Divorce and Shared Custody: When One Parent Cannot Be Trusted to Manage Diabetes

Caring for a child with diabetes requires significant financial, emotional, and psychological resources. In the case of divorce or shared custody, parents’ stressors multiply, as caregivers perpetually have to transfer information, supplies, and strategies across households. This situation can become even more nerve-wracking when one parent is not fulfilling his or her caregiving responsibilities. In such cases, legal recourse is available, although laws, legal procedures, and judicial priorities vary from one family court to the next.

Judges ruling in child custody cases are bound to consider the “best interests of the child.” This is a fundamental principle recognized in every U.S. jurisdiction. Sometimes, though, judges refer to broader societal concerns to determine a child’s interests, rather than focusing exclusively on the child’s physical health. For instance, a judge may mandate shared custody simply because society has deemed it best for a child to have two parents. Alternatively, a judge may favor the mother in custody disputes due to the conventional belief that females make better caretakers. This cultural attitude is supported by certain research on diabetes management. One study found that father-absent T1D adolescents fared significantly better than their peers with the disease.

Furthermore, when judges do consider medical interests, they can’t be expected to be experts in the care of children with chronic conditions. For this reason, parents (or their lawyers) willing to work collaboratively with advice from the child’s treating physician can be of particular assistance to the court. It is entirely appropriate that a court-ordered shared custody stipulation or agreement concerning a child with any chronic medical condition include requirements to be followed by each custodial parent for daily care. In the case of a child who has diabetes, the judge’s order may include a daily care plan that details caregiver response to a medical emergency, dietary requirements, medication administration, glucose monitoring, recording of readings and doses given, and other details. It is critical to put this care plan in place as early as possible during the proceedings.

Once that documented care plan is part of the record, one parent may over time develop a legitimate concern about the other parent’s diligence. In this case, the parent can raise the concern before the judge. This parent will not file an “appeal” in a procedural sense, but rather file a motion or petition that the judge review the care plan, amend or revise it, enforce it against the less than diligent custodial parent, or suspend or modify custody. These actions are available for as long as the court retains jurisdiction over the case, such as to the age of majority or emancipation of the child.

Once again, courts have a lot of discretion, as there is no formula to determine a child’s best interests. In revising or amending the order, judges may consider the impact of decisions on the child’s caregivers and hesitate to impose burdens or decrees on unwilling parents. For instance, a judge may not require a parent to complete diabetes training if she suspects that this requirement would further strain relations between co-parents. This is because hostility between ex-spouses negatively impacts children.

Regardless of the circumstances, here are a few actions that a concerned parent can take to strengthen the case for full custody, improve the child’s diabetes care, and increase collaboration with the co-parent:

1. Maintain good records of the disparity in the child’s care. This means downloading blood glucose information from meters and other devices, as well as recording food, exercise, and other factors influencing blood glucose throughout the day. Of course, depending on the child’s age and the relationship between co-parents, it may be difficult to acquire the latter information. But, generally speaking, the more evidence of the disproportion in care, the stronger the case.

2. Designate a medical expert to give evidence. The court may allow a third party, such as the child’s primary caregiver or specialist, to testify to the severity of the problem. This expert could convey to the court the dangers of extreme highs and lows, thereby establishing that a life-threatening situation does, in fact, exist. Alternatively, this expert could convince the court of the need for some other intervention, such as required diabetes training.

3. Petition the court to appoint a guardian ad litem to investigate the situation. Guardians ad litem act like social workers. Often, they can determine better than the court exactly how negatively a parent impacts the child’s well being.

4. Ask the court to require diabetes education training. This training does not guarantee parental compliance, but it will improve the parent’s knowledge and skills to manage the disease.

5. See a mediator. A neutral party may help to establish mutual expectations and strategies for adhering to care regimens. This person can also serve as an authority to which each parent is accountable. The mediator may be a health care provider, such as the child’s primary care physician.

6. Gain the support of extended family members. If the concerned parent has a good relationship with the co-parent’s new spouse, parents, friends, or neighbors, then he or she can ask these individuals to support the co-parent in managing diabetes.

When divorced parents share custody of a child with diabetes, they have no choice but to find ways to trust each other and collaborate. (That is, unless they invoke an intermediary to transport the child, information, and supplies between homes.) The reality is that it takes a village to control diabetes. And the greater and more fortified the village, the better for all affected persons to manage the burdens of such an unruly disease.

This article should not be considered legal advice or relied upon as such. One should secure the services of a competent lawyer for advice in any circumstances.

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Audrey Farley is a former editor of Insulin Nation.

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