Posted on May 8, 2019 at 11:32 AM
By Steve Phillips
The 2 posts on this blog this week by Neil Skjoldal and Mark McQuain raise issues related to parental decision-making for the medical treatment of their children. Neil raised this issue related to parental refusal of life-saving treatment for acute leukemia and Mark raised it related to parental decisions not to have their children immunized for measles. There are some similarities in these situations and some differences. An obvious similarity is that in both of these situations parents are making a decision to refuse treatment for their children that is the recommended standard of care. Both situations raise issues about who should make decisions about the medical care that children receive and how those decisions should be made.
One thing we should be clear about is that this is not a
conflict between the principle of respect for autonomy and the principle of
beneficence. Respect for autonomy says that a person should be able to make
decisions about what happens to his or her own body. It says that it shows
disrespect to an individual as a person to insist a person receive recommended
medical care when that person has the capability of making his or her own
decisions and does not consent to the recommended care. This principle does not
apply to decisions about the medical care of young children. Young children are
not capable of making decisions about their own care and the parents are not
the ones receiving medical treatment, so respect for autonomy does not apply to
What is involved is our understanding of parental
responsibility for making medical decisions for their children. Because young
children do not have the ability to make their own medical decisions, someone
needs to serve as a decision-maker for them. We generally understand that
parents ought to be the ones making those decisions. We have good reasons for
that. Decisions about the medical care of young children should be made based
on what is in the best interest of those children. God has created us as human
beings to be dependent during the early part of our lives. He has put us in
families with parents who have the responsibility for providing for the needs
of their dependent children. Parents should love their children unconditionally
as a precious gift and make decisions for their children based on what is best
for each child. This usually makes parents the people who care the most about
doing what is best for a child and makes them the best medical decision makers
for their child.
However, sometimes parents do not fulfill their parental responsibilities
as well as they should. None of us are perfect, but there are times when it is
clear that the decision being made by a parent is not what is best for a child.
When the potential consequences for the child are serious enough it can become
the responsibility of the rest of us to intervene for the benefit of the child.
We should not violate parental responsibility lightly, and it needs to be done
in a controlled and orderly way, but when the child’s life is in danger, we
have a responsibility as a society to intervene to protect a child. We should
do this in any type of severe neglect or abuse. We should do it when parents refuse medical treatment
for a child who is likely to die if without treatment and the treatment has a
good chance of saving the child’s life.
That appears to be the case in the situation in Neil’s post.
The concern about parents refusing immunizations for their children has some
similarities, but is more complex. It will take another post to address that.