Abstract
The family is the basic unit of society, and the interests of family members and the family unit are always relevant. Despite much rhetoric, neither parents nor physicians (let alone the state!) have a true fiduciary relationship with children under their care. Parents are responsible for the physical care of their children, and for their education leading them to a status as productive adults. They are responsible for their children’s flourishing. Neither their responsibility to an individual child nor their responsibility to the government is categorical. First, parents appropriately balance the interests of all family members (including their own), and the corporate interests of the family as a whole. Second, the state has non-coercive means of intervention at its disposal. This chapter reviews and expands on some prior approaches to parental authority and responsibility. The chapter classifies parental behavior into four categories, based on the maximum appropriate state response. Parental behavior within the Zone of Acceptability warrants no government attention. The next two zones represent divisions of Gillam’s Zone of Parental Discretion. Parental action within the Zone of State Attention may elicit educational efforts and the provision of services. Parental behavior within the Zone of Concern invites nudges, mandatory programs with op-out possibilities, etc. Finally, parental behavior within the Zone of Unacceptability justifies coercive state action to reverse or punish potential or actual harm. Harm may not involve the child per se, but can involve third parties, as with parental vaccination refusal.
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Notes
- 1.
‘Physician’ is used to refer to all health care professionals.
- 2.
Hardwig convincingly shows that substituted judgment does not help, using a reductio ad absurdum argument that I here concretize. Imagine two comatose 16-year-old boys, Harry and Draco. Dr. Ridgeon can cure them with a new medicine, but there is only enough to treat one of them. Using the substituted judgment standard Ridgeon notes that Harry is altruistic, and has risked his life several times to help other people—even people he disliked. Draco, on the other hand, regularly boasted that he would drown his mother to achieve fame and fortune. Ridgeon appropriately concludes that Harry would offer the drug to Draco, who would take it. She cures Draco, and lets Harry die on the basis of substituted judgment.
- 3.
Sometimes a mens rea is not necessary, as when a parent is physically unable to exercise parental functions.
- 4.
The Charlie Gard litigation took place in the UK, where Parham was not precedential.
- 5.
The FreeEconhelp (2020) blog provides a very simple explanation of marginal benefit and cost, with a helpful graph.
- 6.
The interests of the three Talleyrands are not fungible, but I will compare them anyway to make a point about Pareto analysis.
References
Conti, Adelaide, Emanuele Capasso, Claudia Casella, Piergiorgio Fedeli, Francesco Antonio Salzano, Fabio Policino, Lucia Terracciano, and Paola Delbon. 2018. Blood transfusion in children: The refusal of Jehovah’s witness parents. Open Medicine 13(1). https://doi.org/10.1515/med-2018-0016; Available at https://www.degruyter.com/view/j/med.2018.13.issue-1/med-2018-0016/med-2018-0016.xml
Abramowicz, Sarah. 1999. English child custody law, 1660–1839: The origins of judicial intervention in parental custody. Columbia Law Review 99 (6): 1344–1392.
Andrew, Ernest, and Peter Lindsay. 2008. Are the judgments of conscience unreasonable? Critical Review of International Social and Political Philosophy. 11 (2): 235–254.
Annas, George J. 1994. Asking the courts to set the standard of emergency care-the case of baby K. New England Journal of Medicine 330 (21): 1542–1545.
Asma, Stephen T. 2013. Against Fairness. Chicago: University of Chicago Press.
Audi, Robert. 2011. Democratic Authority and the Separation of Church and State. Oxford: Oxford University Press.
Baier, Annette. 1985. Postures of the Mind: Essays on Mind and Morals. Minneapolis: University of Minnesota Press.
Basu, Sanjay, and Kristine Madsen. 2017. Effectiveness and equity of sugar-sweetened beverage taxation. PLOS Medicine. http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002327;
Beauchamp, Tom L., and James F. Childress. 2013. Principles of Biomedical Ethics, 7th ed. London: Oxford University Press.
Bester, Johan Christiaan. 2018. The harm principle cannot replace the best interest standard: Problems with using the harm principle for medical decision-making for children. American Journal of Bioethics 18 (8): 9–19.
Bross, Donald C. 1982. Medical care neglect. Child Abuse and Neglect 6 (4): 375–381.
Caruso Brown, Amy E., and Amy R. Slutzky. 2017. Refusal of treatment of childhood cancer: A systematic review. Pediatrics 140 (6): e20171951.
Buchanan, Allen E., and Dan W. Brock. 1989. Deciding for Others: The Ethics of Surrogate Decision-Making. Cambridge: Cambridge University Press.
Cooper, Rebecca, and Kathryn A. Koch. 1996. Neonatal and pediatric critical care: Ethical decision making. Critical Care Clinics 12 (1): 149–164.
Cunningham, Thomas V. 2016. A life below the threshold? Examining Conflict between ethical principles and parental values in neonatal treatment decision making. Narrative Inquiry in Bioethics 6 (1): 63–71.
Davis, Dena S. 2013. Ancient rites and new laws: How should we regulate religious circumcision of minors? Journal of Medical Ethics 39 (7): 456–458.
Dawkins, Richard. 2006. The God Delusion. Boston: Houghton Mifflin.
Dawson, Angus. 2011. Vaccination ethics. In Public Health Ethics: Key Concepts and Issues in Policy and Practice, ed. Angus Dawson, 143–153. Cambridge: Cambridge University Press.
DeMarco, Joseph P., Douglas P. Powell, and Douglas O. Stewart. 2011. Best interest of the child: Surrogate decision making and the economics of externalities. Bioethical Inquiry 8 (3): 289–298. https://doi.org/10.1007/s11673-011-9315-1.
Diekema, Douglas S. 2004. Parental refusals of medical treatment: The harm principle as threshold for state intervention. Theoretical Medicine 25 (4): 243–264.
Elwyn, Glyn, Dominick Frosh, Richard Thompson, Natalie Joseph-Williams, Amy Lloyd, Paul Kinnersley, Emma Cording, et al. 2012. Shared decision making: A model for clinical practice. Journal of General Internal Medicine 27 (10): 1361–1367. https://doi.org/10.1007/s11606-012-2077-6.
Epstein, Richard A. 1973. A theory of strict liability. Journal of Legal Studies 2 (1): 151–204.
Fineman, Martha A. 2010. The vulnerable subject and the responsive state. Emory Law Journal 60 (251): 1–41.
Frank, Johann Peter. 1976. A System of Complete Medical Police: Selections. Translated by E. Velum, edited by Erna Lesly. Baltimore: Johns Hopkins University Press.
FreeEconhelp. 2020. Why Marginal Benefit Equals Marginal Cost in Economics … Always! FreeEconhelp. https://www.freeeconhelp.com/2011/10/why-marginal-benefit-equals-marginal.html
Frisch, Ragnar. 1955. From national accounts to macro-economic decision models. IARIW Papers on Income and Wealth Series IV (Bowes & Bowes, London), p. 2. https://www.sv.uio.no/econ/om/tall-og-fakta/nobelprisvinnere/ragnar-frisch/published-scientific-work/rf-published-scientific-works/rf1955b.pdf
Gheaus, Anca. 2018. Children’s vulnerability and legitimate authority over children. Journal of Applied Philosophy 35 (S1): 60–75. https://doi.org/10.1111/japp.12262.
Gillam, Lynn. 2016. The zone of parental discretion: An ethical tool for dealing with disagreement between parents and doctors about medical treatment for a child. Clinical Ethics 11 (1): 1–8.
Goel, Sonu, Federica Angeli, Nonita Dhirar, Neetu Singla, and Dirk Ruwaard. 2018. What motivates medical students to select medical studies: A systematic literature review. BMC Medical Education 18: Art #16. https://doi.org/10.1186/s12909-018-1123-4
Gostin, Lawrence O. 1995. Tuberculosis and the power of the state: Toward the development of rational standards for the review of compulsory public health powers. University of Chicago Law School Roundtable 2 (1): 219–77. http://chicagounbound.uchicago.edu/roundtable/vol2/iss1/10
Groll, Daniel. 2014. Four models of family interests. Pediatrics 134 (Suppl. 2): S81–S86. https://doi.org/10.1542/peds.2014-1394C.
Hardwig, John. 1993. The problem of proxies with interests of their own: Toward a better theory of proxy decisions. Journal of Clinical Ethics 4 (1): 20–27.
Hazony, Yoram. 2018. The virtues of nationalism. New York: Basic Books.
Henderson, Cydney. 2019. Lori Loughlin, Felicity Huffman Sued for $500 Billion (!) Over College Bribery Scandal. USA Today. https://www.usatoday.com/story/life/people/2019/03/14/college-bribery-scandal-mom-sues-loughlin-huffman-500-b/3168445002/
Henrich, Joseph. 2016. The Secret of Our Success. Princeton: Princeton University Press.
Henrich, Joseph. 2020. The WIERDest People in the World. New York: Farrar, Giroux, Straus.
Hickey, Kenneth S., and Laurie Lyckholm. 2004. Child welfare versus parental autonomy: Medical ethics, the law, and faith-based healing. Theoretical Medicine 25 (4): 265–276.
Hoelscher, Deanna M., Nancy F. Butte, Sarah Barlow, Elizabeth A. Vandewater, Shreela V. Sharma, Terry Huang, Eric Finkelstein, et al. 2015. Incorporating primary and secondary prevention approaches to address childhood obesity prevention and treatment in a low-income, ethnically diverse population: Study design and demographic data from the Texas Childhood Obesity Research Demonstration (TX CORD) Study. Childhood Obesity 11 (1): 71–91.
Holm, Søren. 2004. The child as organ and tissue donor: Discussions in the danish council of ethics. Cambridge Quarterly of Healthcare Ethics 13 (2): 156–160.
Iltis, Ana S. 2010. Toward a coherent account of pediatric decision making. Journal of Medicine and Philosophy 35 (5): 526–552.
Jacobs, Allan J. 2012. Do belief exemptions to compulsory vaccination programs violate the fourteenth amendment? University of Memphis Law Review 42 (1): 73–126.
Jacobs, Allan J., and Kavita Shah Arora. 2015. Ritual male infant circumcision and human rights. American Journal of Bioethics 15 (2): 30–39.
Jacobs, Allan. J., and Kavita Shah Arora. 2018. When may government interfere with religious practices to protect the health and safety of children? Ethics, Medicine, and Public Health Ethics in Medicine and Public Health 5 (1): 86–93.
Kass, Leon. R. 1997. The Wisdom of Repugnance. New Republic. June 1997, 17–26.
Kerstetter, Todd. 2004. That’s just the American way’: The branch Davidian tragedy and western religious history. Western Historical Quarterly 35 (4): 453–471.
Lantos, John D. 2017. The tragic case of Charlie Gard. JAMA Pediatrics 171 (10): 935–936.
Leiter, Brian. 2014. Why Tolerate Religion? Princeton: Princeton University Press.
Lindemann, Hilde. 2014. Why families matter. Pediatrics 134 (2): S97–S103. https://doi.org/10.1542/peds.2014-1394E
Manchester, Colin. 1977. The origins of strict criminal liability. Anglo-American Law Review 6 (4): 277–83.
McDougall, Rosalind J., and Lauren Notini. 2014. Overriding parents’ medical decisions for their children: A systematic review of normative literature. Journal of Medical Ethics 40 (7): 448–452.
Miele, Mara. 2016. Killing animals for food: How science, religion and technologies affect the public debate about religious slaughter. Food Ethics 1 (1): 47–60.
Mindes, Paula. 1996. Tuberculosis quarantine: A review of legal issues in Ohio and other states. Journal of Law and Health 10 (2): 403–428.
Henry, O. (pen name of William Sydney Porter). 1905. The Gift of the Magi. http://www.gutenberg.org/ebooks/7256
Post, Stephen G. 1995. Baby K: Medical futility and the free exercise of religion. Journal of Law, Medicine, and Ethics 23 (1): 20–26. https://doi.org/10.1111/j.1748-720x.1995.tb01326.x.
Rhodes, Rosamond, and Ian Holzman. 2004. The not unreasonable standard for assessment of surrogates and surrogate decisions. Theoretical Medicine and Bioethics 25 (4): 367–386.
Roache, Sarah A., and Lawrence O. Gostin. 2017. The untapped power of soda taxes: Incentivizing consumers, generating revenue, and altering corporate behavior. International Journal of Health Policy Management 6 (9): 489–493.
Ross, Lainie Friedman. 1998. Children, families, and health care decision-making. Oxford: Clarendon Press.
Rosemont, Henry, Jr. 2015. Against individualism: A confucian rethinking of the foundations of morality, politics, family, and religion. Lanham, Maryland: Lexington Books.
Schoeman, Ferdinand. 1985. Parental discretion and children’s rights: Background and implications for medical decision-making. Journal of Medicine and Philosophy 10 (1): 45–61.
Semba, Richard D. 2008. Nutrition and development: A historical perspective. In Nutrition and Health in Developing Countries, 2nd edition, edited by Richard D. Semba & Martin W. Bloem, Totowa, New Jersey: Humana Press; Min, 1–32.
Siegal, Nina. 2107. New slaughtering rules pit Dutch religious freedom against animal rights. New York Times December 21, 2107. https://www.nytimes.com/2017/12/31/world/europe/netherlands-kosher-halal-animal-rights.html
Stoljar, Natalie. 2011. Informed consent and relational conceptions of autonomy. Journal of Medicine and Philosophy 36 (3): 375–384. https://doi.org/10.1093/jmp/jhr029.
Sullivan, Laura S., and Fay Niker. 2018. Relational autonomy, paternalism, and maternalism. Ethical Theory and Moral Practice 21 (3): 649–667. https://doi.org/10.1007/s10677-018-9900-z.
Thaler, Richard H., and Cass R. Sunstein. 2008. Nudge: Improving decisions about health, wealth, and happiness. New Haven: Yale University Press.
Tyrrell, Jessica, Samuel E. Jones, Robin Beaumont, Christina M. Astley, Rebecca Lovell, Hanieh Yaghootkar, et al. 2016. Height, body mass index, and socioeconomic status: Mendelian randomisation study in UK biobank. BMJ 352: I 582. https://doi.org/10.1136/bmj.i582
Walter, Jennifer K., and Lainie Friedman Ross. 2014. Relational autonomy: Moving beyond the limits of isolated individualism. Pediatrics 133 (Suppl. 1): S16–S23. https://doi.org/10.1542/peds.2013-3608D.
Weise, Kathryn L., Alexander L. Okun, Brian S. Carter, Cindy W. Christian, MD, and Committee on Bioethics, Section on Hospice and Palliative Medicine, Committee on Child Abuse and Neglect. 2017. Guidance on forgoing life-sustaining medical treatment. Pediatrics 140 (3): e20171905. https://doi.org/10.1542/peds.2017-1905
Wilkinson, Dominic. 2013. Death or Disability? The “Carmentis Machine” and Decision-Making for Critically Ill Children. Oxford: Oxford University Press.
Williams, Rebecca. 2012. Faith healing exception versus Parens Patriae: Something’s Gotta give. First Amendment Law Review 10 (3): 692–730
Woolley, S. 2005. Children of Jehovah’s witnesses and adolescent Jehovah’s witnesses: What are their rights? Archives of Diseases in Childhood 90 (7): 715–719.
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Jacobs, A.J. (2022). What We Owe Parents and Family. In: Assigning Responsibility for Children’s Health When Parents and Authorities Disagree: Whose Child?. The International Library of Bioethics, vol 90. Springer, Cham. https://doi.org/10.1007/978-3-030-87698-2_4
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