How Should Clinicians Respond When a Parent's Medical Decision Making for their Child is Influenced by the Parent's Psychotic Illness?

Parents are presumed to have decision-making capacity and authority to make treatment decisions for their child. Healthcare providers only question parents’ capacity and authority when their decisions place their child at imminent risk of death or permanent disability. Presuming parents’ capacity respects the autonomy of parents and the family to incorporate their religious and cultural values into the decisions they make for their child’s medical care. Yet there are times when a parent lacks decision-making capacity, which hinders them from making autonomous decisions. How should the medical team respond when they suspect that a parent has a condition that impairs their decision making-capacity? Should the medical team allow the parent to continue to make medical decisions as long as there is no imminent risk of death or permanent disability to their child? If a parent’s decision presents a risk to their child, should there be a formal protocol to assess the parent’s medical decision-making capacity? In this article, the authors aim to initiate discussion of these issues by summarizing current thinking about parental decision making, presenting two cases of children admitted with psychiatric conditions when the parents presented with psychosis—a condition frequently associated with decreased decision-making capacity—and provide ways that clinicians might approach similar situations. The cases also illustrate the need to acknowledge and address cultural and contextual issues that impact a parent’s decisions, even when a parent lacks decision-making capacity.