Summary. Disputes about pediatric, educational, and other child-related matters may reflect more general concepts of parenthood, including parental rights and responsibilities. These concepts may be child-centered, focusing either on a child’s needs or on a child’s development. Needs and development are not wholly distinct or in competition, but some parents may emphasize one or the other and, in case of conflict, favor one over the other. Such emphasis and preference tends to distinguish parents as child-carers and parents as child-raisers (in (...) most cases, adult-raisers). So distinguished, these kinds of parental focus involve different temporal perspectives (present and future), as well of different categories of assessment and analogies (associated with nursing and teaching). (shrink)

American Academy of Pediatrics (AAP) and American College of Medical Genetics (ACMG) recently provided two recommendations about predictive genetic testing of children. The Clinical Sequencing Exploratory Research Consortium's Pediatrics Working Group compared these recommendations, focusing on operational and ethical issues specific to decision making for children. Content analysis of the statements addresses two issues: (1) how these recommendations characterize and analyze locus of decision making, as well as the risks and benefits of testing, and (2) whether the guidelines conflict or (...) come to different but compatible conclusions because they consider different testing scenarios. These statements differ in ethically significant ways. AAP/ACMG analyzes risks and benefits using best interests of the child and recommends that, absent ameliorative interventions available during childhood, clinicians should generally decline to order testing. Parents authorize focused tests. ACMG analyzes risks and benefits using the interests of the child and other family members and recommends that sequencing results be examined for additional variants that can lead to ameliorative interventions, regardless of age, which laboratories should report to clinicians who should contextualize the results. Parents must accept additional analysis. The ethical arguments in these statements appear to be in tension with each other. (shrink)