What are mental states? When we talk about people’s beliefs or desires, are we talking about what is happening inside their heads? If so, might cognitive science show that we are wrong? Might it turn out that mental states do not exist? Mental fictionalism offers a new approach to these longstanding questions about the mind. Its core idea is that mental states are useful fictions. When we talk about mental states, we are not formulating hypotheses about people’s inner machinery. Instead, (...) we simply talk "as if" people had certain inner states, such as beliefs or desires, in order to make sense of their behaviour. This is the first book dedicated to exploring mental fictionalism. Featuring contributions from established authors as well as up-and-coming scholars in this burgeoning field, the book reveals the exciting potential of a fictionalist approach to the mind, as well as the challenges it faces. In doing so, it offers a fresh perspective on foundational debates in the philosophy of mind, such as the nature of mental states and folk psychology, as well as hot topics in the field, such as embodied cognition and mental representation. Mental Fictionalism: Philosophical Explorations essential reading for advanced undergraduates, postgraduates and professionals alike. (shrink)

_Self-Reflection for the Opaque Mind_ attempts to solve a grave problem about critical self-reflection. Psychological studies indicate not just that we are bad at detecting our own "ego-threatening" thoughts; they also suggest that we are ignorant of even our ordinary thoughts. However, self-reflection presupposes an ability to know one’s own thoughts. So if ignorance is the norm, why attempt self-reflection? While admitting the psychological data, this book argues that we are infallible in a limited range of self-discerning judgments—that in some (...) cases, these judgments are self-fulfilling or self-verifying. Even so, infallibility does not imply indubitability, and the author does not wish to provide a "foundation" for empirical knowledge. The point is rather to explain how self-reflection as a rational activity is possible. The book will be of interest to scholars working on the issue of self-reflection across a wide range of disciplines, including philosophy, psychology, and cognitive science. (shrink)

In “Does Controlled Donation after Circulatory Death Violate the Dead Donor Rule?” the authors maintain that compliance with the dead donor rule (DDR) does not require a valid determination of deat...

È questa la prima raccolta completa dei frammenti relativi a questo autore, comprendente anche testimonianze biografiche che precedentemente non erano state prese in considerazione. This is the first comprehensive collection of fragments related to this author, including biographical accounts that had not previously been considered.

Several authors have argued that, assuming we have apriori knowledge of our own thought-contents, semantic externalism implies that we can know apriori contingent facts about the empirical world. After presenting the argument, I shall respond by resisting the premise that an externalist can know apriori: If s/he has the concept water, then water exists. In particular, Boghossian's Dry Earth example suggests that such thought-experiments do not provide such apriori knowledge. Boghossian himself rejects the Dry Earth experiment, however, since it would (...) imply that externalism is true of empty concepts as well as non-empty concepts. Yet in this paper I respond by defending empty-concept externalism, from criticisms suggested by Boghossian and Brown, and recently developed further by Besson. My contention is that an externalist can give a non-ad hoc descriptivist account of empty concepts. Accordingly, apriori self-knowledge does not enable an externalist to know contingent features of the external world. (shrink)

Oppenheimer & Zalta have re-formulated their non-modal version of the ontological argument, with the help of PROVER9, an automated reasoning engine. The authors end up rejecting the new argument; however, the theist has a rejoinder worth considering. But after presenting the rejoinder, I highlight that the conceivability of the being does not imply its possibility. One lesson is that even non-modal ontological arguments must engage modal matters concerning God. Another lesson is that if PROVER9 is able to derive a conclusion (...) from fewer premises, the proof is sometimes inferior as an argument. (shrink)

ITALIAN: Vivere con onore la missione di pensare come El viviente luminoso y brutal , del filosofo Ibn tufayl, è il principio incarnato nelle idee di Ortega che ispira Rosa Chacel a vantaggio dell’autenticità della vita intellettuale. ella vive la passione meditativa del suo maestro come un aspetto peculiare del suo modo di essere: una funzione vitale che illumina il cammino grazie all’autorità di una personalità forte e carismatica. Pertanto Ortega è definito luminoso e brutale , volendo legare queste due (...) qualità con la congiunzione “e” per dare risalto all’antitesi racchiusa nella ricerca della verità esistenziale dell’uomo. ENGLISH: Living with honor the mission of thinking how El viviente luminoso y brutal, of the philosopher Ibn tufayl, is the principle embodied in the ideas of Ortega which inspires Rosa Chacel benefitting the authenticity of the intellectual life. She lives the meditative passion of his teacher as a specific aspect of her way of being: a vital function that illuminates the way through the authority of a strong and charismatic personality. therefore Ortega is defined bright and brutal, tying these two qualities with the conjunction “and” in order to emphasize the antithesis contained in the human search for existential truth. (shrink)

To most people outside the relevant laboratories and operating rooms, xenotransplants and artificial organ transplants are bizarre. While the bizarre scares many away and angers others, Lesley A. Sharp approached it and asked, What behooves medical research to take organs out of pigs and primates and design organs out of metal and plastic and use them to replace failing organs in humans? Sharp attended years of conferences, visited countless hospitals and laboratories, and interviewed engineers, scientists, and surgeons to explore the (...) choices and implicit values of decision‐makers in alternative transplantation. The Transplant Imaginary: Mechanical Hearts, Animal Parts, and Moral Thinking in Highly Experimental Science is a rich resource for philosophers who wish to expound on the morality of implanting nonhuman animal and mechanical organs into humans. The author's thorough ethnographic survey of xeno‐ and biomechanical transplant research leads well into two lines of questioning. First, how ethical is the pursuit of alternative transplant? Second, what is essential for transplant researchers to do their jobs ethically? (shrink)

In this seminal work, acclaimed philosopher Bernhard Waldenfels deals with the problem of the nature of order after the “shattering of the world,” and the loss of the idea of a universal or fundamental order._ _ Order in the Twilight__ unites phenomenological methodology with recent work on the theory of order, normativity, and dialogue, as well as structuralism and Gestalt theory. Philosophically stringent, it expresses a more optimistic attitude than much modern philosophy, especially deconstruction._ Waldenfels passes the question of order (...) through numerous defining aspects, and concludes that there is not one global order, but rather various conflicting domains of order. Whenever the boundary of a vital or experiential domain is crossed, a discourse speaks at the boundary, not about it, and across a threshold without abolishing it. The rest is rationalization, i.e., an attempt to find a place in the respective order for what is to-be-ordered. But why, the author concludes, should a theory be more unambiguous than reality? _ Order in the Twilight__ is an important book at this time, because it may help lift the humanities out of the skeptical, relativistic disarray in which they have been embroiled in recent decades. Waldenfels does not attempt to dictate what reality should be; rather, he is open to any valid evidences. His book offers a solid footing to the human and social sciences as they seek to escape from deconstructive irrationalism. (shrink)

This study investigated the modus operandi strategies employed by 120 coaches who committed sexual abuse toward 331 athletes under their authority. More than 2,000 Canadian court judgements and media reports were identified using online search databases. Using descriptive analysis, 51 strategies used in six modus operandi stages were identified. Results highlighted the most frequent strategies used by coaches for each stage of the crime commission process. Additionally, findings revealed the influence of the victims' gender, coaches' sport level and year (...) of coaches' first offenses on modus operandi strategies used. Implications for crime prevention measures are discussed. (shrink)

The translational research community, in general, and the Clinical and Translational Science Awards (CTSA) community, in particular, share the vision of repurposing EHRs for research that will improve the quality of clinical practice. Many members of these communities are also aware that electronic health records (EHRs) suffer limitations of data becoming poorly structured, biased, and unusable out of original context. This creates obstacles to the continuity of care, utility, quality improvement, and translational research. Analogous limitations to sharing objective data in (...) other areas of the natural sciences have been successfully overcome by developing and using common ontologies. This White Paper presents the authors’ rationale for the use of ontologies with computable semantics for the improvement of clinical data quality and EHR usability formulated for researchers with a stake in clinical and translational science and who are advocates for the use of information technology in medicine but at the same time are concerned by current major shortfalls. This White Paper outlines pitfalls, opportunities, and solutions and recommends increased investment in research and development of ontologies with computable semantics for a new generation of EHRs. (shrink)

In this paper, I offer a view beyond that which would narrowly reduce the role of parents in medical decision making to acting as custodians of the best interests of children and toward an account of family authority and family autonomy. As a fundamental social unit, the good of the family is usually appreciated, at least in part, in terms of its ability successfully to instantiate its core moral and cultural understandings as well as to pass on such commitments (...) to future generations. The putative rights of children to expression, information, freedom of thought, conscience, religion, and to freedom of association with others are, in this essay, assessed from the perspective of those conditions necessary for the family to function as a moral community. In so doing, I respond to the move to liberate children from parental authority and to effect the transformation of the family as implied by the United Nations’ "Convention on the Rights of the Child" and the pediatric bioethics it supports. (shrink)

The debate over the genetic testing of minors has developed into a major bioethical topic. Although several controversial questions remain unanswered, a degree of consensus has been reached regarding the policies on genetic testing of minors. Recently, several commentators have suggested that these policies are overly restrictive, too narrow in focus, and even in conflict with the limited empirical evidence that exists on this issue. We respond to these arguments in this paper, by first offering a clarification of three key (...) concepts—autonomy of the minor, future autonomy, and parental authority—which must be disentangled. We then respond to the arguments by noting the uncertainty of the value of predictive genetic information, and by assessing the psychosocial risks still involved in genetic testing of minors, which are also largely unknown. We conclude that the current consensus position is justified at this stage, in light of the predictions of harm resulting from genetic testing of minors that have not been adequately proved to be unwarranted. (shrink)

There is an increased focus on, and evidence of, children's capability to both understand and make decisions about issues relating to participation in medical research. At the same time there are divergent ideas of when, how and to what extent children should be allowed to decide for themselves. Furthermore, little is known about parents' views on these matters, an important issue since they often provide the formal consent. In this questionnaire study of 2500 families in south-east Sweden (with and without (...) research experience) we explored parents' views on issues relating to information, consent and research data. We found that parents are generally positive about supplying their child with individual information (93.3%; median age 7) and assuring the child's consent/assent to participation (74.3%; median age 12). However, parents' views vary regarding the extent to which children should influence research data: as many as 47–61% of our sample were opposed to children's rights to decide about the use and storage of biological samples and natural history data. Parents who are opposed to child consent and a wider influence on their research participation argue that parental authority and research quality are two important factors opposing enhanced child influence. Drawing on this, we underline the need to discuss how to balance children's rights against parental autonomy and research interests before implementing any standardized protocols granting children the right to consent and revoke data in long-term research. (shrink)

There is an increased focus on, and evidence of, children's capability to both understand and make decisions about issues relating to participation in medical research. At the same time there are divergent ideas of when, how and to what extent children should be allowed to decide for themselves. Furthermore, little is known about parents' views on these matters, an important issue since they often provide the formal consent. In this questionnaire study of 2500 families in south-east Sweden we explored parents' (...) views on issues relating to information, consent and research data. We found that parents are generally positive about supplying their child with individual information and assuring the child's consent/assent to participation. However, parents' views vary regarding the extent to which children should influence research data: as many as 47–61% of our sample were opposed to children's rights to decide about the use and storage of biological samples and natural history data. Parents who are opposed to child consent and a wider influence on their research participation argue that parental authority and research quality are two important factors opposing enhanced child influence. Drawing on this, we underline the need to discuss how to balance children's rights against parental autonomy and research interests before implementing any standardized protocols granting children the right to consent and revoke data in long-term research. (shrink)

A recent judgment by a lower court in Germany brought the problem of ritual male circumcision to the consciousness of the wider public and legal academia. This essay weighs in on this emerging discussion and argues that ritual male circumcision is not covered by parental authority. It first considers and dismisses the best interest of the child test, which is the most widely used test of parental authority in legal practice. Instead, the essay proposes what it (...) terms the autonomy conception of parental authority, according to which parental authority must be exercised such as to ensure that the child will become an autonomous adult. While parents may raise their child in line with their ethical, including religious, convictions, respect for his autonomy requires that this be done in a way that allows the child to later distance himself from these values; this implies, among other things, that irreversible physical changes are impermissible. (shrink)

In the recently published collection, Criminal Law and the Authority of the State, two contributions allude to an analogy with parental authority as a means to a better understanding of the institution of criminal punishment, but reach different conclusions. Malcolm Thorburn uses the parental authority analogy to justify the institution of state punishment as an assertion of robust authority over offenders. Antje du Bois-Pedain uses the same analogy to advocate the idea of punishment as (...) an inclusionary practice, designed to reintegrate offenders into society. I argue that Thorburn’s theory of robust authority is inconsistent if not self-contradictory when it tries to assume a liberal posture, and that du Bois-Pedain’s reintegrative model provides a better account of the justification and objectives of state punishment. (shrink)

This book offers a novel theory of childhood well-being as a social good. It re-examines our fundamental assumptions about parenting, parental authority, and a liberal society's role in the raising of children. The author defends the idea that the good of a child is inexorably linked to the good of society. He identifies and critiques the problematic assumption that parenting is an extension of individual liberty and shows how we run into problems in medical decision-making for children because (...) of this assumption. He develops an objective conception of what is good for a child in liberal society, drawing on the assumptions of liberty, and from here constructs a set of things that society and its members owe children. There are ways in which society should support and intervene in parental decisions to guarantee a child's well-being. Ultimately, raising children is a social activity that requires input from society. The author then applies this theory of childhood well-being to develop a framework for medical decision-making for children. He also uses practical examples, such as vaccinations, parental leave, and healthcare access, to demonstrate the implications of his theory for public policy. The Limits of Parental Authority: Childhood Wellbeing as a Social Good will be of interest to research and advanced students working in bioethics, political philosophy, and public health policy. (shrink)

This book examines recent attempts by liberal theorists to defend parental authority and the paradoxes that it poses. Dennis Arjo explores various topics within the philosophy of parenting such as education, discipline, and the right of parents to teach their own religious beliefs to their children.

The question of parental authority has been the focus of social interest for a long time. However, in recent times, it has gained greater attention from the public. Due to the opacity concerning the concept’s nature, the goal of this article is to establish detailed and profound conceptualization for the construct of parental authority while relying on relevant theoretical and empirical literature. An analysis of the concept has shown that it is a bi-dimensional theoretical construct, with (...) its dimensions sharing four main aspects: parental power: parental demandingness, and parental potential influence on the child’s behaviour, legitimate parental authority: the parent’s right to demand, and the child’s obligation to obey. Parental authority is expressed in parent-child conflicts, while its extent varies according to the child’s age and to the specific context in which it appears. (shrink)

When mature minors face a decision with important consequences, such as whether to undergo a risky but potentially life-saving medical procedure, who should decide? Relying on liberal political theory’s account of the importance of decisional autonomy for adults, and given the scalar nature of the capacities needed to exercise decisional autonomy, I argue that mature minors with the requisite capacities and commitments have a right to decisional autonomy though they are not yet 18. I argue for this right using a (...) ‘balancing of interest’ account of rights: the interest mature minors have in decisional autonomy outweighs their parents’ interest in shaping their children as a means of ‘creative self-extension’. But I propose two limitations on this right: requests for waivers of the rule that one must be at least 18 to decide cannot be so numerous as to make adjudication impractical; and though a competent adult’s voluntary decision to refuse medical treatment should generally be respected, the state may reject a mature minor’s decision upon review by an indifferent judge of the minor’s capacities and reasons. The judge reviews not the substantive merits or prudence of the decision, but whether the decision promotes the interest in decisional autonomy, by asking among other things whether the decision is the minor’s own, is tethered to core commitments rather than based on arbitrary preferences, and could be regarded as reasonable to the minor’s ‘future self’. (shrink)

Cognitive incompetence cannot adequately explain the special character of children's moral status. It is, in fact, because children lack preference structures that are sufficiently stable over time that they are not ’temporally extended agents’. They are best viewed as 'special agents’, and parents have the responsibility of fostering the development of temporally extended agency and other necessary related moral capacities. Parental authority should be exercised with the view to assisting children to acquire the capacities that facilitate their transition (...) from 'special agents’ to full and functioning members of the moral community. (shrink)

John Locke occupies a central place in the contemporary philosophical literature on parental authority, and his child-centered approach has inspired a number of recognizably Lockean theories of parenthood.2 But unlike the best historically informed scholarship on other aspects of Locke's thought, those interested in his account of parental rights have not yet tried to understand its connection to debates of the period or to Locke's broader theory of natural law. In particular, Locke's relation to the seventeenth-century conversation (...) about the role of generation in grounding 'paternal power' is not well-known. Understanding this background is interesting in itself, but more importantly, it can provide us with a .. (shrink)

Like any philosophically interesting health care practice, ethical analysis of Pre-implantation Genetic Diagnosis has produced a wide range of moral positions. For example, one might contrast David King's view that warns PGD should be strictly limited and regulated because it will soon result in the expansion of a troubling "laissez-faire eugenics" with Julian Savulescu's argument for the "principle of procreative beneficence" morally requiring parents to use information attained through PGD to select the "best child". That is, these authors represent two (...) poles of a sort of moral spectrum regarding PGD. At one end, we have a deep suspicion of the technology as directly leading to... (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 case analysis examines the pediatric clinical ethics issues of adolescent autonomy and parental authority in medical decision–making. The case involves a dying adolescent whose parents request that the medical team withhold diagnosis and prognosis information from the patient. The analysis engages two related ethical questions: Should Annie be given information about her medical condition? And, who is the proper decision–maker in Annie’s case? Ultimately, four practical recommendations are offered.

This paper discusses the use of deep brain stimulation for the treatment of neurological and psychiatric disorders in children. At present, deep brain stimulation is used to treat movement disorders in children and a few cases of deep brain stimulation for psychiatric disorders in adolescents have been reported. Ethical guidelines on the use of deep brain stimulation in children are therefore urgently needed. This paper focuses on the decision-making process, and provides an ethical framework for (future) treatment decisions in pediatric (...) deep brain stimulation. I defend a shared decision-making model in case of deep brain stimulation for neurological and psychiatric disorders in children. To protect the vulnerable child patient, a dual consent process is needed where parents or parental guardians give their consent, and the child gives his/her assent. (shrink)

Bioethics, Volume 36, Issue 7, Page 809-811, September 2022.

The parents of Charlie Gard, who was born August 4, 2016, with an exceedingly rare and incurable disease called mitochondrial DNA depletion syndrome, fought a prolonged and heated legal battle to allow him access to experimental treatment that they hoped would prolong his life and to prevent his doctors from withdrawing life-sustaining care. Charlie's clinicians at the Great Ormond Street Hospital in London believed that the brain damage Charlie had suffered as a result of frequent epileptic seizures, along with many (...) other severe disabilities, would render any innovative therapy futile, and they disagreed with his parents’ wishes to use an experimental therapy. They felt it in Charlie's best interest that he be allowed to die. A battle ensued among Charlie's parents, his doctors, and a guardian who had been appointed to represent him that drew the attention of politicians and prominent persons from all over the world. The case was much in the news over the past year, but it has also been frequently misunderstood. (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)

Rob Reich’s claim that fruitful discussions about the balance among state, parental, and children’s educational interests would benefit by contemplating the widespread phenomenon of homeschooling is a welcome suggestion. His policy recommendations, however, place an unjustified burden on parents to show the adequacy of homeschooling arrangements instead of placing the burden on the state to clarify commonly agreed‐upon outcome measures. In this essay, Perry Glanzer argues that Reich places the burden on parents by overstating the threat that the freedom (...) given to homeschooling parents represents to the interests of liberal democratic states and children. Reich, Glanzer contends, also underestimates the state’s tendency to use regulation to weaken the civil society essential for liberal democracy. To counter Reich’s proposal, Glanzer offers recommendations regarding the proper limits of parental authority in education in general and in the case of homeschooling in particular. (shrink)

Journal of Applied Philosophy, EarlyView.

Making a career decision is one of the most complex development tasks faced by high school students who will graduate from school. Students need to believe that they would succeed in their effort to do the necessary tasks during the process of career decision-making. This belief is referred to as a career decision self-efficacy. This study examined the influence of parenting style on career decision self-efficacy through the mediation of proactive personality in senior high school students. A total of 949 (...) participants were involved in this study. Data were collected using Career Decision Self-Efficacy Scale-Short Form, Parental Authority Questionnaire, and Proactive Personality Scale. Data were analyzed using the regression technique with the Macro Process from Hayes. The regression results show that fathers’ and mothers’ authoritative parenting directly affect career decision self-efficacy; fathers’ and mothers’ authoritarian parenting, as well as mother's permissive parenting, affect the career decision self-efficacy only through the mediation of proactive personality. Also, fathers’ permissive parenting did not have a significant effect on career decisions self-efficacy either directly or indirectly through a proactive personality. Therefore parents – both father and mother – need to involve in developing career decision self-efficacy of their children through parenting process, especially authoritative parenting. (shrink)

The public often believes that parents have a right to make medical decisions about their child. The idea that, in respect of children, doctors should do what parents tell them to do is problematic on the face of it. The effect of such a claim would be that a doctor who acted deliberately to harm a child would be making a morally correct decision, providing only that it is what the child’s parents said they wanted. That is so obviously nonsense (...) that it cannot be what people who claim it actually mean. In this paper, I suggest that the claim actually represents either or both of two misunderstandings. It can be a result of wrongly appealing to the principle of respect for autonomy, or a belief that doctors are not committed to acting in the interests of the child. In this paper, I show that, while neither belief is entirely justified, there are elements of truth in both. I argue that if ethically correct decisions are those that are directed to improving the quality of a child’s existence, then neither parents nor doctors are in a position to make ethically correct decisions about a child except in discussion with one another. Where such discussion is not possible, I suggest there should be a national Children’s Interests Panel to agree on the child’s interests. The panel should include, but not be limited to, paediatricians and lawyers and its decisions should be legally binding on all parties. (shrink)

This paper reports two cases in Hong Kong involving two native Chinese adolescent cancer patients (APs) who were denied their rights to consent to necessary treatments refused by their parents, resulting in serious harm. We argue that the dynamics of the ‘AP‐physician‐family‐relationship’ and the dominant role Chinese families play in medical decision‐making (MDM) are best understood in terms of the tendency to hierarchy and parental authoritarianism in traditional Confucianism. This ethic has been confirmed and endorsed by various Chinese writers (...) from Mainland China and Hong Kong. Rather than giving an unqualified endorsement to this ethic, based more on cultural sentimentalism than rational moral reasoning, we warn that a strong familism in MDM, which deprives ‘weak’ family members of rights, represents the less desirable elements of this tradition, against which healthcare professionals working in this cultural milieu need to safeguard. Specifically for APs, we suggest that parental authority and family integrity should be re‐interpreted in terms of parental responsibility and the enhancement of children's interests respectively, as done in the West. This implies that when parents refuse to consent to necessary treatment and deny their adolescent children's right to consent, doctors, as the only remaining advocates of the APs' interest, have the duty to inform the state, which can override parental refusal to enable the doctors to fulfill their professional and moral obligations. In so doing the state exercises its ‘parens patriae’ power to defend the defenseless in society and the integrity of the medical profession. (shrink)

Minors are generally considered incompetent to provide legally binding decisions regarding their health care, and parents or guardians are empowered to make those decisions on their behalf. Parental authority is not absolute, however, and when a parent acts contrary to the best interests of a child, the state may intervene. The best interests standard is the threshold most frequently employed in challenging a parent''s refusal to provide consent for a child''s medical care. In this paper, I will argue (...) that the best interest standard provides insufficient guidance for decision-making regarding children and does not reflect the actual standard used by medical providers and courts. Rather, I will suggest that the Harm Principle provides a more appropriate threshold for state intervention than the Best Interest standard. Finally, I will suggest a series of criteria that can be used in deciding whether the state should intervene in a parent''s decision to refuse medical care on behalf of a child. (shrink)

This paper reports two cases in Hong Kong involving two native Chinese adolescent cancer patients (APs) who were denied their rights to consent to necessary treatments refused by their parents, resulting in serious harm. We argue that the dynamics of the 'AP-physician-family-relationship' and the dominant role Chinese families play in medical decision-making (MDM) are best understood in terms of the tendency to hierarchy and parental authoritarianism in traditional Confucianism. This ethic has been confirmed and endorsed by various Chinese writers (...) from Mainland China and Hong Kong. Rather than giving an unqualified endorsement to this ethic, based more on cultural sentimentalism than rational moral reasoning, we warn that a strong familism in MDM, which deprives 'weak' family members of rights, represents the less desirable elements of this tradition, against which healthcare professionals working in this cultural milieu need to safeguard. Specifically for APs, we suggest that parental authority and family integrity should be re-interpreted in terms of parental responsibility and the enhancement of children's interests respectively, as done in the West. This implies that when parents refuse to consent to necessary treatment and deny their adolescent children's right to consent, doctors, as the only remaining advocates of the APs' interest, have the duty to inform the state, which can override parental refusal to enable the doctors to fulfill their professional and moral obligations. In so doing the state exercises its 'parens patriae' power to defend the defenseless in society and the integrity of the medical profession. (shrink)

I examine how co-parents should handle differing commitments about how to raise their child. Via thought experiment and the examination of our practices and affective reactions, I argue for a thesis about the locus of parental authority: that parental authority is invested in full in each individual parent, meaning that that the command of one parent is sufficient to bind the child to act in obedience. If this full-authority thesis is true, then for co-parents to (...) command different things would be for them to contest one another’s authority. The only course that respects the authority of both parents is for co-parents to agree to command the same thing. Further, what is commanded must not result from a ‘capitulation’ by one co-parent, rather, it should result from a compromise. Parental authority involves a duty to deliberate about which commands it is best to give the child. If a command results from a capitulation, one parent will rightly think of themselves as not having fulfilled their parental duty. Parental compromises are not best understood as bargains or conflicts, but by the metaphor of gifts given by each parent out of respect for the other’s authority. (shrink)

This paper argues that liberal tenats that justify intervention to promote the welfare of an incompetent do not suffice as a basis for analyzing parent-child relationships, and that this inadequacy is the basis for many of the problems that arise when thinking about the state's role in resolving family conflicts, particularly when monitoring parental discretion in medical decision-making on behalf of a child. The state may be limited by the best interest criterion when dealing with children, but parents are (...) not. The state's relation with the child is formal while the parental relation is intimate, having its own goals and purposes. While the liberal canons insist on the incompetent one's best interest, parents are permitted to compromise the child's interests for ends related to these familial goals and purposes. Parents decisions should be supervened, in general, only if it can be shown that no responsible mode of thinking warrants such treatment of a child. Keywords: proxy medical consent, children's rights, state's protection of children, parental authority and the state's intervention, paternalism, liberalism, parental values CiteULike Connotea Del.icio.us What's this? (shrink)

The ethical issues around decision making on behalf of infants have been illuminated by two empirical research studies carried out in Scotland. In-depth interviews with 176 medical and nursing staff and with 108 parents of babies for whom there was discussion of treatment withholding/withdrawal, generated a wealth of data on both the decision making process and the management of cases. Both staff and parents believe that parents should be involved in treatment limitation decisions on behalf of their babies. However, whilst (...) many doctors and nurses consider the ultimate responsibility too great for families to carry, the majority of parents wish to be the final arbiters. We offer explanations for the differences in perception found in the two groups. The results of these empirical studies provide both aids to ethical reflection and guidance for clinicians dealing with these vulnerable families. They demonstrate the value of empirical data in the philosophical debate. (shrink)

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)

This highly original collection of essays, first published in 1989, is concerned with the nature of children and their moral and political status. The international team of contributors explore, and in some cases criticise and revise popular thought on children and their place in society. The book is divided into three parts: the first deals with the historical, social and psychological framework of contemporary perspectives on children and childhood; a second set of papers takes up questions about the position of (...) the young in democracy, the limits of parental authority and the appropriateness of characterising only child-adult relationships in terms of a social contract; the final essays are concerned with adult attitudes toward children's lives and experiences. These essays will interest philosophers, political scientists, as well as all those professionally concerned with the education and care of children. (shrink)

This paper reviews the ethical literature on conflicts between health professionals and parents about medical decision-making for children. We present the results of a systematic review which addressed the question ‘when health professionals and parents disagree about the appropriate course of medical treatment for a child, under what circumstances is the health professional ethically justified in overriding the parents’ wishes?’ We identified nine different ethical frameworks that were put forward by their authors as applicable across various ages and clinical scenarios. (...) Each of these frameworks centred on a different key moral concept including harm, constrained parental autonomy, best interests, medically reasonable alternatives, responsible thinking and rationality. (shrink)

The English cases of Charlie Gard and Alfie Evans involved a conflict between the desires of their parents to preserve their children’s lives and judgments of their medical teams in pursuit of clinically appropriate therapy. The treatment the children required was clearly extraordinary, including a wide array of advanced life-sustaining technological support. The cases exemplify a clash of worldviews rooted in different philosophies of life and medical care. The article highlights the differing perspectives on parental authority in medical (...) care in England, Canada, and the United States. Furthermore, it proposes a solution that accommodates for both reasonable parental desires and professional medical opinion. This is achieved by looking at concepts of extraordinary therapy, best interest, reasonable parenthood and medical objections. (shrink)

Marcus William Hunt argues that when co-parents disagree over whether to raise their child (or children) as a vegan, they should reach a compromise as a gift given by one parent to the other out of respect for his or her authority. Josh Millburn contends that Hunt’s proposal of parental compromise over veganism is unacceptable on the ground that it overlooks respect for animal rights, which bars compromising. However, he contemplates the possibility of parental compromise over ‘unusual (...) eating,’ of animal-based foods obtained without the violation of animal rights. I argue for zero parental compromise, rejecting a rights-oriented approach, and propose a policy that an ethical vegan parent and a non-vegan co-parent should follow to determine how to raise their children. (shrink)