As a surgical specialty, pediatric surgery is extremely gratifying to those of us who practice it because we are often called upon to correct life-threatening abnormalities in newborn infants, who, as a result of our surgical intervention, can be expected to grow and develop into healthy babies with prospects for normal, healthy lives. Such expectations, however, are not always fulfilled, and it is not uncommon for a pediatric surgeon to be confronted with an extremely difficult decision when the patient is a severely impaired newborn whose parents do not consent to surgery, a patient who would probably have died had he been born 15 years ago. In such situations, a dilemma arises for a pediatric surgeon: he is caught between the requirements of a state child abuse/neglect reporting law on the one hand and parental rights and responsibilities on the other.

As a result of my extensive involvement with the passage and implementation of Virginia's 1975 child abuse and neglect reporting law, I have become acutely aware of how valuable these reporting laws can be for providing medical treatment to children when parents either willfully or negligently fail to do so. At the same time, it has become apparent to me that inherent in these statutes is the potential for conflict between parental legal rights and those of the child. Consider the example of a seemingly irreconcilable dilemma for the pediatric surgeon faced with a severely defective, newborn child whose parents wish to withhold lifesaving surgery or to withdraw life-support systems. It