Assessment for Parental Capacity and Medical Neglect

Physicians generally make determinations about a patient's decision-making capacity to ensure that the patient is able to make appropriate medical decisions. When patients are children and adolescents, consultants need to consider the parents' decision-making capacity. In a general sense, two kinds of competence exist: competence to decide (e.g., competence to refuse or consent to treatment) and competence to perform an act (e.g., competence to parent). The latter category is broader because it encompasses both decisions and actions (Gutheil and Appelbaum 2000). Issues of parental competence frequently arise in the hospital, often with regard to the parents' ability to adequately meet their child's medical needs. Parental abuse or neglect of physically ill children is not uncommon, and child protective services agencies often become involved during inpatient admission and are ultimately responsible for decisions regarding placement. Although competence is a legal concept determined by a judge, the consultant can be asked to give an opinion about parenting capacity.

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