Clinicians who provide care to children are frequently challenged and distressed by various degrees of caregiver nonadherence to recommended tests or treatments. This can raise concerns for medical neglect, activating decision making as mandatory reporters. A determination of reportable medical neglect requires that multiple conditions be met, and that each child suspected of having been medically neglected be assessed in the context of their specific family situation. Ethical issues including equity and responsibilities to protect the best interests of children are important to these decisions. Dr. Asnes will provide a framework for the assessment of caregiver nonadherence with attention to the rights of parents and common pitfalls from her years of experience and will suggest an approach to decision-making when filing a child protective services report is considered. She also will explore how to minimize harm and maintain trusting clinical-caregiver relationships when a report has been filed, in order to continue shared commitment to the best interest of children.
Learning Objectives:
- Review the related but separate concepts of caregiver nonadherence to recommended medical treatment and medical neglect
- Construct an ethically informed framework for the assessment of nonadherence that centers the rights of parents, each family’s specific circumstances, and the limits of medical therapies
- Recognize best practice actions that clinicians who file child protective services reports can take to continue to support children and families and meet our ethical responsibilities to both patients and families
Speaker:
- Andrea Asnes, MD, MSW
This seminar was delivered as an Ethics Grand Rounds Lecture at Children’s Hospital of Philadelphia, on August 26, 2026.
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Course Includes
- 1 Lesson
- Course Certificate