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Medical neglect can have serious consequences for children, even leading to death. Yet while the American Academy of Pediatrics defines medical neglect in terms of a child who “is harmed or is at risk of harm because of lack of health care”, in practice intervention is often limited to situations where the child’s life is threatened. In this article we report a potentially unrecognized form of medical neglect-parental refusal of pain management-which does not affect the probability of the patient’s survival, but does render inevitable a heightened degree of suffering and consequent psychological trauma. While it can be challenging to determine whether a specific refusal rises to the level of neglect, certain cases do meet the criteria of the “harm principle” and thus justify state intervention to protect the child.

Parental Refusal of Pain Management: A Potentially Unrecognized Form of Medical Neglect