Consent for Children of Divorced or Separated Parents

If parents separate or divorce during their child's treatment, the physician may need to reassess parental rights before continuing treatment. If the physician becomes aware of questions regarding legal guardianship or if parents with equal legal rights differ on treatment options, the physician must take immediate steps to clarify the custody situation, including obtaining a copy of the custody decree. The physician may need to obtain legal informed consent from the authorized parent, or the parents may need to return to court for judicial clarification.

In general, communication with both parents is recommended when parents with joint legal custody disagree, even if the child is brought for treatment by the parent who has physical custody. When a clinician becomes aware of disagreement between parents with equal legal authority, he or she should attempt direct communication with the opposing parent to better understand that parent's position. Encouraging the opposing parent to obtain a second opinion may be helpful.

If disagreement continues, the clinician has two alternatives. The first is to advise the consenting parent to consult with an attorney to attempt resolution of differences either informally or formally (through a court). The second alternative comes into play if medication is immediately necessary and the benefits exceed the risks, in which case the clinician can obtain authorization for treatment from the consenting parent and notify the opposing parent that these steps are being taken based on the belief that medications are imminently necessary and appropriate. Attempts should be made to continue a dialogue with the opposing parent and encourage his or her involvement, but treatment may be initiated with the focus on the child's "best clinical interest."

Because this best interest standard is difficult to define, several factors should be considered: 1) severity of the underlying condition (i.e., the more severe, the lower the threshold to initiate treatment), 2) treatment options (i.e., whether the recommended treatment is the only one available or the clearly preferred option, and whether other safe and effective alternatives are available), and 3) potential risks versus benefits of treatment. A guardian ad litem (usu ally an attorney or clinician in a "neutral" position) may be appointed by the court to investigate the clinical situation and provide recommendations to the court prior to an order being entered.

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