglect in many cases. Clear communication and empathy remain hallmarks of good Medical practice.
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CLINICAL REPORT Beyond Munchausen Syndrome by Proxy: Identification and Treatment of Child Abuse in a Medical Setting
2015Co-Authors: John Stirling, The Committee On Child AbuseAbstract:The condition widely known as Munchausen syndrome by proxy comprises both physical abuse and Medical Neglect and is also a form of psychological maltreat-ment. Although it is a relatively rare form of child abuse, pediatricians need to have a high index of suspicion when faced with seemingly inexplicable findings or treatment failures. The fabrication of a pediatric illness is a form of child abuse and not merely a mental health disorder, and there is a possibility of an extremely poor prognosis if the child is left in the home. In this statement, factors are identified that may help the physician recognize this insidious type of child abuse that occurs in a Medical setting, and recommendations are provided for physicians regarding when to report a case to their state’s child protective service agency
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beyond munchausen syndrome by proxy identification and treatment of child abuse in a Medical setting
Pediatrics, 2007Co-Authors: John StirlingAbstract:The condition widely known as Munchausen syndrome by proxy comprises both physical abuse and Medical Neglect and is also a form of psychological maltreatment. Although it is a relatively rare form of child abuse, pediatricians need to have a high index of suspicion when faced with seemingly inexplicable findings or treatment failures. The fabrication of a pediatric illness is a form of child abuse and not merely a mental health disorder, and there is a possibility of an extremely poor prognosis if the child is left in the home. In this statement, factors are identified that may help the physician recognize this insidious type of child abuse that occurs in a Medical setting, and recommendations are provided for physicians regarding when to report a case to their state's child protective service agency.
Douglas J Opel - One of the best experts on this subject based on the ideXlab platform.
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parental refusal of childhood vaccines and Medical Neglect laws
Social Science Research Network, 2017Co-Authors: Efthimios Parasidis, Douglas J OpelAbstract:Objectives: To examine the relation of vaccine refusal and Medical Neglect under child welfare laws. Methods: We used the Westlaw legal database to search court opinions from 1905 to 2016 and identified cases in which vaccine refusal was the sole or a primary reason in a Neglect proceeding. We also delineated if religious or philosophical exemptions from required school immunizations were available at the time of adjudication. Results: Our search yielded 9 cases from 5 states. Most courts (7 of 9) considered vaccine refusal to constitute Neglect. In the 4 cases decided in jurisdictions that permitted religious exemptions, courts either found that vaccine refusal did not constitute Neglect or considered it Neglect only in the absence of a sincere religious objection to vaccination. Conclusions: Some states have a legal precedent for considering parental vaccine refusal as Medical Neglect, but this is based on a small number of cases. Each state should clarify whether, under its laws, vaccine refusal constitutes Medical Neglect.
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parental refusal of childhood vaccines and Medical Neglect laws
American Journal of Public Health, 2017Co-Authors: Efthimios Parasidis, Douglas J OpelAbstract:Objectives. To examine the relation of vaccine refusal and Medical Neglect under child welfare laws.Methods. We used the Westlaw legal database to search court opinions from 1905 to 2016 and identified cases in which vaccine refusal was the sole or a primary reason in a Neglect proceeding. We also delineated if religious or philosophical exemptions from required school immunizations were available at the time of adjudication.Results. Our search yielded 9 cases from 5 states. Most courts (7 of 9) considered vaccine refusal to constitute Neglect. In the 4 cases decided in jurisdictions that permitted religious exemptions, courts either found that vaccine refusal did not constitute Neglect or considered it Neglect only in the absence of a sincere religious objection to vaccination.Conclusions. Some states have a legal precedent for considering parental vaccine refusal as Medical Neglect, but this is based on a small number of cases. Each state should clarify whether, under its laws, vaccine refusal constitut...
John D Lantos - One of the best experts on this subject based on the ideXlab platform.
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when specialty care is unavailable to rural families
Pediatrics, 2019Co-Authors: Jennifer E Desantebertkau, Catherine D Shubkin, William A Nelson, Erica K Salter, John D LantosAbstract:We present the case of a 2-year-old boy with epidermolysis bullosa and supraglottic stenosis whose parents refuse an elective tracheostomy because of the significant care the tracheostomy would require. The patient's family lives in a rural area with few health care resources and his parents are already handling hours of daily skin care for his epidermolysis bullosa. In an attempt to convince the parents to pursue the intervention, the Medical team recommends that the family move to an area with additional resources to assist in the child's care. The parents refuse to move, citing the many benefits their home environment provides for their son. The Medical team calls an ethics consultation, questioning whether this decision constitutes Medical Neglect. This case raises important questions about Medical decision-making in pediatrics. First, is a parent's refusal of a recommended Medical intervention because it would require moving their family to a new environment a reasonable decision? Second, how broadly can parents define their child's best interest? Should only physical interests be included when making Medical decisions? Is there a limit to what can be considered a relevant interest? Third, can parents only consider the interests of the individual child, or can they consider the interests of other members of the family? Finally, what is the threshold for overruling a parental decision? Is it whenever the parent's definition of a patient's best interest is different from the Medical team's, or do other criteria have to be met?
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failure to provide adequate palliative care may be Medical Neglect
Pediatrics, 2019Co-Authors: Carly Levy, Kristin S Weeks, Rebecca J Benson, Jonathan M Miller, Jennifer Higgins, Stephanie Anne Deutsch, John D LantosAbstract:Doctors are required to notify Child Protective Services (CPS) if parents do not provide appropriate Medical care for their children. But criteria for reporting Medical Neglect are vague. Which treatments properly fall within the realm of shared decision-making in which parents can decide whether to accept doctors' recommendations? Which treatments are so clearly in the child's interest that it would be Neglectful to refuse them? When to report Medical Neglect concerns to CPS may be controversial. It would seem inhumane to allow a child to suffer because of parental refusal to administer proper analgesia. In this ethics rounds, we present a case of an adolescent with chronic pain who is terminally ill. Her parents were not adherent to recommended analgesia regimens. Her palliative care team had to decide whether to report the case to CPS.
Efthimios Parasidis - One of the best experts on this subject based on the ideXlab platform.
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parental refusal of childhood vaccines and Medical Neglect laws
Social Science Research Network, 2017Co-Authors: Efthimios Parasidis, Douglas J OpelAbstract:Objectives: To examine the relation of vaccine refusal and Medical Neglect under child welfare laws. Methods: We used the Westlaw legal database to search court opinions from 1905 to 2016 and identified cases in which vaccine refusal was the sole or a primary reason in a Neglect proceeding. We also delineated if religious or philosophical exemptions from required school immunizations were available at the time of adjudication. Results: Our search yielded 9 cases from 5 states. Most courts (7 of 9) considered vaccine refusal to constitute Neglect. In the 4 cases decided in jurisdictions that permitted religious exemptions, courts either found that vaccine refusal did not constitute Neglect or considered it Neglect only in the absence of a sincere religious objection to vaccination. Conclusions: Some states have a legal precedent for considering parental vaccine refusal as Medical Neglect, but this is based on a small number of cases. Each state should clarify whether, under its laws, vaccine refusal constitutes Medical Neglect.
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parental refusal of childhood vaccines and Medical Neglect laws
American Journal of Public Health, 2017Co-Authors: Efthimios Parasidis, Douglas J OpelAbstract:Objectives. To examine the relation of vaccine refusal and Medical Neglect under child welfare laws.Methods. We used the Westlaw legal database to search court opinions from 1905 to 2016 and identified cases in which vaccine refusal was the sole or a primary reason in a Neglect proceeding. We also delineated if religious or philosophical exemptions from required school immunizations were available at the time of adjudication.Results. Our search yielded 9 cases from 5 states. Most courts (7 of 9) considered vaccine refusal to constitute Neglect. In the 4 cases decided in jurisdictions that permitted religious exemptions, courts either found that vaccine refusal did not constitute Neglect or considered it Neglect only in the absence of a sincere religious objection to vaccination.Conclusions. Some states have a legal precedent for considering parental vaccine refusal as Medical Neglect, but this is based on a small number of cases. Each state should clarify whether, under its laws, vaccine refusal constitut...
Norman Fost - One of the best experts on this subject based on the ideXlab platform.
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Childhood Obesity and Medical Neglect
Pediatrics, 2009Co-Authors: Todd Varness, David B. Allen, Aline Lucie Carrel, Norman FostAbstract:The incidence of childhood obesity has increased dramatically, including severe childhood obesity and obesity-related comorbid conditions. Cases of severe childhood obesity have prompted the following question: does childhood obesity ever constitute Medical Neglect? In our opinion, removal of a child from the home is justified when all 3 of the following conditions are present: (1) a high likelihood that serious imminent harm will occur; (2) a reasonable likelihood that coercive state intervention will result in effective treatment; and (3) the absence of alternative options for addressing the problem. It is not the mere presence or degree of obesity but rather the presence of comorbid conditions that is critical for the determination of serious imminent harm. All 3 criteria are met in very limited cases, that is, the subset of obese children who have serious comorbid conditions and for whom all alternative options have been exhausted. In these limited cases, a trial of enforced treatment outside the home may be indicated, to protect the child from irreversible harm.