In this essay I shall argue that the state should require all parents to be licensed. My main goal is to demonstrate that the licensing of parents is theoretically desirable, though I shall also argue that a workable and just licensing program actually could be established.

When shared decision making breaks down and parents and medical providers have developed entrenched and conflicting views, ethical frameworks are needed to find a way forward. This article reviews the evolution of thought about the best interest standard and then discusses the advantages of the harm principle and the zone of parental discretion. Applying these frameworks to parental refusals in situations of complexity and uncertainty presents challenges that necessitate concrete substeps to analyze the big picture and identify key questions. (...) I outline and defend a new decision-making tool that includes three parts: identifying the nature of the disagreement, checklists for key elements of the HP and ZPD, and a “think list” of specific questions designed to enhance use of the HP and ZPD in clinical decision making. These tools together will assist those embroiled in complex disagreements to disentangle the issues to find a path to resolution. (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)

Although systems for licensing professionals are far from perfect, and their problems and costs should not be ignored, they are justified as a necessary means of protecting innocent people's vital interests. Licensing defends patients from inept doctors, pharmacists, and physical therapists; it protects clients from unqualified lawyers. We should protect people who are highly vulnerable to those who are supposed to serve them, those with whom they have a special relationship. Requiring professionals to be licensed is the most plausible way (...) of doing that. Given the overwhelming support for the licensing of these professionals, I find it odd that so many people categorically reject proposals to license parents. Although the relationship between a parent and her children is different in some respects, it is also relevantly similar to that between a professional and those she serves. To defend these claims, I show how and why the rationale for licensing parents parallels the rational for licensing professionals. I then ask whether such a program could be justifiably implemented. Finally, I describe and reject what I see as the flawed view of the relationship between parents and their children. (shrink)

In this paper we re-examine Hugh LaFollette's proposal that the state carefully determine the eligibility and suitability of prospective parents before granting them a ?license to parent?. Assuming a prima facie case for licensing parents grounded in our duty to promote the welfare of the child, we offer several considerations that complicate LaFollette's radical proposal. We suggest that LaFollette can only escape these problems by revising his proposal in a way that renders the license effectively obsolete, a route (...) he implicitly adopts in his recent revisiting of the licensing proposal. We conclude that there is little merit in the idea of licensing ?natural? parents as a practical policy proposal, and raise some questions about its continued use in relation to adoptive and foster parents. (shrink)

This book examines the negative power that child maltreatment has on individuals and society ethically and politically, while analyzing the positive power that parental love and healthy families have. To address how best to confront the problem of child maltreatment, it examines several policy options, ultimately defending a policy of licensing parents, while carefully examining the tension between child and adult rights and duties.

Adolescents have increasing discretionary income, expenditures, and purchasing power. Inventory shrinkage costs $123.4 billion globally to retail outlets. Adolescents are disproportionately responsible for theft and shoplifting. Both parents and peers significantly influence adolescents’ monetary values, materialism, and dishonesty as consumers. In this study, we develop a theoretical model involving teenagers’ social attachment and their consumer ethics, treat adolescents’ money attitude in the context of youth materialism as a mediator, and simultaneously examine the direct and indirect paths. Results of 1018 (...) adolescents illustrate that social attachment discourages unethical beliefs directly, but encourages it indirectly through monetary values. Our multi-group analyses demonstrate a novel paradox: The correlation between parental and peer attachments is smaller in France than in China, but similar across gender. Parents contribute more than peers to social attachment in France, but both carry equal weight in China. There is a negative direct path for the Chinese sample and for girls. Indirectly, parental attachment prevents French teenagers’ unethical beliefs, whereas peer attachment promotes boys’ unethical intention, supporting the notion—bad company corrupts good morals. Across both culture and gender, monetary attitude excites dishonesty consistently for all adolescents. A negative direct path exists for Chinese boys only. Overall, social attachment reduces unethical beliefs. Parental and peer supports shape teenagers’ monetary intelligence and ethical or unethical decision making, differently, across culture and gender. We provide theoretical, empirical, and practical implications to ethical parenting, peer attachment, monetary values, and business ethics. (shrink)

Legitimate parental interests need to be distinguished from any putative rights parents qua parents may be said to possess. Parents have no right to insulate their children from conceptions of the good at variance with those of their own. Claims to the right to faith schools, private schools, home-schooling or to withdraw a child from any aspect of the curriculum designed to enhance a child’s capacity for autonomous decision-making, are refuted.

Decisions concerning children in the health care setting have engendered significant controversy and sparked ethics policies and statements, legal action, and guidelines regarding who ought to make decisions involving children and how such decisions ought to be made. Traditionally, parents have been the default decision-makers for children not only with regard to health care but with regard to other matters, such as religious practice and education. In recent decades, there has been a steady trend away from the view that (...) parents are in authority over their children and toward the view that children are rights-bearers who should be granted greater authority over themselves. The mature minor doctrine refers to the decision to grant mature minors the authority to make decisions traditionally reserved for their parents. This essay (1) documents the trend towards expanding the understanding of some minors as “mature” and hence as having the right and authority to give informed consent, (2) examines the reasons for which some commentators have a special interest in expanding the mature minor doctrine to the research setting and allowing minors to enroll in research without parental permission, and (3) defends the view that the mature minor doctrine, regardless of its application to clinical health care decisions, ought to be set aside in the research setting in favor of greater parental involvement. (shrink)

Much of the bioethical literature on parenthood does not address a fact about parenthood which deserves more attention: parental rights and obligations are attached to socially constructed institutional roles. Both the content of these roles, and the way in which they determine who a child’s parents will be, issue from social and legal institutions of parenthood, and this makes a difference to accounts of the moral basis of parenthood. I will argue that this poses a problem for the causal (...) account of parenthood: the variability of parental obligations, and their assignment, underscores the problems the causal account has with defining the relevant notion of cause and with fixing procreative costs. If institutional role obligations arise only through voluntary undertakings, then understanding moral parenthood as an institutional role makes the voluntarist account of parenthood more attractive. However, I must address two questions: whether such role obligations can arise non-voluntarily, and whether the voluntarist account can deal with common cases of parenthood. (shrink)

Most theories of parenthood assume, at least implicitly, that a child will grow up to be an independent, autonomous adult. However, some children with cognitive limitations or psychiatric illness are unable to do so. For this reason, these accounts do not accommodate the circumstances and responsibilities of parents of such adult children. Our article attempts to correct this deficiency. In particular, we describe some of the common characteristics and experiences of this population of parents and children, examine the (...) unique aspects of their relationships, review several philosophical accounts of parental obligations, consider how these accounts might be extrapolated to semiautonomous adult children, and provide suggestions about parental obligations to promote autonomy and independence in adult children with cognitive limitations or psychiatric illness. In extending accounts of parental responsibilities to the case of semiautonomous adults, we find that the parental role includes the duty to continue to provide care—indefinitely if necessary—while cultivating autonomy and independence. (shrink)

Parents and their child's class‐teachers were instructed to rate the child's potential for improvement in mathematics and Finnish. The results showed that there was a moderate correlation between the parents' and teachers' ratings. The parents rated their child's potential more optimistically than the teachers did. Views of malleability may be seen as a potentially important factor in defining the child's educability.

Gul and Pesendorfer provide the best-known and most strident of a set of recent backlashes by economists against methodological revolutions promoted by some behavioural economists and neuroeconomists. Philosophers are likely to read these responses as merely reactionary, especially as their rhetoric goes beyond what their explicit argumentation validly supports. The present paper identifies the accurate insight on Gul and Pesendorfer's part that explains the impact of their philosophically ragged polemic. This centers on importantly different concepts of choice in the psychological (...) and economic literatures. The psychologist's idea of choice descends from a culturally familiar folk construct generally thought to lie within everyone's unreflective personal acquantance. By contrast, the economist's concept of choice refers to abstract sensitivity of behavioral patterns to changes in incentives, typically at the statistical level of populations. It is reasonable to regard this abstract idea as the basic subject matter of economics, just as Gul and Pesendorfer assert. Appreciating the difference between psychological choice and economic choice is crucial for understanding the methodologically schizophrenic character of neuroeconomics. Much of it merely identifies neural correlates of elements from models in the psychology of valuation. However, the neuroeconomics worthy of the name, as constructed by Glimcher and his collaborators, aims to unify economics and neuroscience. It so far fails to do so in an entirely satisfactory way because it falsely assumes that the conception of choice in psychology and economics is already shared. (shrink)

The Hague Conference on Private International Law currently has a Parentage/Surrogacy Project, which evaluates the legal status of children in cross-border situations, including situations involving international contract pregnancy. Should a convention focusing on international contract pregnancy emerge from this project, it will need to be consistent with the Hague convention on Intercountry Adoption. The latter convention prohibits adoptions unless, among other things, ‘the competent authorities of the receiving State have determined that the prospective adoptive parents are eligible and suited (...) to adopt’. Included in it, therefore, is a parental vetting or licensing requirement. In our view, a similar requirement must also appear in any Hague Convention on international contract pregnancy if the two conventions are to be ethically consistent with one another. In particular, there should be a licensing requirement in such a convention for at least some of the prospective parents in contract pregnancy arrangements. We consider several arguments against this conclusion, and argue that none of them is successful. (shrink)

The goal is to present how shared decision-making in paediatric oncology occurs from the viewpoints of parents and physicians. Eight Swiss Pediatric Oncology Group centres participated in this prospective study. The sample comprised a parent and physician of the minor patient. Surveys were statistically analysed by comparing physicians’ and parents’ perspectives and by evaluating factors associated with children’s actual involvement. Perspectives of ninety-one parents and twenty physicians were obtained for 151 children. Results indicate that for six aspects (...) of information provision examined, parents’ and physicians’ perceptions differed. Moreover, parents felt that the children were more competent to understand diagnosis and prognosis, assessed the disease of the children as worse, and reported higher satisfaction with decision-making on the part of the children. A patient’s age and gender predicted involvement. Older children and girls were more likely to be involved. In the decision-making process, parents held a less active role than they actually wanted. Physicians should take measures to ensure that provided information is understood correctly. Furthermore, they should work towards creating awareness for systematic differences between parents and physicians with respect to the perception of the child, the disease, and shared decision-making. (shrink)

I develop a model of love or care between children and their parents guided by experiences of parents, especially mothers, with disabilities. On this model, a caring relationship requires both parties to be aware of each other as a particular person and it requires reciprocity. This does not mean that children need to be able to articulate their interests, or that they need to be self-reflectively aware of their parents’ interests or personhood. Instead, parents and children (...) manifest their understanding of one another as unique, irreplaceable individuals, with identifiable needs and interests through their interactions with one another. (shrink)

Researchers are working to derive sperm from banked testicular tissue taken from pre-pubertal boys who face therapies or injuries that destroy sperm production. Success in deriving sperm from this tissue will help to preserve the option for these boys to have genetically related children later in life. For the twin moral reasons of preserving access and equity in regard to having such children, clinicians and researchers are justified in offering the option to the parents of all affected boys. However, (...) some parents may wish to decline the option to bank tissue from their boys because the technique may seem too unfamiliar or unusual, but over time people may become more comfortable with the technique as they have done with other novel assisted reproductive treatments. Other parents may wish to decline the option because of moral or religious reasons. A prominent natural law theory holds, for example, that the ARTs that would be involved in using sperm derived from banked tissue to produce a child are morally objectionable. Some parents might not want to bank tissue in order to shield their son from using ARTs they see as objectionable. Clinicians and researchers should respect parents who wish to decline banking tissue, but parents should ordinarily embrace choices that protect the possible interests their sons may have as adult men, including the wish to have genetically related children. (shrink)

In The Netherlands, it is openly acknowledged that the parents' ability to take care of their child plays a role in the decision-making process over administration of life-prolonging treatment to severely defective newborn babies. Unlike other aspects of such decision-making process up until the present time, the ‘ability to take care’ has not received specific attention in regulation or in empirical research. The present study is based on interviews with neonatologists in two Dutch NICUs concerning their definition of the (...) ability to take care and its relevance in non-treatment decisions. All of the respondents think that the ability to take care consists of more than one factor. Most doctors mention the parents' emotional state, social network and cognitive abilities. Some doctors mention the presence of psychological conditions in the parents, their financial situation and physical condition. A few refer to the parents' experience and age, their chances to have another baby and their cultural background. Most doctors think the ability to take care has a secondary relevance in the decision-making process, while the primary concern is assessing the condition of the child. A substantial minority thinks the ability to take care does not play any role, while one doctor thinks it is a factor of primary importance. The study constitutes an important stepping-stone for future research in The Netherlands and elsewhere. (shrink)

The purpose of this paper is to unveil the incompleteness of John Harris' view that parents have a moral obligation to genetically enhance their unborn children. Specifically, here two main conclusions are proposed: (1) at present there exist insufficient empirical data for determining whether prenatal genetic enhancement (PGE) is a moral obligation on prospective parents. Although the purpose of PGE research would be to determine the extent to which PGE is safe and effective, the task of determining the (...) veracity of Harris' premises is impossible to achieve without begging the question; we would be forced to assume the moral permissibility of PGE in order to generate the data that are required for determining its moral standing. So, given this empirical blindness, consequence-based normative frameworks like that of Harris cannot determine the moral standing of PGE, but merely push the question of the moral standing of PGE back a step, without offering any plausible and morally endorsable recourse for how to answer it; (2) even if PGE research were legal, which it is not, parents nevertheless have good reason not to consent to it for their children, especially as participants in the first wave(s) of such research. (shrink)

Advances in genomic medicine have lead to debate about the potential inclusion of genetic tests for susceptibility to common complex disorders in newborn screening programmes. Empirical evidence concerning psychosocial reactions to genetic testing is a crucial component of both ethical debate and policy development, but while there has been much speculation concerning the possible psychosocial impact of screening newborns for genetic susceptibilities, there remains a paucity of data. The aim of the study reported here is to provide some of this (...) missing empirical evidence, using type 1 diabetes as an example of a common disorder with multiple significant genetic contributors to its aetiology. Semi-structured interviews were conducted with 11 parents of babies who had received increased risk results in a study that involved newborn screening for genetic susceptibility to type 1 diabetes. Interpretative phenomenological analysis was used to evaluate the data. The interview data suggest that the probabilistic nature of results of genetic susceptibility tests impacts upon all aspects of parents' psychosocial reactions, resulting in a complex and dynamic process quite different to that described in relation to current newborn screening programmes. While parents generally reported fairly minor levels of concern in response to news of their child's increased genetic risk, these worries frequently recurred, and perception of risk also varied and fluctuated over time. Both individual and contextual factors appeared to interact with the inherent uncertainty of the test result to contribute to the dynamic nature of parental reactions, and their behavioural responses. The implications of these findings for future research and for the debate concerning potential expansion of newborn screening are discussed. (shrink)

This study is a contribution to the bioethical debate about new and possibly emerging reproductive technologies. Its point of departure is the intuition, which many people seem to share, that using such technologies to select non-disease traits – like sex and emotional stability - in yet unborn children is morally problematic, at least more so than using the technologies to avoid giving birth to children with severe genetic diseases, or attempting to shape the non-disease traits of already existing children by (...) environmental means, like education. The study employs philosophical analysis for the purpose of making this intuition intelligible and judging whether it is justified. Different ways in which the moral problems posed by reproductive technologies are often framed in bioethical debates are criticised as inadequate for this task. In particular, it is argued that the intuition cannot fully be made sense of in terms of harm to the children that such technologies help create. The study attempts to elaborate an alternative to that broadly consequentialist approach, by drawing on Martin Heidegger’s philosophy of technology, Hans Jonas’s ethics, and Aristotle’s practical philosophy, as it has been received and developed in the hermeneutical tradition. It is suggested that reproductive choices, unlike decisions for already born children, are characterised by a peculiar one-sidedness: the future child appears to the parents as something wholly theirs to decide about, not as a concrete other with whom they must interact in a responsive and attuned way. This is problematic because it means that such choices cannot call upon the particularised moral understanding only gained in interpersonal encounters. In particular, it makes them easily shaped by various tendencies, to which parents are always susceptible, to relate to children in instrumentalising ways, and at risk of reinforcing such tendencies. However, this does not mean that all uses of reproductive technologies are equally troubling. When selecting against severe disease the parents can rely on a widely shared illness experience to escape the dangers that one-sidedness involves. It is concluded that the intuition under discussion, thus explicated and in some ways qualified, makes sense morally. (shrink)

Some philosophers argue that we should limit procreation – for instance, to one child per person or one child per couple – in order to reduce our aggregate carbon footprint. I provide additional support to the claim that population size is a matter of justice, by explaining that we have a duty of justice towards the current generation of children to pass on to them a sustainable population. But instead of, or, more likely, alongside with, having fewer children in in (...) each family, we could also create families with more than two parents. I explore this possibility by pointing out the ways in which multi-parenting can advance children’s interests: in higher levels of well-being, in non-monopolistic child-rearing, and in a future opportunity to become themselves parents. (shrink)

In this article, we explore to what extent parents should be ?educators? of their children. In the course of this exploration, we offer some examples of these practices and ways of speaking and thinking, indicate some of the problems and limitations they import into our understanding of the parent?child relationship, and make some tentative suggestions towards an alternative way of thinking about this relationship.

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)

Clinical ethics records offer bioethics researchers a rich source of cases that clinicians have identified as ethically complex. In this paper, we suggest that clinical ethics records can be used to point to types of cases that lack attention in the current bioethics literature, identifying new areas in need of more detailed bioethical work. We conducted an analysis of the clinical ethics records of one paediatric hospital in Australia, focusing specifically on conflicts between parents and health professionals about a (...) child’s medical treatment. We identified, analysed, and compared cases of this type from the clinical ethics records with cases of this type discussed in bioethics journals. While the cases from journals tended to describe situations involving imminent risk to the child’s life, a significant proportion of the clinical ethics records cases involved different stakes for the child involved. These included distress, poorer functional outcome, poorer psychosocial outcome, or increased risk of surgical complications. Our analysis suggests that one type of case that warrants more detailed ethics research is parental refusal of recommended treatment, where the refusal does not endanger the child’s life but rather some other aspect of the child’s well-being. (shrink)

Research shows that a high majority of parents receiving prenatal diagnosis of intellectual disability terminate pregnancy. They have reasons for rejecting a child with intellectual disabilities—these reasons are, most commonly, beliefs about quality of life for it or them. Without a negative evaluation of intellectual disability, their choice makes no sense. Disability-based abortion has been critiqued through virtue ethics for being inconsistent with admirable moral character. Parental selectivity conflicts with the virtue of acceptingness and exhibits the vice of wilfulness. (...) In this paper I claim that, beyond failures of moral virtue, disability abortion often involves failures of epistemic virtue on the part of parents. I argue two things: parents believe something false, or at least contested, about life with intellectual disability—and they do so because they are not epistemically conscientious. I first explain why a central motivation for disability abortion—that it prevents harm to the child—is mistaken. I next give a brief account of intellectual virtue and culpable ignorance. I then indicate why many parents fail to be intellectually virtuous when choosing to terminate pregnancy. I focus on elimination of intellectual disability and have little to say about physical and sensory impairments. (shrink)

Differences in family factors in determining academic achievement were investigated by testing 432 parents in nine independent, coeducational Melbourne schools. Schools were ranked and categorized into three groups , based on student achievement scores in their final year of secondary school and school improvement indexes. Parents completed a questionnaire investigating their attitudes towards the school environment, their aspirations, expectations, encouragement and interest in their child’s education . They also responded to six open‐ended questions on their attitudes to achievement (...) and to their school. Multiple regression analyses revealed that parental expectations of their children’s educational level made the strongest unique prediction of high achievement followed by the length of time they had maintained their expectations. Limitations discussed include the disparity in meaning associated with the definition of school success and whether these results can be generalized to all students considering the biased sample. (shrink)

The rapidly increasing numbers of elderly people in our society have raised some important moral questions: How should we distribute social resources among different age groups? What does justice require from both the young and the old? In this book, Norman Daniels offers the first systematic philosophical discussion of these urgent questions, advocating what he calls a "lifespan" approach to the problem: Since, as they age, people pass through a variety of institutions, the challenge of caring for the elderly becomes (...) the prudent allocation of public resources among the various stages of people's lives. Using this philosophical approach, Daniels addresses specific public policy issues such as the allocation of medical funds, the adequacy of long-term care, current Medicare cost-containment measures, and the equitable distribution of income support over the lifespan and between generations. (shrink)

In attempting to provide protection to individuals and communities, childhood immunization has benefits that far outweigh disease risks. However, some parents decide not to immunize their children with some or all vaccines for reasons including lack of trust in governments, health professionals, and vaccine manufacturers. This article employs a theoretical analysis of trust and distrust to explore how twenty-seven parents with a history of vaccine rejection in two Australian cities view the expert systems central to vaccination policy and (...) practice. Our data show how perceptions of the profit motive generate distrust in the expert systems pertaining to vaccination. Our participants perceived that pharmaceutical companies had a pernicious influence over the systems driving vaccination: research, health professionals, and government. Accordingly, they saw vaccine recommendations in conflict with the interests of their child and “the system” underscored by malign intent, even if individual representatives of this system were not equally tainted. This perspective was common to parents who declined all vaccines and those who accepted some. We regard the differences between these parents—and indeed the differences between vaccine decliners and those whose Western medical epistemology informs reflexive trust—as arising from the internalization of countering views, which facilitates nuance. (shrink)

Parents of children who died following complex heart surgery have recently discovered that organs were removed and retained in post-m.

The ethics of advertising to children has been identified as one of the most important topics worthy of academic research in the marketing field. A fast growing advertising technique is product placement, and its use in children's films is becoming more and more common. The limited evidence existing suggests that product placements are especially potent in their effects upon children. Yet regulations regarding placements targeted at children are virtually non-existent, with advertising guidelines suggesting that it remains the prime responsibility of (...) the parents to provide guidance for children. This study measured the ethical evaluations of parents in the UK and Canada regarding product placements in children's films. After exposing parents to a four-type typology of product placements, results show that explicit placements of ethically charged products were perceived as the most unethical type of placements. Parents in the UK were more sensitive to the use of the technique and there was a significant difference in relativism between the two groups. Both sets of respondents would like to see more regulation on the use of placements, especially placements of alcohol, tobacco and fast foods. (shrink)

This paper argues that Charlie Gard’s parents should have been the decision-makers about their son’s best interests and that determination of Charlie’s best interests depended on a moral decision about which horn of a profound moral dilemma to choose. Charlie’s parents chose one horn of that moral dilemma and the courts, like Charlie Gard’s doctors, chose the other horn. Contrary to the first UK court’s assertion, supported by all the higher courts that considered it, that its judgement was (...) ‘objective’, this paper argues that the judgement was not and could not be ‘objective’ in the sense of objectively correct but was instead a value judgement based on the judge’s choice of one horn of the moral dilemma. While that horn was morally justified so too was the horn chosen by the parents. The court could and should have avoided depriving the parents of their normal moral and legal right and responsibility to decide on their child’s best interests. Instead, this paper argues that the court should have acknowledged the lawfulness of both horns of the moral dilemma and added to its judgement that Charlie Gard’s doctors were not legally obliged to provide treatment that they believed to be against their patient’s best interests the additional judgement that Charlie’s parents could lawfully transfer his care to other doctors prepared to offer the infant a trial of the experimental treatment requested by his parents. (shrink)

A continuing need for care for elderly, combined with looser family structures prompt the question what filial obligations are. Do adult children of elderly have a duty to care? Several theories of filial obligation are reviewed. The reciprocity argument is not sensitive to the parent–child relationship after childhood. A theory of friendship does not offer a correct parallel for the relationship between adult child and elderly parent. Arguments based on need or vulnerability run the risk of being unjust to those (...) on whom a needs-based claim is laid. To compare filial obligations with promises makes too much of parents’ expectations, however reasonable they may be. The good of being in an unchosen relationship seems the best basis for filial obligations, with an according duty to maintain the relationship when possible. We suggest this relationship should be maintained even if one of the parties is no longer capable of consciously contributing to it. We argue that this entails a duty to care about one’s parents, not for one’s parents. This implies that care for the elderly is not in the first place a task for adult children. (shrink)

Futile treatment. Do not resuscitate. These terms and the thoughts they evoke may be unfamiliar to families with ill children. Similarly, laws, such as the Americans with Disabilities Act or the Emergency Medical Treatment and Active Labor Act, are probably unfamiliar. Yet these terms and laws, and, more important, their implications, are part of a new world of health care into which more families are thrust—the world of wrenching and complicated decisions.Although the number of these situations is increasing and even (...) predictable, the infrastructure of support services for families dealing with these medical decisions for seriously ill children has not been adequately addressed or developed. Parents know that some children are born with or develop serious illnesses and die. Amid absorbing large amounts of new information and interpreting the parameters and implications of what they are learning about their child's condition, families are forced by circumstances to assess—and to act on—their most critical, and perhaps previously unexamined, values. (shrink)

This study examines parents’ perspectives on their children working on their family dairy farms in Wisconsin. The objective of this focus group study is (1) to gain insights on why children work on their family farms, (2) to identify those benefits that parents perceive that they and their children gain from their children working on-farm, (3) to determine the concerns that parents have about their children working, (4) to identify ways to improve the safety of children on (...) family farms, and (5) to understand how US agricultural policy impacts family decisions to use their children’s labor on their farms. The two focus groups reveal that fathers and mothers have different concerns and different perceptions regarding the benefits gained from having their children work on farms. The findings suggest that in response to US agricultural policy, parents are increasingly reliant upon their children’s labor. Children work the longest hours on economically stressed farms. (shrink)

BackgroundAs the number of randomised controlled trials of medicines for children increases, it becomes progressively more important to understand the experiences of parents who are asked to enrol their child in a trial. This paper presents a narrative review of research evidence on parents' experiences of trial recruitment focussing on qualitative research, which allows them to articulate their views in their own words.DiscussionParents want to do their best for their children, and socially and legally their role is to (...) care for and protect them yet the complexities of the medical and research context can challenge their fulfilment of this role. Parents are simultaneously responsible for their child and cherish this role yet they are dependent on others when their child becomes sick. They are keen to exercise responsibility for deciding to enter a child in a trial yet can be fearful of making the 'wrong' decision. They make judgements about the threat of the child's condition as well as the risks of the trial yet their interpretations often differ from those of medical and research experts. Individual parents will experience these and other complexities to a greater or lesser degree depending on their personal experiences and values, the medical situation of their child and the nature of the trial. Interactions at the time of trial recruitment offer scope for negotiating these complexities if practitioners have the flexibility to tailor discussions to the needs and situation of individual parents. In this way, parents may be helped to retain a sense that they have acted as good parents to their child whatever decision they make.SummaryDiscussing randomised controlled trials and gaining and providing informed consent is challenging. The unique position of parents in giving proxy consent for their child adds to this challenge. Recognition of the complexities parents face in making decisions about trials suggests lines for future research on the conduct of trials, and ultimately, may help improve the experience of trial recruitment for all parties. (shrink)