Medical Decision Making for Youth in the Foster Care System
Youth in the foster care system often have no one person who isclearly authorized to make medical decisions for them. From acaseworker insisting upon a vaccine to a birth parent refusingpermission for psychotropic medication, this paper argues that thequestion of who makes these decisions matters for children’s rights.This paper reports the results of a survey of 132 stakeholdersrepresenting all U.S. states, 17 qualitative interviews, and a reviewof relevant laws and policies. The stakeholders and legal researchrevealed that in sixteen states, common practice disagreed with thewritten laws and policies about who should be making medical decisionsfor youth in the foster care system. Most often, foster parents aremaking medical decisions despite note having legal authority to do so,and birth parents are rarely making decisions even when they arelegally allowed to do so. This paper proposes that following federallaw about promoting family reunification, birth parents should be incharge of medical decision making for the first 12-24 months. Afterthat time, the foster parent, if one is available and has showncommitment to the child, should become the medical decision maker.Such a policy would promote birth parent involvement and familyreunification while acknowledging the need of young people in care fordecision makers who can make long-term commitments to their care.