PARENTS v. THE STATE

[This notice appeared in the online Chronicle of High Education this morning.]

A glance at the November 11 issue of
"The New England Journal of Medicine":
An exception to parental rights in health care

Parents generally have the right to make medical decisions for
their children, but a recent ruling by the Texas Supreme Court
provides a notable exception, says George J. Annas, a professor
of health law at Boston University.

"In the absence of child neglect, parents have the right to give
or withhold consent for medical treatment for their children,"
he writes, but in the case of "Miller v. HCA," the court ruled
that physicians may treat extremely premature newborns without
the parents' consent.

The case concerned Sidney Miller, who in 1990 was born after
only 23 weeks of gestation, barely half the normal term of 40
weeks. Her parents requested before the birth that "no heroic
measures" be taken to save her life, Mr. Annas writes, but the
hospital insisted that it had to wait until she was born and to
allow a neonatologist to decide whether to intervene.

The physician successfully resuscitated the infant, but a few
days later Sidney suffered a brain hemorrhage that left her
severely impaired, both mentally and physically. The Millers
sought damages from the hospital for refusing to respect their
wishes, and a lower court ruled in their favor. But the verdict
was reversed on appeal, and that decision was upheld by the
Texas Supreme Court in September 2003.

"The court concluded that the circumstances of extreme
prematurity were unique because a decision about resuscitation
could not reasonably be made before birth," Mr. Annas writes.

Although Mr. Annas finds the ruling reasonable, he says it is
also troubling because it "implies that life is always
preferable to death for a newborn and thus could be interpreted
in the future to support the neonatologist who always
resuscitates newborns, no matter how premature or how unlikely
their survival is without severe disabilities."

The article, "Extremely Preterm Birth and Parental Authority to
Refuse Treatment -- The Case of Sidney Miller," is online for
subscribers and for purchase here.