Published in the American Journal of Bioethics.

The pandemic has adversely impacted children. The vaccine roll-out to children aged 12 - 17 years is important to curb the spread of the virus and allow children to revert to some form of normality. Children’s rights to equality, education, health and food have been impeded during the pandemic. However, there is a persistent hesitancy towards the vaccine roll-out. This is apparent from a case before the High Court in Pretoria, in the pending matter between the African Christian Democratic (...) Party and others v The Minister of the National Department of Health: Dr M Phaahla and Others. SECTION27’s intervention as amicus curiae highlights the importance of vaccines, and provides evidence to illustrate the adverse impact of the pandemic on learners’ rights to equality, education, food and health. Further, the evidence illustrates the inequalities that exist among learners. (shrink)

This paper discusses children's right to play and its bioethical importance for children affected by war. Against the background of the current military conflicts, it analyses physical, psychological, and institutional factors that limit children's right to play in a situation involving armed conflict. Considering that the lack of institutional support of play for children affected by war constitutes a failure to fulfil our societal and political obligation under Article 31 of the United Nations Convention on the Rights (...) of the Child, this paper analyses the understanding of play adopted in this legal instrument. In line with the distinctions made in the Convention, it discusses the importance of play for children's life and survival, for their health and well‐being, as well as for the recovery of trauma experienced by children affected by armed conflict. It thereby aims to contribute to the recognition and protection of this right on the grounds of bioethics and healthcare. (shrink)

The transgender population generally faces rights violations and discrimination in their day-to-day lives, which was exacerbated during the recent pandemic. This necessitates close scrutiny from an ethics perspective. Following directives from a 2014 Supreme Court judgement, Kerala became the first Indian state to implement a comprehensive policy to enforce the constitutional rights of transgender people. Despite such positive actions, a basic social tendency not to respect gender diversity has led to discrimination and marginalization. This was very evident during (...) the pandemic. In this empirical work, we have documented the lives of the transgender community during the pandemic wherein they share experiences related to livelihood, interaction with the healthcare system, and acceptance in society vis-à-vis the pandemic. Simply providing third-gender status will not help the gender-marginalized community to grow to their fullest potential and have a better lifestyle on par with others in mainstream society. (shrink)

If we agree that the adoption of Human Rights Instruments during the second half of the last century has led to a system of globally accepted values, are these also applicable to children? There are some indications that the Convention on the Rights of the Child is beginning to have an impact, in particular where a culture of rights is already in existence. This paper examines policy issues concerned with three interconnected rights: to education, rest and (...) leisure, and freedom from exploitation. Does the fact that a society subscribes to a culture of rights make any difference in this respect?The paper begins by considering different approaches to the right of freedom from economic exploitation in International Instruments and discusses a number of aspects relevant to the work of children. It then compares recent amendments to child labour legislation in two societies, one of which is a state party to several children's rights conventions, while the other has not ratified any International Treaties of relevance to its own child citizens. (shrink)

Advances in genomic technologies such as CRISPR‐Cas9, mitochondrial replacement techniques, and in vitro gametogenesis may soon give us more precise and efficient tools to have children with certain traits such as beauty, intelligence, and athleticism. In this paper, I propose a new approach to the ethics of reproductive genetic engineering, a human rights approach. This approach relies on two claims that have certain, independent plausibility: (a) human beings have equal moral status, and (b) human beings have human rights (...) to the fundamental conditions for pursuing a good life. I first argue that the human rights approach gives us a lower bound of when reproductive genetic engineering would be permissible. I then compare this approach with other approaches such as the libertarian, perfectionist, and life worth living approaches. Against these approaches, I argue that the human rights approach offers a novel, and more plausible, way of assessing the ethics of reproductive genetic engineering. (shrink)

Background: This article describes the overall attitudes of children, their parents, and attending physicians toward including or excluding pediatric patients in medical communication and health care decision-making processes. Methods: Fifty-two interviews were carried out with pediatric patients (n = 17), their parents (n = 19), and attending oncologists (n = 16) in eight Swiss pediatric oncology centers. The interviews were analyzed using thematic coding. Results: Parenting styles, the child's personality, and maturity are factors that have a great impact upon the (...) inclusion of children in their health care processes. Children reported the desire to be heard and involved, but they did not want to dominate the decision-making process. Ensuring trust in the parent–child and physician–patient relationships and respecting the child as the affected person were important values determining children's involvement. These two considerations were closely connected with the concern that fantasies are often worse than reality. Seeking children's compliance with treatment was a practical but critical reason for informing them about their health care. The urge to protect them from upsetting news sometimes resulted in their (partial) exclusion. Conclusions: The ethical imperative for inclusion of children in their health care choices was not so much determined by the right for self-determination, but by the need to include them. If children are excluded, they imagine things, become more isolated, and are left alone with their fears. Nevertheless, the urge to protect children is innate, as adults often underestimate children's coping capacities. (shrink)

It may soon be possible to develop pills that allow parents to induce in themselves more loving behaviour, attitudes and emotions towards their children. In this paper, I consider whether pharmacologically induced parental love can satisfy reasonable conditions of authenticity; why anyone would be interested in taking such parental love pills at all, and whether inducing parental love pharmacologically promotes narcissism or results in self-instrumentalization. I also examine how the availability of such pills may affect the duty to love a (...) child. (shrink)

There is an intrinsic connection between genocide and colonialism where both concepts are in close proximity and are based on the logic of elimination. The fact that an active genocide of the Palestinian people continues in 2024 is extremely disturbing. A plethora of human rights laws and principles complement and reinforce the protections afforded under international humanitarian law. These laws were developed in order to prevent historical atrocities from repeating themselves. As history is re-written, it is submitted that these (...) laws, while good on paper, are not being put into practice in the case of Palestine. This article reflects on the application of specific international humanitarian laws, namely protecting healthcare, preserving nutrition and safeguarding children during times of conflict, and analyses how these protections are being flouted in the case of Gaza. (shrink)

Within and among societies, there are competing understandings of the status of children, including debates over whether they can bear rights and, if so, which rights they bear and against whom, and their capacity to make decisions and be held responsible and accountable for actions. There also are different understandings of what constitutes a family; what authority parents have over and regarding their children; and what should happen to children who are without parents because of death, desertion, or (...) imprisonment. These and other related debates reflect deep differences in worldviews, in how one understands the legitimate role of the state, in how one comes to know the proper way to raise children, and so on. The United Nations Convention on the Rights of the Child purports to reflect international convergence on the rights of children, on how decisions concerning children should be made, and on how children ought to be treated by the state and by their parents. This paper examines whether the Convention's framework for decision making concerning children is an appropriate framework for pediatric bioethics. Questions about how to make health care decisions for children ultimately are questions of who is in authority to make and judge such decisions. Establishing who is in authority, determining whether there are any limits to that authority and, if so, defining those limits should be the focus of efforts to develop and implement a pediatric decision-making framework. (shrink)

This paper advances a novel conception of the child’s best interest in regard to pediatric surgeries that do not promote the preventive or therapeutic health needs of children, or elective pediatric surgeries (EPS). First, children’s capacity for decision-making is examined, and the best decision-making model for EPS is identified as the Best Interest Standard. What follows is a discussion of the interests of children in the context of EPS, the correlation of fundamental interests to rights, and guidelines for weighing (...) children’s competing interests. Next, the rights and duties of parents as proxy decision makers are considered. Finally, a reinterpretation of the Best Interest Standard is proposed, identifying as paramount a child’s ability to make elective medical decisions for herself when she reaches maturity. (shrink)

Somerville, Margaret Over the millennia of human history, the idea that children - at least those born into a marriage - had rights with respect to their biological parents was taken for granted and reflected in law and public policy. But with same-sex marriage, which gives same-sex spouses the right to found a family, that is no longer the case. Likewise, children's rights with respect to their biological origins were not an issue when there was no technoscience (...) that could be used to manipulate or change those origins: a baby could only be conceived in vivo through sexual reproduction. But with assisted human reproductive technologies and genetic technologies, that, too, is no longer the case. So, in light of these new realities, what are our obligations, as societies, to children with respect to their biological origins and biological families? What protections do children need and deserve? I propose that the most fundamental human right of all is a child's right to be born from natural human biological origins and that children also have human rights with respect to knowing who their biological parents and families are, and that these rights must be recognized. Children also have a right to be reared within their biological families and to have a mother and a father, unless an exception can be justified as being in the 'best interests' of a particular child. The connection among adoption, the use of new reproductive technologies, and same-sex marriage is that they all unlink child-parent biological bonds. Each context raises one or more of three important issues: children's right to know the identities of their biological parents; children's right to both a mother and a father, preferably their own biological parents; and children's right to come into being with genetic origins that have not been tampered with; that is, 'designing' our children should be prohibited. Such 'designing' would result in losses with implications far beyond those persons directly affected and far beyond the present time. It would undermine the rights to equality and freedom of future generations. Because the liberty and equality of all citizens is at the heart of democratic societal institutions and of the values that democratic societies promote, to create people who are neither free nor equal undermines those institutions and values. In short, not to prohibit 'designer children' would undermine the very foundations of our Western democratic societies. (shrink)

This paper examines the ethicalproblems that arise when research is carriedout after autopsy on dead infants. It comparesthe right of parents against that of the publicinterest in matters of research on dead minors. The basis for the respect that is widelyaccorded to the body of a dead person isexamined and is shown to ground the parentalinterest. A discussion of the nature of thefamily suggests that `informed consent' is notthe best term to apply to the process ofparental consultation. Some reasons areprovided (...) against using this term in the contextin which bereaved parents are consulted aboutautopsy and research on their dead infants. Itis suggested that a term such as `authorize'might better apply to this situation. (shrink)

Background This analysis is about practical living bioethics and how law, ethics and sociology understand and respect children’s consent to, or refusal of, elective heart surgery. Analysis of underlying theories and influences will contrast legalistic bioethics with living bioethics. In-depth philosophical analysis compares social science traditions of positivism, interpretivism, critical theory and functionalism and applies them to bioethics and childhood, to examine how living bioethics may be encouraged or discouraged. Illustrative examples are drawn from research interviews and observations in two (...) London paediatric cardiac units. This paper is one of a series on how the multidisciplinary cardiac team members all contribute to the complex mosaic of care when preparing and supporting families’ informed consent to surgery. Results The living bioethics of justice, care and respect for children and their consent depends on theories and practices, contexts and relationships. These can all be undermined by unseen influences: the history of adult-centric ethics; developmental psychology theories; legal and financial pressures that require consent to be defined as an adult contract; management systems and daily routines in healthcare that can intimidate families and staff; social inequalities. Mainstream theories in the clinical ethics literature markedly differ from the living bioethics in clinical practices. Conclusion We aim to contribute to raising standards of respectful paediatric bioethics and to showing the relevance of virtue and feminist ethics, childhood studies and children’s rights. (shrink)

The ratification of the United Nations Convention on the Rights of the Child (UNCRC) demands that those participating nations, adopt the aims of the convention as state responsibilities toward their child citizens. The central premise of the convention is clear: that it is the right of all children to develop to their full potential. The authors propose six basic interdependent developmental requirements if the child is to reach ‘full potential’. Without prioritising any one need, but instead concentrating on the (...) facilitation of complete care of the child, the paper aims to examine how the UNCRC may finally be realised. This is achieved by highlighting several key situations and associated factors, which contribute to deficient care. Whilst the factors leading to the creation of such situations are often culturally specific, the consequences for the child, and the implications for care providers (parents, aid agencies, and policy makers), are often very similar within and between continents. (shrink)

This discussion paper considers how seldom recognised theories influence clinical ethics committees. A companion paper examined four major theories in social science: positivism, interpretivism, critical theory and functionalism, which can encourage legalistic ethics theories or practical living bioethics, which aims for theory–practice congruence. This paper develops the legalistic or living bioethics themes by relating the four theories to clinical ethics committee members’ reported aims and practices and approaches towards efficiency, power, intimidation, justice, equality and children’s interests and rights. Different (...) approaches to framing ethical questions are also considered. Being aware of the four theories’ influence can help when seeking to understand and possibly change clinical ethics committee routines. The paper is not a research report but is informed by a recent study in two London paediatric cardiac units. Forty-five practitioners and related experts were interviewed, including eight members of ethics committees, about the work of informing, preparing and supporting families during the extended process of consent to children’s elective heart surgery. The mosaic of multidisciplinary teamwork is reported in a series of papers about each profession, including this one on bioethics and law and clinical ethics committees’ influence on clinical practice. The qualitative social research was funded by the British Heart Foundation, in order that more may be known about the perioperative views and needs of all concerned. Questions included how disputes can be avoided, how high ethical standards and respectful cooperation between staff and families can be encouraged, and how minors’ consent or refusal may be respected, with the support of clinical ethics committees. (shrink)

Abstract. In this paper, which was among Don Browning's last writings before he died, we review and evaluate the main arguments against the United Nations Convention on the Rights of the Child (the “CRC”) that conservative American Christians in particular have opposed. While we take their objections seriously, we think that, on balance, the CRC is worthy of ratification, especially if it is read in light of the profamily ethic that informs the CRC and many earlier human rights (...) instruments. More fundamentally, we think that the CRC captures some of the very best traditional Western legal and theological teachings on marriage, family, and children, which we retrieve and reconstruct for our day. (shrink)

It is widely accepted that children enjoy some form of a right to bodily integrity. However, there is little agreement about the precise nature and scope of this right. This paper offers a conceptual analysis of the child's right to bodily integrity, in order to further elucidate the relationship between the child's right to bodily integrity and considerations of autonomy. Following a discussion of Leif Wenar's work on the structure and justification of rights, I first explain how the adult's (...) right to bodily integrity can be distilled into separate elements that may plausibly be justified by different moral considerations. In particular, I claim that this analysis suggests that whilst the adult's right to bodily integrity is not wholly reducible to bodily autonomy, autonomy nonetheless remains entwined with our understanding of this right in a number of ways. On the basis of this discussion, I go on to outline three important complexities that arise when we consider the child's right to bodily integrity, before particularly focusing on the question of how third parties should determine whether or not to perform a physical interference upon a child who lacks decision-making capacity. Here, I raise some objections to Earp and Mazor's recent attempts to answer this question, before briefly defending an ‘autonomy-based interests’ account of permissible interference, an account that shares in what I take to be the spirit, if not the precise letter, of these earlier views. (shrink)

Events surrounding the September 11 terrorist attacks on the United States raise compelling moral questions about the effects of war and globalization on children in many parts of the world. This paper adopts Sartre's notion of freedom, particularly its connection with materiality and intersubjectivity, to assess the moral responsibility that we have as a global community toward our most vulnerable members. We conclude by examining important first steps that should be taken to address the plight of children.

This book provides a multidisciplinary analysis of the potential conflict between a government’s duty to protect children and a parent’ right to raise children in a manner they see fit. Using philosophical, bioethical, and legal analysis, the author engages with key scholars in pediatric decision-making and individual and religious rights theory. Going beyond the parent-child dyad, the author is deeply concerned both with the inteests of the broader society and with the appropriate limits of government interference in the private (...) sphere. The text offers a balance of individual and population interests, maximizing liberty but safeguarding against harm. Bioethics and law professors will therefore be able to use this text for both a foundational overview as well as specific, subject-level analysis. Clinicians such as pediatricians and gynecologists, as well as policy-makers can use this text to achieve balance between these often competing claims. The book is written by a physician with practical and theoretical knowledge of the subject, and deep sympathy for the parental and family perspectives. As such, the book proposes a new way of evaluating parental and state interventions in children's’ healthcare: a refreshing approach and a useful addition to the literature. (shrink)

S. Matthew Liao argues here that children have a right to be loved. To do so he investigates questions such as whether children are rightholders; what grounds a child's right to beloved; whether love is an appropriate object of a right; and other philosophical and practical issues. His proposal is that all human beings have rights to the fundamental conditions for pursuing a good life; therefore, as human beings, children have human rights to the fundamental conditions for pursuing (...) a good life. Since being loved is one of those fundamental conditions, children thus have a right to be loved. Liao shows that this claim need not be merely empty rhetoric, and that the arguments for this right can hang together as a coherent whole. This is the first book to make a sustained philosophical case for the right of children to be loved. It makes a unique contribution to the fast-growing literature on family ethics, in particular, on children's rights and parental rights and responsibilities, and to the emerging field of the philosophy of human rights. (shrink)

: Events surrounding the September 11 terrorist attacks on the United States raise compelling moral questions about the effects of war and globalization on children in many parts of the world. This paper adopts Sartre's notion of freedom, particularly its connection with materiality and intersubjectivity, to assess the moral responsibility that we have as a global community toward our most vulnerable members. We conclude by examining important first steps that should be taken to address the plight of children.

A number of international organizations have claimed that children have a right to be loved, but there is a worry that this claim may just be an empty rhetoric. In this paper, I seek to show that there could be such a right by providing a justification for this right in terms of human rights, by demonstrating that love can be an appropriate object of a duty, and by proposing that biological parents should normally be made the primary bearers (...) of this duty, while all other able persons in appropriate circumstances have the associate duties to help biological parents discharge their duties. I also consider some policy implications of this right. (shrink)

With more than a year to reflect on the accomplishments of the Symposium on “The Interface of Child Rights and Pediatric Bioethics in the Clinical Setting,” what remains is to synthesize what we have learned as a framework for further inquiry into the intersection of pediatric bioethics and children’s rights. Considered individually, the articles in this issue of Perspectives in Biology and Medicine present a kaleidoscope of seemingly disparate perspectives. However, viewed as a collective work, this issue provides (...) a balance of tonality and nuance and point and counterpoint with respect to the integration of ethics and rights—and we hope, as Jeffrey Brosco suggests, that “intelligent disagreement can produce.. (shrink)

Our goal in producing this special issue is to encourage our colleagues to incorporate topics related to LGBT populations into bioethics curricula and scholarship. Bioethics has only rarely examined the ways in which law and medicine have defined, regulated, and often oppressed sexual minorities. This is an error on the part of bioethics. Medicine and law have served in the past as society's enforcement arm toward sexual minorities, in ways that robbed many people of their dignity. We feel that bioethics (...) has an obligation to discuss that history and to help us as a society take responsibility for it.We can address only a small number of topics in this special issue of the Hastings Center Report, and we selected topics we believe will stimulate discourse. Andrew Solomon offers an elegant overview of the challenges that bioethics faces in articulating a solid basis for LGBT rights. Timothy F. Murphy asks whether bioethics still faces issues related to lesbian, gay, and bisexual people, given the deletion of homosexuality as a disease and the progress toward same‐sex marriage. Jamie Lindemann Nelson's essay addresses the search for identity for transgender persons and the role of science in that search. Two articles, those by Brendan S. Abel and by Jack Drescher and Jack Pula, take up the complex issue of medical treatment for children who reject their assigned birth gender. Celia B. Fisher and Brian Mustanski address the special challenges of engaging LGBT youth in research, balancing the need for better information about this vulnerable group against the existing restrictions on research involving children. Tia Powell and Edward Stein consider the merits of legal bans on psychotherapies intended to change sexual orientation, particularly in the light of current research on orientation. Mary Beth Foglia and Karen I. Fredricksen‐Goldsen highlight health disparities and resilience among LGBT older adults and then discuss the role of nonconscious bias in perpetuating disparities. Stephan Davis and Nancy Berlinger assess the challenges of access to care and health policy for transgender persons. Edward J. Callahan et al. tackle the ways in which diverse aspects of medicine should change to better incorporate the needs of LGBT patients, including through use of the electronic medical record, education of health professionals, and recruitment efforts for LGBT health professionals. Virginia Ashby Sharpe and Uchenna S. Uchendu describe multifaceted efforts within Veterans Administration facilities to create change for LGBT veterans across the largest integrated health care network in the United States. Lance Wahlert and Autumn Fiester find a mixed record in the use of case studies in teaching about LGBT issues. (shrink)

Children are young human beings. Some children are very young human beings. As human beings children evidently have a certain moral status. There are things that should not be done to them for the simple reason that they are human. At the same time children are different from adult human beings and it seems reasonable to think that there are things children may not do that adults are permitted to do. In the majority of jurisdictions, for instance, children are not (...) allowed to vote, to marry, to buy alcohol, to have sex, or to engage in paid employment. What makes children a special case for philosophical consideration is this combination of their humanity and their youth, or, more exactly, what is thought to be associated with their youth. One very obvious way in which the question of what children are entitled to do or to be or to have is raised is by asking, Do children have rights? If so, do they have all the rights that adults have and do they have rights that adults do not have? If they do not have rights how do we ensure that they are treated in the morally right way? Most jurisdictions accord children legal rights. Most countries—though not the United States of America—have ratified the United Nations Convention on the Rights of the Child which was first adopted in 1989. The Convention accords to children a wide range of rights including, most centrally, the right to have their ‘best interests’ be ‘a primary consideration’ in all actions concerning them, the ‘inherent right to life’, and the right of a child “who is capable of forming his or her own views … to express these views freely in all matters affecting the child”. However it is normal to distinguish between ‘positive’ rights, those that are recognised in law, and ‘moral’ rights, those that are recognised by some moral. (shrink)

Should significant enhancement of human capacities using genetic technologies become possible, each generation will have an unprecedented power over the next. I argue that it is implausible to leave decisions about the genetic traits of children entirely up to individuals and that communities will sometimes be justified in intervening to protect the interests of children against their parents. While a number of influential authors have suggested that the primary interest that the community should aim to protect is the child’s right (...) to “an open future”, when we examine closely what we desire for our children, it is clear that sometimes we have good reasons to try to restrict their opportunities to pursue dangerous, corrupting, or meaningless projects. Rather than maximise the openness of their future, then, we should strive to ensure that children have access to sufficient opportunities to make available a reasonable range of valuable life-choices. Importantly, both the assessment of what counts as a reasonable range and our judgements about which forms of life are valuable must inevitably make reference to substantive notions about the nature of human flourishing. A more appropriate formulation, then, of what should be protected by law and/or regulation, is the child’s right to a “decent future”, understood as a future which promises a reasonable range of opportunities to lead a life of human flourishing. I then proceed to highlight the challenge posed by the task of settling upon an idea of what counts as a decent future, for multicultural societies wherein ideas about the standards against which we should evaluate human flourishing are likely to be highly contested. (shrink)

Children’s Rights and Moral Parenting offers systematic treatment of a variety of issues involving the intersection of the rights of children and the moral responsibility of parents.

Can appealing to children’s rights help to solve the non-identity problem in cases of procreation? A number of philosophers have answered affirmatively, arguing that even if children cannot be harmed by being born into disadvantaged conditions, they may nevertheless be wronged if those conditions fail to meet a minimal standard of decency to which all children are putatively entitled. This paper defends the tenability of this view by outlining and responding to five prominent objections that have been raised against (...) it in the contemporary literature: the identifiability objection; the non-existence objection; the waiving of rights objection, the lack of legitimate complaint objection; and the unfairness objection. (shrink)

Liberals who want to support multiculturalism need to be able to justify the parental authority to instill cultural value systems or worldviews into children. However, such authority may be at odds with liberal demands that citizens be autonomous. This paper argues that parents do not have the legitimate authority to instill in their children a specific value system, contrary to the complex and intriguing arguments of Robert Noggle (2002). Noggle’s argument, which draws heavily on key ideas in Rawls’ theory of (...) justice, is that children are not moral agents and that parents are in a special kind of fiduciary relationship vis-à-vis their children. Noggle’s position is contrasted with the more limited conception of parental authority advanced by David Archard (2002). I argue that we can accept that parents are agents of their children, but contra Noggle, this does not entitle them to impose their parochial value systems onto their children. I argue that while children have an interest in acquiring values, they do not have an interest in acquiring a value system. (shrink)

This chapter contains sections titled: Basic Principles Concerning Rights Against Parents' Rights Against State or Citizen Rights Formal Characteristics of Children's Rights Conclusion.

Letter in reply to previous article on children's rights.

Volume 19, Issue 6, June 2019, Page W10-W15.

Worldwide, many impoverished parents migrate, leaving their children behind. As a result children are deprived of continuity in care and, sometimes, suffer from other forms of emotional and developmental harms. I explain why coercive responses to care drain are illegitimate and likely to be inefficient. Poor parents have a moral right to migrate without their children and restricting their migration would violate the human right to freedom of movement and create a new form of gender injustice. I propose and defend (...) an institutional solution. Taxes levied on the remittances sent by temporary migrants ought to be used to provide migrants' children with psychological counselling in order to mitigate the harm resulted from discontinuity in care. (shrink)

Originally published in 1981, this book provides a detailed account of the emergence of the children's rights movement, and analyses the concept of a right. It considers the justifications which may be sought when rights are claimed. Particular attention is given to the problem which arises when different rights are seen to be in conflict with each other or with other kinds of moral consideration. These arguments are then examined with regard to such special features of (...) children as their incomplete but developing rationality and their material dependence on adults. (shrink)

Margaret Mohrmann, Paul Lauritzen, and Sumner Twiss raise questions about my account of basic interests, liberal theory, and the challenges of multiculturalism as developed in "Children, Ethics, and Modern Medicine." Their questions point to foundational issues regarding the justification and limitation of parental authority to make decisions on behalf of children in medical and other contexts. One of the central questions in that regard is whether adults' decisions deserve to be respected, especially when they seem contrary to a child's or (...) adolescent's basic interests. Questions about respect, in turn, focus attention on others' decisions about what seems good for families and children, decisions that may be paternalistic or utilitarian. Such decisions are further complicated by a child's or adolescent's budding autonomy and need for respect and recognition. Pediatric bioethics grounded in an account of a child's basic interests produces a theory of negative and positive rights for assessing adults' actions in relation to children, especially (but not only) when adults demand respect in their expressions of care. (shrink)

Transgender children who are not treated for their condition are at high risk of violence and suicide. As a matter of survival, many are willing to take whatever help is available, even if this is offered by illegal sources, and this often traps them into the juvenile criminal system and exposes them to various threats. Endocrinology offers a revolutionary instrument to help children /adolescents with gender identity disorder: suspension of puberty. Suspension of puberty raises many ethical issues, and experts dissent (...) as to when treatment should be commenced and how children should be followed up. This paper argues that suspension of puberty is not only not unethical: if it is likely to improve the child’s quality of life and even save his or her life, then it is indeed unethical to defer treatment. (shrink)