Whose harm? Which metaphysic?

  • Abram BrummettEmail author


Douglas Diekema has argued that it is not the best interest standard, but the harm principle that serves as the moral basis for ethicists, clinicians, and the courts to trigger state intervention to limit parental authority in the clinic. Diekema claims the harm principle is especially effective in justifying state intervention in cases of religiously motivated medical neglect in pediatrics involving Jehovah’s Witnesses and Christian Scientists. I argue that Diekema has not articulated a harm principle that is capable of justifying state intervention in these cases. Where disagreements over appropriate care are tethered to metaphysical disagreements (as they are for Jehovah’s Witnesses and Christian Scientists), it is moral-metaphysical standards, rather than merely moral standards, that are needed to provide substantive guidance. I provide a discussion of Diekema’s harm principle to the broader end of highlighting an inconsistency between the theory and practice of secular bioethics when overriding religiously based medical decisions. In a secular state, ethicists, clinicians, and the courts are purportedly neutral with respect to moral-metaphysical positions, especially regarding those claims considered to be religious. However, the practice of overriding religiously based parental requests requires doffing the mantle of neutrality. In the search for a meaningful standard by which to override religiously based parental requests in pediatrics, bioethicists cannot avoid some minimal metaphysical commitments. To resolve this inconsistency, bioethicists must either begin permitting religiously based requests, even at the cost of children’s lives, or admit that at least some moral-metaphysical disputes can be rationally adjudicated.


Harm principle Medical neglect Parental refusals Children Best interests Metaphysics Religious belief 



I would like to thank Jeffrey Bishop, Erica Salter, Stephanie Cargill, and Harold Braswell for their guidance in the preparation of this manuscript, as well as the reviewers and editorial staff at Theoretical Medicine and Bioethics for their help refining and clarifying my arguments.

Compliance with ethical standards

Conflict of interest

The authors declare to have no conflicts of interest.


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© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Albert Gnaegi Center for Health Care EthicsSaint Louis UniversitySaint LouisUSA

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