Abstract
Until today, ethical theories have implicitly adopted a difference perspective with regard to the child, and, in consequence, theoretical and practical inconsistencies plague child ethics. In this chapter, I analyse inconsistencies in the current debate on autonomy and develop a concept of minimal autonomy that is feasible for healthcare and can be applied to both children and adults.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
- 2.
For example, Gerald Dworkin , in his fundamental study “The Theory and Practice of Autonomy”, deals with the child but only insofar as he analyses different approaches to proxy consent. Thus, Dworkin assumes that children per se are not autonomous (Dworkin 1988, pp. 85–99).
- 3.
We conducted the survey in Lower Saxony, a northern federal state of Germany (Peters 2016).
- 4.
- 5.
This may also be due to the fact that parents have to pay for their children, as Feuillet-Liger rightly points out (Feuillet-Liger 2012, p. 332).
- 6.
Perera (2008); for a critical reformulation of ‘Gillick competence’ , see Freeman (2006).
- 7.
See the paragraph on consent, WMA: Background Information, Declaration of Ottawa on Child Health, p. 4. Available online at http://www.wma.net/en/30publications/40background_docs/Background_Ottawa_Declaration-Oct2009.pdf, accessed February 22, 2016. This is a particularly telling example since the Declaration explicitly mentions the refusal of the child when it refers to research participation.
- 8.
Just consider how the impression changes when the examples are slightly modified: deciding to fire (instead of hire) an employee or to not take the last university exams (instead of deciding to attend university) although one’s father had gone to a lot of trouble to pay the expensive tuition. These new conditions would certainly not render the decision less autonomous, but they shed an altogether different, and less favourable, light on the “normal chooser” since this “normality” would be less whole-heartedly endorsed.
- 9.
When exploring the capacity of adolescents to consent to treatment, Blustein and Moreno hold that a decision should be “based on a well-established set of values that constitute a stable and recognizable moral self” (Blustein and Moreno 1999, p. 104). Since the authors consider adolescence to be the developmental phase when the moral self evolves, adolescents, according to their view, do not regularly display such a stable self. However, besides the fact that this argument is somehow tautological, many adults, too, will have difficulties to satisfy this criterion, particularly in case of illness or other crises of life.
- 10.
Dworkin (1988, p. 9) puts forward this important argument with regard to adults. With regard to children, strangely enough, he upholds the more demanding criteria of competency. He considers minors to be incompetent since they “have not been able to choose life plans, form various intentions, develop certain desires, and so on” (p. 96).
- 11.
- 12.
James Stacey Taylor argues against proceduralist accounts on the basis of his example of a person unknowingly hypnotized to do what someone else wants her to do (Taylor 2005). Yet, hypnotists claim that it is impossible to hypnotize someone into doing anything the person would not have wanted to do in the first place. For example, it is impossible to hypnotize a normally decent person into killing someone (Taylor 2005).
- 13.
For an overview, see Christman (2011, p. 10).
- 14.
In comparison, causal concepts, according to which human relationships are causally relevant for the development of human agency, are less problematic.
- 15.
Cf. Baumann and Bleisch (2015); Monika Betzler also focusses the carings of children and the responsibility of parents to encourage them: “This involves taking an interest in what children care about, encourage them in pursuing what they care about, empathizing with them if what they care about gives rise to frustration, giving them critical feedback if what they care about is imprudent, immoral, or otherwise of disvalue, and helping them understand when their emotions are appropriate and their caring directed to something valuable” Betzler (2015, p. 75). However, Betzler remains somewhat ambivalent about the moral significance of carings.
- 16.
With regard to this aspect, see Beate Rössler’s (2002) interpretation of the work of Iris Murdoch .
References
Alderson, P. 1993. Children’s consent to surgery. Buckingham: Open University Press.
Anderson, J., and A. Honneth. 2005. Autonomy, vulnerability, recognition, and justice. In Autonomy and the challenges to liberalism, ed. J. Christman, and J. Anderson, 127–149. Cambridge: Cambridge University Press.
Baines, P. 2008. Medical ethics for children: Applying the four principles to paediatrics. Journal of Medical Ethics 34: 141–145.
Baumann, H., and B. Bleisch 2015. Respecting children and children’s dignity. In The nature of children’s well-being. Theory and practice, ed. A. Bagattini, C. Macleod, 141–156. Dordrecht: Springer.
Beauchamp, T., and J. Childress. 2009. Principles of biomedical ethics. New York, Oxford: Oxford University Press.
Benson, P. 1994. Free agency and self-worth. The Journal of Philosophy 91: 650–668.
Betzler, M. 2001. Bedingungen personaler Autonomie. In Harry G. Frankfurt. Freiheit und Selbstbestimmung, ed. M. Betzler, and B. Guckes, 17–49. Berlin: Akademie Verlag.
Betzler, M. 2015. Enhancing the capacity for autonomy: What parents owe their children to make their lives go well. In The nature of children’s well-being. Theory and practice, ed. A. Bagattini, and C. Macleod, 65–84. Dordrecht: Springer.
Blustein, J., N. Dubler, and C. Levine. 1999a. Ethical Guidelines For Health Care Providers. In: The Adolescent Alone. Decision Making in Health Care in the United States, ed. J. Blustein, C. Levine, N. Dubler, 251–269. Cambridge: Cambridge University Press.
Blustein, J. 2009a. Reply to Ross’s ‘Arguments against Respecting a Minor’s Refusal of Efficacious Life-Saving Treatment Redux’. Cambridge Quarterly of Healthcare Ethics 18: 440–442.
Blustein, J. 2009b. Response. Cambridge Quarterly of Healthcare Ethics 18: 315–320.
Brock, D.W. 1996. Children’s competence for health care decisionmaking. In Children’s rights re-visioned. Philosophical readings, ed. R.E. Ladd, 184–200. Belmont: Wadsworth Publishing.
Brooks, C.M. 2014. The child should not have the right to refuse medical treatment to which the child’s parents or guardians have consented. In Contemporary debates in bioethics, ed. A.L. Caplan, and R. Arp, 181–191. Chichester: Wiley.
Christman, J. 2011. The politics of persons. Individual autonomy and socio-historical selves. New York: Cambridge University Press.
Dettenborn, H. 2010. Kindeswohl und Kindeswille. Ernst Reinhardt, München: Psychologische und rechtliche Aspekte.
Dörries, A. 2013. Zustimmung und Veto. Aspekte der Selbstbestimmung im Kindesalter. In Patientenautonomie. Theoretische Grundlagen, praktische Anwendungen, ed. C. Wiesemann, A. Simon, 180–189. Münster: Mentis.
Dworkin, G. 1988. The theory and practice of autonomy. Cambridge: Cambridge University Press.
Ekstrom, L.W. 1993. A coherence theory of autonomy. Philosophy and Phenomological Research 53: 599–616.
Ekstrom, L.W. 2005. Autonomy and personal integration. In Personal autonomy. New essays on personal autonomy and its role in contemporary moral philosophy, ed. J.S. Taylor, 143–161. Cambridge University Press, Cambridge.
Elliston, S. 2007. The Best Interest of the Child in Healthcare. London, New York: Routledge-Cavendish.
Feinberg, J. 1980. The child’s right to an open future. In Whose child? Children’s rights, parental authority, and state power, ed. W. Aiken, H. LaFollette, 124–153. Totowa, NJ: Littlefield, Adams, and Co.
Feuillet-Liger, B. 2012. Adolescents and medical treatment: A common reality? In Adolescents, autonomy and medical treatment. Divergence and convergence across the globe. ed. B. Feuillet-Liger, I. Ryuichi, and T. Callus, 323–341. Bruxelles: Editions Bruylant.
Frankfurt, H.G. 1999. Necessity, volition, and love. Cambridge: Cambridge University Press.
Furkel, F. 2012. Adolescents and medical treatment in the federal republic of germany. A growing autonomy despite the regrettable silence of the legislator. In Adolescents, autonomy and medical treatment. Divergence and convergence across the globe, ed. B. Feuillet-Liger, I. Ryuichi, T. Callus, 57–80. Bruxelles: Editions Bruylant.
Giesinger, J. 2012. Respect in education. Journal of Philosophy of Education 46: 100–112.
Guggenheim, M. 2002. Minor rights: the adolescent abortion case. Hofstra law review 30: 589–646.
Jaworska, A. 2007. Caring and internality. Philosophy and Phenomological Research 74: 529–568.
Jaworska, A. 2009. Caring, minimal autonomy, and the limits of liberalism. In Naturalized bioethics. Toward responsible knowing and practice, ed. H. Lindemann, M. Verkerk, M. Urban Walker, 80–105. New York: Cambridge University Press.
Mackenzie, C., and N. Stoljar. 2000. Introduction: Autonomy refigured. In Relational autonomy. Feminist perspectives on autonomy, agency, and the social self, ed. C. Mackenzie, N. Stoljar, 3–34. New York, Oxford: Oxford University Press.
May, T. 2005. The concept of autonomy in bioethics: An unwarranted fall from grace. In Personal autonomy. New essays on personal autonomy and its role in contemporary moral philosophy, ed. J.S. Taylor, 299–309. Cambridge: Cambridge University Press.
McLeod, C. 2002. Self-trust and reproductive autonomy. Cambridge, Mass: MIT Press.
Mills, C. 2003. The child’s right to an open future? Journal of Social Philosophy 34: 499–599.
Orfali, K. 2012. The rights of adolescents in healthcare in the USA: A complex legal patchwork and an evolving situation. In Adolescents, autonomy and medical treatment. Divergence and convergence across the globe, ed. B. Feuillet-Liger, I. Ryuichi, T. Callus, 288–308. Bruxelles: Editions Bruylant.
Oshana, M.A.L. 2005. Autonomy and self-identity. In Autonomy and the challenges to liberalism, ed. J. Christman, and J. Anderson, 77–97. Cambridge: Cambridge University Press.
Perera, A. 2008. Can i decide, please. The state of children’s consent in the UK. European Journal of Health Law 15: 411–420.
Peters, S. 2016. Wenn Kinder anderer Meinung sind. Die ethische Problematik von Kindeswohl und Kindeswille in der Kinder- und Jugendmedizin.
Piker, A. 2011. Balancing liberation and protection: A moderate approach to adolescent health care decision-making. Bioethics Quarterly 25: 202–208.
Purdy, L.M. 1992. In their best interest? The case against equal rights for children. Ithaca, New York: Cornell University Press.
Quante, M. 2000. The things we do for love. Zur Weiterentwicklung von Frankfurts Analyse personaler Autonomie. In Autonomes Handeln. Beiträge zur Philosophie von Harry G. Frankfurt, ed. M. Betzler, and B. Guckes, 117–136. Akademie Verlag, Berlin.
Ross, L.F. 2009a. Against the tide: Arguments against respecting a minor’s refusal of efficacious life-saving treatment. Cambridge Quarterly of Healthcare Ethics 18: 302–315.
Ross, L.F. 2009b. Arguments against respecting a minor’s refusal of efficacious life-saving treatment Redux, part II. Cambridge Quarterly of Healthcare Ethics 18: 432–440.
Rössler, B. 2002. Problems with autonomy. Hypatia 17: 143–162.
Rössler, B. 2011. Autonomie. In Handbuch Ethik, ed. R. Stoecker, C. Neuhäuser, and M.-L. Raters, 93–99. Stuttgart: Metzler.
Rothärmel, S. 2004. Einwilligung, Veto, Mitbestimmung. Die Geltung der Patientenrechte für Minderjährige. Baden-Baden: Nomos.
Stultiëns, L., T. Goffin, P. Borry, C. Dierickx, and H. Nys. 2007. Minors and informed consent: A comparative approach. European Journal of Health Law 14: 21–46.
Taylor, J.S. 2005. Introduction. In Personal autonomy. New essays on personal autonomy and its role in contemporary moral philosophy, ed. J.S. Taylor, 1–29. Cambridge: Cambridge University Press.
Winslade, W.J. 2014. The child should have the right to refuse medical treatment to which the child’s parents or guardians have consented. In Contemporary debates in bioethics, ed. A.L. Caplan, and R. Arp, 173–180. Chichester: Wiley.
Zitelmann, M. 2001. Kindeswohl und Kindeswille im Spannungsfeld von Pädagogik und Recht. Münster: Votum.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Wiesemann, C. (2016). Autonomy. In: Moral Equality, Bioethics, and the Child. International Library of Ethics, Law, and the New Medicine, vol 67. Springer, Cham. https://doi.org/10.1007/978-3-319-32402-9_6
Download citation
DOI: https://doi.org/10.1007/978-3-319-32402-9_6
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-32400-5
Online ISBN: 978-3-319-32402-9
eBook Packages: Religion and PhilosophyPhilosophy and Religion (R0)