J Med Ethics 35:635-637 doi:10.1136/jme.2009.030510
  • Paper
  • Law, ethics and medicine

Mixed motives, mixed outcomes when accused parents won’t agree to withdraw care

  1. J M Appel
  1. Correspondence to Dr Jacob M Appel, 140 Claremont Avenue #3D, New York, NY 10027, USA; jacobmappel{at}
  • Received 30 March 2009
  • Revised 15 May 2009
  • Accepted 5 June 2009


One of the basic tenets of paediatric ethics is that competent parents may render healthcare decisions for children who are too young or too incapacitated to make meaningful medical choices for themselves. In the USA, many jurisdictions have expanded this principle to include the right to terminate a child's life support, including nutrition and hydration, when that child enters a persistent vegetative state. However, this approach to the withdrawal of care in the paediatric setting has been put to the test by an increasing number of cases in which one or both parents are themselves accused of causing the child's life-threatening injuries. In such “mixed-motive” situations, parents may express a desire to keep a child on life support for religious or moral reasons; at the same time, forestalling the child's death may also prevent a murder charge against the accused parent. Principles need to be established for handling such tragic cases.


  • Competing interests None declared.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

Free sample
This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of JME.
View free sample issue >>

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

Navigate This Article