This review essay examines H. Tristram Engelhardt, Jr.'s The Foundations of Bioethics, a contemporary nonfeminist text in mainstream biomedical ethics. It focuses upon a central concept, Engelhardt's idea of the moral community and argues that the most serious problem in the book is its failure to take account of the political and social structures of moral communities, structures which deeply affect issues in biomedical ethics.

Dealing with situations where parents’ views about treatment for their child are strongly opposed to doctors’ views is one major area of ethical challenge in paediatric health care. The traditional approach focuses on the child’s best interests, but this is problematic for a number of reasons. The Harm Principle test is regarded by many ethicists as more appropriate than the best interests test. Despite this, use of the best interests test for intervening in parental decisions is still very common in (...) clinical settings and can lead to confusion. In this paper, I propose the Zone of Parental Discretion as a means of putting into practice the key ideas of the Harm Principle, in a clear, step-by-step process. The Zone of Parental Discretion provides a tool for ethical deliberation by clinicians and ethicists about all situations in which parents and doctors disagree about treatment of a child, whether parents are refusing medically recommended treatment, or requesting non-recommended treatment. (shrink)

This paper provides an answer to the question why birth parents have a moral right to keep and raise their biological babies. I start with a critical discussion of the parent-centred model of justifying parents’ rights, recently proposed by Harry Brighouse and Adam Swift. Their account successfully defends a fundamental moral right to parent in general but, because it does not provide an account of how individuals acquire the right to parent a particular baby, it is insufficient for addressing the (...) question whether and why there is a right to parent one’s biological child. Such a right is important because, in its absence, fairness towards adequate prospective parents who are involuntarily childless would demand a ‘babies redistribution’; moreover, in societies with entrenched histories of injustice there may be reasons of fairness for shuffling babies amongst all recent parents. I supplement the Brighouse-Swift account of fundamental parental rights by an account of how adequate parents acquire the right to parent their biological babies. I advance two arguments to this conclusion: by the time of birth, the birth parents will have already shouldered various burdens in order to bring children into existence, and are likely to have formed an intimate relationship with the future baby. Denying birth parents who would make at least adequate parents the right to keep their baby would be unfair to them and would destroy already formed parent-baby relationships which, I assume, are intrinsically valuable. (shrink)

I argue that the notion of human rights is a flawed notion of relatively recent historical origin, growing primarily out of Enlightenment concerns to separate human beings from their metaphysical and communal heritage. I critique liberal, secular individualism as an abstract perspective that fails to comprehend those fundamental family relations out of which genuine human life emerges and within which it must remain if it is to be perceptive, grounded, and concrete. Finally, I argue that the most important relations humans (...) sustain to each other are internal, not external to them and that the bonding found through empathy is more insightful in decision making than the analytic connections engendered through human reason. (shrink)

This book addresses the perennial question: What is justice?

Personhood is a foundational concept in ethics, yet defining criteria have been elusive. In this article we summarize attempts to define personhood in psychological and neurological terms and conclude that none manage to be both specific and non-arbitrary. We propose that this is because the concept does not correspond to any real category of objects in the world. Rather, it is the product of an evolved brain system that develops innately and projects itself automatically and irrepressibly onto the world whenever (...) triggered by stimulus features such as a human-like face, body, or contingent patterns of behavior. We review the evidence for the existence of an autonomous person network in the brain and discuss its implications for the field of ethics and for the implicit morality of everyday behavior. (shrink)

When do children become aware of themselves as differentiated and unique entity in the world? When and how do they become self-aware? Based on some recent empirical evidence, 5 levels of self-awareness are presented and discussed as they chronologically unfold from the moment of birth to approximately 4-5 years of age. A natural history of children's developing self-awareness is proposed as well as a model of adult self-awareness that is informed by the dynamic of early development. Adult self-awareness is viewed (...) as the dynamic flux between basic levels of consciousness that develop chronologically early in life. (shrink)

Children: Rights and Childhood is widely regarded as the first book to offer a detailed philosophical examination of children’s rights. David Archard provides a clear and accessible introduction to a topic that has assumed increasing relevance since the book’s first publication. -/- The third edition has been fully revised and updated throughout with a new chapter providing an in-depth analysis of the United Nations Convention on the Rights of the Child (UNCRC) and Part 2 has been restructured to move the (...) reader from general theoretical considerations of children’s rights through to practical issues. This volume is ideal reading for advanced studies across Philosophy, Social Work, Law, Childhood Studies, Politics, and Social Policy. (shrink)

Demands for access to experimental therapies are frequently framed in the language of rights. This article examines the justifiability of such demands in the specific context of surgical innovations, these being promising but non-validated and potentially risky departures from standard surgical practices. I argue that there is a right to access innovative surgery, drawing analogies with other generally accepted rights in medicine, such as the right not to be forcibly treated, to buy contraceptives, and to choose to have an abortion, (...) including a post-viability abortion where the mother's life or health is threatened by the pregnancy. I argue that we accept these rights because we believe that people are entitled to try to preserve their lives and health and to make choices of an important and intensely personal kind, and I suggest that a person's choice of medical treatment should be seen in the same light. However, since few rights are absolute, I also consider the circumstances in which it may be justifiable to limit the right to access innovative surgery. In discussing this question, I apply the human rights standard of proportionality, comparing the importance of the reasons for limiting the right with the severity of the invasion on liberty. (shrink)

In the western healthcare, shared decision making has become the orthodox approach to making healthcare choices as a way of promoting patient autonomy. Despite the fact that the autonomy paradigm is poorly suited to paediatric decision making, such an approach is enshrined in English common law. When reaching moral decisions, for instance when it is unclear whether treatment or non-treatment will serve a child’s best interests, shared decision making is particularly questionable because agreement does not ensure moral validity. With reference (...) to current common law and focusing on intensive care practice, this paper investigates what claims shared decision making may have to legitimacy in a paediatric intensive care setting. Drawing on key texts, I suggest these identify advantages to parents and clinicians but not to the child who is the subject of the decision. Without evidence that shared decision making increases the quality of the decision that is being made, it appears that a focus on the shared nature of a decision does not cohere with the principle that the best interests of the child should remain paramount. In the face of significant pressures toward the displacement of the child’s interests in a shared decision, advantages of a shared decision to decisional quality require elucidation. Although a number of arguments of this nature may have potential, should no such advantages be demonstrable we have cause to revise our commitment to either shared decision making or the paramountcy of the child in these circumstances. (shrink)

Surgical innovation involves practices, such as new devices, technologies, procedures, or applications, which are novel and untested. Although innovative practices are believed to offer an improvement on the standard surgical approach, they may prove to be inefficacious or even dangerous. This article considers how surgeons considering innovation should reason in the conditions of uncertainty that characterize innovative surgery. What attitude to the unknown risks of innovative surgery should they take? The answer to this question involves value judgments about the acceptability (...) of risk taking when satisfactory scientific information is not available. This question has been confronted in legal contexts, where risk aversion in the form of the precautionary principle has become increasingly influential as a regulatory response to innovative technologies that pose uncertain future hazards. This article considers whether it is appropriate to apply a precautionary approach when making decisions about innovative surgery. (shrink)

When is it permissible to allow a newborn infant to die on the basis of their future quality of life? The prevailing official view is that treatment may be withdrawn only if the burdens in an infant's future life outweigh the benefits. In this paper I outline and defend an alternative view. On the Threshold View, treatment may be withdrawn from infants if their future well-being is below a threshold that is close to, but above the zero-point of well-being. I (...) present four arguments in favor of the Threshold View, and identify and respond to several counterarguments. I conclude that it is justifiable in some circumstances for parents and doctors to decide to allow an infant to die even though the infant's life would be worth living. The Threshold View provides a justification for treatment decisions that is more consistent, more robust, and potentially more practical than the standard view. (shrink)

The fundamental principle of modern-day bioethics is that “the competent adult has the right to accept or refuse all medical care, including life-saving medical care,” a principle that has been upheld by the U.S. Supreme Court in Bouvia v. Superior Court ) and Cruzan v. Director, Missouri Department of Health ). If the adult lacks decision-making capacity, a surrogate can speak on his or her behalf. The adult may have chosen his or her surrogate through an advance directive; if not, (...) laws assign guardianship based on a hierarchy of relationships. Surrogates are expected.. (shrink)

In this paper I explore the question of whether gestation can ground parental rights. I consider Anca Gheaus’s claim that the labour and bonding of gestation give one the right to parent one’s biological child. I argue that, while Gheaus’s gestational account of parental rights is the most successful of such accounts in the literature, it is ultimately unsuccessful, because the concept ‘maternal-fetal bonding’ does not stand up to scrutiny. Gheaus argues that the labour expended in gestation generates parental rights. (...) This is a standard, Lockean sort of a move in parental ethics—it usually relies on the claim that I have proprietary rights over the products of my labour. However, Gheaus argues that a standard labour account of parental rights could not generate parental rights over one’s own birth child via gestation without ownership, since the labour would merely afford one a right to enjoy the goods of parenthood. At best, then, labour alone would generate a right to a child. But, Gheaus argues, not only do gestational mothers expend labour in the course of the pregnancy; they also develop emotional ties to the fetus. They ‘bond’ with it. This, Gheaus argues, coupled with labour, gives the birth mother parental rights over her birth child. Fathers, on her account, acquire rights over their birth child by contributing labour—in the form of antenatal support—during the course of the pregnancy. I argue that because ‘bonding’ is not an appropriately morally salient phenomenon, Gheaus’s account does not work unless it relies on a proprietary claim, and this is prima facie reason to reject the account. Further, the fact that it only confers parental rights on fathers by proxy also gives us reason to reject the account. I then offer a brief sketch of a more promising, positive account of parental rights. (shrink)

What exactly is it that makes someone a parent? Many people hold that parenthood is grounded, in the first instance, in the natural derivation of one person's genetic constitution from the genetic constitutions of others. We refer to this view as "Geneticism". In Part I we distinguish three forms of geneticism on the basis of whether they hold that direct genetic derivation is sufficient, necessary, or both sufficient and necessary, for parenthood. Parts two through four examine three arguments for geneticism: (...) the property argument, the causal argument, and the parity argument. We conclude that none of these arguments succeeds. (shrink)

: In Engelhardt's secular bioethics, moral obligations derive from contracts and agreements between rational persons, and no infants or children and few adolescents meet Engelhardt's requirements for being a rational person. This is a problem, as one cannot have any direct secular moral obligations toward nonpersons such as infants and adolescents. The Engelhardtian concepts of ownership, indenture, and social personhood, which are meant to allow the theory to accommodate children and adolescents adequately, fail to give an Engelhardtian any actual means (...) of determining the right action to take in difficult cases, even on his or her own terms. Thus, the theory is incapable of determining the morally correct action to take in cases involving children and therefore is unhelpful in dealing with moral questions involving children. (shrink)

ABSTRACT This paper is concerned with the philosophical foundations of parental rights. Some commonly held accounts are rejected. The question of whether parental rights are property rights is examined. It is argued that there are useful analogies with property rights which help us to see that the ultimate justification of parental rights lies in the special value of parenthood in human life. It is further argued that the idea of generation is essential to our understanding of parenthood as having special (...) value and that parental rights properly belong, in the first instance, to natural parents. (shrink)

This paper briefly reviews highlights from decades of debates in medicine, law, bioethics, psychology and social research about children’s and parents’ views and consent to medical treatment and research. There appears to have been a rise and later a fall in respect for children’s views, illustrated among many examples by a recent book on the zone of parental discretion, which is reviewed. A return to greater respect for children’s views and consent is advocated.