The Child’s Right to an Open Future: Philosophical Foundations and Bioethical Applications

Abstract

The child’s right to an open future (ROF) is a normative ideal that is frequently invoked in pediatric bioethics. At its core, ROF holds that when childhood decisions threaten the autonomy of the future adult, fiduciaries should defer and, hence, preserve the choice until children reach maturity and can choose for themselves. In this chapter, I explore several conceptual and normative issues raised by ROF. I begin by briefly summarizing how ROF came to dominate certain debates within pediatric ethics before mapping out the conceptual space that ROF occupies in relation to other rights attributed to children. I then reconstruct the prima facie case for ROF that has made this ideal attractive within pediatric ethics before analyzing some of its primary conceptual and normative challenges. Finally, I defend an alternative framework in which children’s interest in preserving a relatively open future is regarded not as a strict right but instead as one (important) interest among many to weigh and balance in pediatric decision-making. This alternative interest-based framework allows for the open future to be treated within a broader pediatric ethical framework like the best interest standard rather than as an independently robust ethical constraint. I conclude by comparatively evaluating ROF with this interest-based framework when applied to three different pediatric bioethics controversies: (1) the sterilization of minors, (2) elective pediatric surgeries, and (3) predictive genetic testing.