## Facts

- Phillip B., a twelve-year-old child with Down syndrome, had a serious congenital heart defect causing significant strain on his heart and elevated pulmonary blood pressure.
- Phillip lived in a residential care facility; his parents retained legal custody.
- A cardiologist recommended cardiac catheterization in 1973; Phillip’s parents initially refused but later consented, and the procedure was performed in 1977.
- The 1977 catheterization revealed extensive cardiac pathology; physicians recommended open-heart surgery.
- Medical testimony indicated that without surgery Phillip faced progressive decline and early death (with an estimated maximum lifespan of about age 20), while surgery could substantially extend his life expectancy.
- The proposed surgery involved material risks, including an estimated 5–10% operative mortality risk and heightened postoperative complications due to delayed treatment and Phillip’s condition.
- Phillip’s parents refused to authorize surgery, citing operative risks and concerns about whether the procedure would meaningfully improve Phillip’s life.
- A petition sought to declare Phillip a dependent child of the juvenile court for the limited purpose of authorizing surgery over the parents’ objection; the juvenile court denied the petition.

## Issues

1. Whether a juvenile court may assert dependency jurisdiction to authorize high-risk, potentially life-prolonging medical treatment over parents’ objection based on alleged neglect or endangerment.
2. What level of threat to a child’s health must be shown before the state may override parental medical decision-making.

## Decision

- The Court of Appeal affirmed the order denying the dependency petition.
- The court held the evidence did not establish parental neglect or a level of danger sufficient to justify state intervention to compel the surgery.
- The parents’ refusal, given significant surgical risk and uncertainty, fell within the range of constitutionally protected parental discretion.

## Legal Principles

- Parents have a primary, constitutionally protected authority and duty to make medical decisions for their children, subject to limited state interference.
- The state may intervene only when a child’s health or safety is actually and seriously threatened by parental action or inaction.
- Dependency jurisdiction is not a mechanism for substituting the state’s preferred treatment choice when reasonable medical judgment could differ on a high-risk decision.
- Refusal of treatment does not constitute neglect merely because physicians recommend an aggressive approach; the threshold requires more than a disagreement about best medical or moral choice.

## Conclusion

The court refused to authorize state-compelled surgery because the record showed a difficult, high-risk treatment decision rather than neglect, and the state could not override parental judgment absent proof that the child’s health was actually and seriously threatened within the meaning of dependency law.


In re Phillip B., 156 Cal. Rptr. 48 (Cal. Ct. App. 1979)