Legal and social precedent support broad parental discretion in the absence of immediate and severe endangerment of the minor’s welfare. However, in many cases of maltreatment, suspected or substantiated, parents retain PDM rights. The possibility of a guardian who is both surrogate and cause of harm threatens the conventional decision-making model; this paper offers an analysis of the primary challenges and shows that many of the ethical questions arise as the decision-making process unfolds and information is gathered.