Medical Decision Making for Children in Foster Care

I have learned the hard way during my career as a pediatric hospitalist not to make assumptions about relationships when meeting a new patient and their family. It can be exceptionally difficult to establish trust after calling a parent a grandparent.

I now commonly ask, “Would someone please tell me who’s who?”

The importance of not making assumptions is even more the case for children in foster care. It is important not only to distinguish foster and biological parents, but also to determine who is authorized to consent for the child.

In this month’s Pediatrics Ethics Rounds (10.1542/peds.2023-065110), Mary V. Greiner, MD, MS, from Cincinnati Children’s Hospital and Grace Muntz, MSW, LSW, from Hamilton County Job and Family Services in Cincinnati discuss the case of a girl who fulfills criteria for tympanostomy tube placement. The girl is in foster care and, while her foster parents support the procedure, her biological mother is hesitant.

The authors discuss the variability in laws among local jurisdictions and reinforce the need to clarify who has legal authority to consent in each case. They also argue that the person with legal authority may not be the optimal person to determine what treatment, if any, is in the child’s best interest.

Read this month’s Ethics Rounds and think about what you would do if you were faced by a disagreement between a biological and foster parent. What information can each individual provide, and how would you support the patient getting the treatment they need?