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The Ethical Grounds for the Best Interest of the Child

  • LYNNE BOWYER

Abstract:

Managing a healthcare situation in accordance with the best interests of a child can be challenging for both parents and healthcare professionals. These challenges take different forms as the child grows and develops physically, emotionally, and cognitively. In this article I argue that a child’s best interests cannot be construed in terms of a narrow conception of human beings as isolated, self-contained biological organisms, in which “health” and “illness” are understood in terms of physiological function and dysfunction. Such an approach overlooks the wider context in which the child grows into and comes to dwell in the world, continually enacting her life within her community. The health of a child is intimately connected to the ways in which she is involved in the world, through active and rewarding engagement with significant others. That embeddedness implies that acting in her best interests calls for others to nurture and integrate her into a sustainable human community so that she is supported appropriately throughout all the contingencies and vagaries of life that impact on her health.

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Notes

1. Heidegger, M. Being and Time. Macquarrie, J, Robinson, E, trans. Oxford: Basil Blackwell; 1962, at 264–5,173–4, 82–4.

2. See note 1, Heidegger 1962, at 98.

3. Lindemann, Nelson H. What child is this? The Hasting’s Centre Report 2002;32:2938.

4. Bowyer, L. Autonomy and why you can never let me go. Journal of Bioethical Inquiry 2014;11:139–49. doi:10.1007/s11673-014-9533-4.

5. In their paper Cynthia L. Battle and colleagues show that a range of adverse childhood experiences are implicated in a variety of disordered ways of Being: see Battle, CL, Shea, MT, Johnson, DM, Yen, S, Zlotnick, C, Zanarini, MC, et al. Childhood maltreatment associated with adult personality disorders: Findings from the collaborative longitudinal personality disorders study. Journal of Personality Disorders 2004;18:193211. See also note 1, Heidegger 1962, at section 26.

6. Heidegger 1962, at 154–61.

7. Lev Vygotsky discusses the dynamic relationship between thought and language developed through the guidance and support of community. See Vygotsky LS. Thinking and speech. In: Vygotsky LS. Collected Works. Vol. 1. Rieber, R, Carton, A, eds. Minick, N, trans. New York: Plenum; 1987:39285.

8. See note 1, Heidegger 1962, at 233.

9. Wittgenstein L. Philosophical Investigations. 3rd ed. Anscombe GEM, trans. Oxford: Basil Blackwell; 1958, at #7, #19.

10. Gadamer, H-G. The Enigma of Health: The Art of Healing in a Scientific Age. Gaiger, J, Walker, N, trans. Stanford, CA: Stanford University Press; 1996, at 112–14. This dynamic equilibrium of health and illness has also been discussed by other thinkers; see Danzer, G, Rose, M, Walter, M, Klapp, BF. On the theory of individual health. Journal of Medical Ethics 2002;28:1719. This dynamic equilibrium is also recognized in the healing practices of other cultures, for example, the continual balancing of yin and yang in traditional Chinese medicine and the maintenance of the harmonious structure of iki in traditional Japanese cultural practices.

11. Barbery, M. The Elegance of the Hedgehog. Anderson, A, trans. New York: Europa Editions; 2008, at 69.

12. Many forms of life have healing ceremonies that are performed by holy people (referred to as tohungas or shamans in some cultures) on those who are afflicted by illness, and those practices are part of the healing and reintegration of the individual, finding her a place in the world to Be.

13. McMurdo, M, Gillett, G. Consent, competence and lies to children: Veracity in paediatric care. Journal of Law and Medicine 2013;21:265–72.

14. See note 13, McMurdo, Gillett 2013, at 268–70.

15. See note 13, McMurdo, Gillett 2013, at 270–1.

16. The importance of recognizing, understanding, and working with an individual’s unique situation is thoughtfully laid out in Anne Fadiman’s book: Fadiman, A. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. New York: Farrar, Straus and Giroux; 1998. Her account explores the ways in which the biomedical approach reduces a young Hmong child to an analyzable collection of symptoms in order to provide optimal “care,” but in the process the doctors involved systematically fail to tailor her treatment in such a way that it engages with the family’s reality. Thus, they are unable to work effectively together in the best interests of the child in her familial situation.

17. See note 3, Lindemann Nelson 2002.

18. Aristotle. The Nicomachean Ethics. Ross D, trans. Oxford: Oxford University Press; 2009, at 1097a, 11–14.

19. See note 10, Danzer et al. 2002, at 18.

20. Illich I. Medical Nemesis: The Expropriation of Health. New York: Pantheon Books; 1976, at 129.

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The Ethical Grounds for the Best Interest of the Child

  • LYNNE BOWYER

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