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Basic Concepts for Clinical Practice

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Moral Equality, Bioethics, and the Child

Part of the book series: International Library of Ethics, Law, and the New Medicine ((LIME,volume 67))

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Abstract

Both trust and autonomy are concepts related to the moral worth of the child as a person and a human being. Respect for the child’s trust protects her as being-in-relation; respect for her (developing) autonomy aims at the child as an individual. Together, they characterize the child as a moral agent.

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Notes

  1. 1.

    United Nations : “Convention on the Rights of the Child”, available online at http://www.ohchr.org/en/professionalinterest/pages/crc.aspx (adopted and opened for signature, ratification and accession by General Assembly resolution 44/25 of 20 November 1989), accessed February 22, 2016.

  2. 2.

    As an alternative, Goldstein et al. have suggested choosing the “least detrimental available alternative for safeguarding the child’s growth and development” (Goldstein et al. 1973, p. 53). But, would it really respect the child’s moral worth to choose between only available alternatives when these are very restricted per se?

  3. 3.

    In German law, the exact meaning of ‘child well-being’ (‘Kindeswohl’) is deliberately left vague. For a critical discussion, see Dörries (2003), Rothärmel (2004), Dettenborn (2010), Schües and Rehmann-Sutter (2013).

  4. 4.

    An expert in medical law, Sarah Elliston , offers a similarly critical evaluation of the UK (Elliston 2007). The Canadian paediatric ethicist Franco Carnevale criticizes the implicit adult centredness of the best-interest standard (Carnevale 2004, p. 401f); for another detailed critical analysis, see Salter (2012). The British paediatrician Paul Baines hints at the fact that the best-interest standard “does not recognize the complex way that interests must be balanced within a family”, for example, if a parent puts both children in a car to take one to a swimming lesson (Baines 2008, p. 143). For a critical evaluation with regard to new families, see also Munthe (2012).

  5. 5.

    Ross tries to escape the dilemma by arguing for (constrained) parental autonomy in healthcare decision-making except when the basic needs of the child are concerned (Ross 1997, 1998). However, Ross does not substantiate her definition of ‘basic needs’.

  6. 6.

    For a critical appraisal of Ross’s arguments, see Blustein (2009a, b).

  7. 7.

    See, for example, the self-evaluation tool developed by a task group of the WHO for paediatric hospitals, Simonelli, F., Guerreiro, A.I.F. (eds.), “The respect of children’s rights in hospital: an initiative of the International Network on Health Promoting Hospitals and Health Services. Final Report on the implementation process of the Self-evaluation Model and Tool on the respect of children’s rights in hospital”. January 2010. Available online at http://www.schn.health.nsw.gov.au/files/attachments/task-force_hph-ca_childrens_rights_in_hospital_self_evaluation_model_final_report.pdf, accessed February 22, 2016.

  8. 8.

    See Child Welfare Information Gateway (2013). “What is child abuse and neglect? Recognizing the signs and symptoms”. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau. Available online at www.childwelfare.gov/pubs/factsheets/whatiscan.cfm, accessed February 22, 2016.

  9. 9.

    Available online at https://www.education.gov.uk/publications/eOrderingDownload/00305-2010DOM-EN.pdf, accessed February 22, 2016. “In each case, it is necessary to consider any maltreatment alongside the child’s own assessment of his or her safety and welfare” (Department for Children, Schools and Families 2010, p. 36).

  10. 10.

    See, for example, the statement of the German Federal Medical Association’s Central Ethics Committee with regard to the medical treatment of immigrant populations (Birnbacher et al. 2013).

  11. 11.

    Child Welfare Information Gateway (2013). “What is child abuse and neglect? Recognizing the signs and symptoms”. Washington, DC: U.S. Department of Health and Human Services, Children's Bureau. Available online at https://www.childwelfare.gov/pubPDFs/whatiscan.pdf, p. 3, accessed February 22, 2016.

  12. 12.

    Child Welfare Information Gateway (2013), https://www.childwelfare.gov/pubPDFs/whatiscan.pdf.

  13. 13.

    As when the UK Department for Children, Schools and Families renders ‘neglect and abuse’ as ‘forms of maltreatment’ (Department for Children, Schools and Families 2010, p. 37). Similarly, the CAPTA definition renders ‘abuse’ as ‘exploitation’.

  14. 14.

    See her personal homepage available online at http://www.lauradekker.nl/, accessed February 22, 2016.

  15. 15.

    Norvin Richards argues that “while to neglect a child is to leave her at unacceptable risk of harm, to abuse her is actually to do her the harm” (Richards 2010, p. 87). My point is, however, that the child is actually harmed in both cases.

  16. 16.

    See also Jennifer Freyd’s website on betrayal trauma, available online at http://dynamic.uoregon.edu/jjf/defineBT.html, accessed February 22, 2016

  17. 17.

    Some of them are already under way. See, e.g., Van Bueren (2007), Alderson (2008), Freeman (2009).

  18. 18.

    Dworkin, Gerald, “Paternalism”, The Stanford Encyclopedia of Philosophy (Summer 2010 Edition), Edward N. Zalta (ed.), http://plato.stanford.edu/archives/sum2010/entries/paternalism/.

  19. 19.

    Dworkin, Gerald, “Paternalism”, The Stanford Encyclopedia of Philosophy (Summer 2010 Edition), Edward N. Zalta (ed.), http://plato.stanford.edu/archives/sum2010/entries/paternalism/. Schickhardt rightly discards this general rule as a case of age discrimination (Schickhardt 2012, p. 198).

  20. 20.

    McKinstry (2000). For trust in the medical setting, see also Pellegrino (1991), Zaner (1991).

  21. 21.

    Statements of professionalism are a way of making explicit the values for which a profession stands. They are thus able to mediate trust. See, for example, the statement of professionalism in paediatrics of the Committee on Bioethics (2007).

  22. 22.

    Christoph Schickhardt develops other principles for determining when a paternalistic intervention can be justified, like the prevention principle (to consider if there are alternatives to a paternalistic intervention), the principle of the minimal amount of coercion, and the risk principle (Schickhardt 2012, p. 212). Yet, although these are not wrong, they are ambivalent with regard to the moral status of the child. The risk principle, for example, demands that the higher the risks involved, the easier it is to justify a paternalist intervention. But, what counts as risk? In Lee’s case, would this principle demand overriding Lee’s decision because of his life-threatening condition? Or, would it demand respecting his decision because of the risk of shattering Lee’s self-esteem and his trust in his next of kin?

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  1. Department of Medical Ethics and History of Medicine, University Medical Centre Göttingen, Göttingen, Germany

    Claudia Wiesemann

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Wiesemann, C. (2016). Basic Concepts for Clinical Practice. In: Moral Equality, Bioethics, and the Child. International Library of Ethics, Law, and the New Medicine, vol 67. Springer, Cham. https://doi.org/10.1007/978-3-319-32402-9_8

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