Abstract

In this thesis, I argue in favor of a broad discretionary authority for parents in pediatric decision-making based directly on the special nature of the parent-child relationship. I argue that, based on our knowledge of cognitive development and an age appropriate understanding of illness, preadolescent children at least will tend not to make medical decisions with sufficient autonomy to warrant the personal authority generally given to adult patients. I argue that these circumstances require the designation of a decisional authority, although that authority should be gradually restricted in the face of a child's evolving autonomy. An analysis of executive authority provides an understanding of both the nature of such claims and their requirements for justification. Many attempts have been made to apply various models of executive authority to the parent-child relationship, but I argue that the available models of ownership, identity, creation, and stewardship inadequately explain the extent of parental authority and provide poor descriptions of its moral foundation. Instead, I propose a model of parental commitment which bases the authority claim on the long term commitment of parents to the developing good of a child under circumstances where that good is understood within the context of an intimate personal relationship. This intimacy allows for a partial identity of interests between parent and child, thus supplying a richer content to the best interests standard and accounting for the extraordinary scope of parental authority as it is usually understood. However, this identity is only partial and the distinctness of the child provides for an independent set of basic interests which ought to remain inviolable, placing important limitations on any parental authority claim. I argue that state intervention may be justified when these basic interests are threatened and the likely harm to the child of such intervention is outweighed by the anticipated benefits. I discuss the possibility of autonomous children and difficulties raised by intrafamilial conflicts. Overall, I believe this model provides a useful framework for addressing questions of parental authority in pediatrics