Parental Refusal of Recommended Pediatric Treatment: Ethical and Legal Tensions

Abstract

Parental refusal of recommended pediatric treatment sits at the intersection of parental authority, child welfare, and, at times, third-party interests, and the frameworks used to resolve it are more differentiated than a simple parental-rights-versus-intervention framing suggests. This analysis surveys the best interests and harm-principle standards used to justify overriding parental refusal, narrower doctrines of medical tolerance and second-best accommodation used to avoid escalation, and considerations distinctive to religious refusal, withdrawal of life-sustaining treatment, and refusal of preventive care such as vaccination. It also examines the mature minor doctrine and adolescent decision-making capacity, which increasingly treats the adolescent as a party to the refusal rather than only its subject. Across these scenarios, the harm threshold justifying intervention and the weight given to parental values
shift depending on whether harm is immediate or probabilistic, borne by the child alone or by others, and whether adolescent capacity is implicated. We conclude that no single doctrine resolves these disputes, and that defensible policy calibrates the intervention threshold to each scenario's harm profile rather than applying one uniform standard.