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Intervention principles in pediatric health care: the difference between physicians and the state

  • D. Robert MacDougallEmail author
Article
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Abstract

According to various accounts, intervention in pediatric decisions is justified either by the best interests standard or by the harm principle. While these principles have various nuances that distinguish them from each other, they are similar in the sense that both focus primarily on the features of parental decisions that justify intervention, rather than on the competency or authority of the parties that intervene. Accounts of these principles effectively suggest that intervention in pediatric decision making is warranted for both physicians and the state under precisely the same circumstances. This essay argues that there are substantial differences in the competencies and authorities of physicians and the state, and that the principles that guide their interventions should also be conceived differently. While both the best interests standard and the harm principle effectively incorporate important aspects of physicians’ ethical obligations, neither adequately reflects the state’s ethical obligations. In contrast to physicians, the state has major obligations of distributive justice and neutrality that should form an integral part of any proposed ethical principles guiding state intervention in pediatric decision making. The differences are illustrated by examining recent cases involving parental refusal of chemotherapy in aboriginal Canadian communities and parental refusal of blood transfusions by Jehovah’s Witnesses.

Keywords

Best interests standard Harm principle Pediatric decision making State intervention Liberalism Justice Parens patriae 

Notes

Acknowledgements

I would like to thank audiences at the American Society of Bioethics and Humanities and the Canadian Bioethics Society for comments on presented versions of this paper, and the reviewers and editors at Theoretical Medicine and Bioethics for their helpful comments, insights, and criticisms on earlier versions of this manuscript.

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.New York City College of Technology, CUNYBrooklynUSA

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