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‘Who Is Silent Gives Consent’: Power And Medical Decision-Making For Children
[Thesis]. Manchester, UK: The University of Manchester; 2011.
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Abstract
This thesis seeks to examine how healthcare decisions are made for children, with a particular focus on situations where medical interventions that (1) are not intended to advance the medical welfare of the individual child (eg bone marrow donation and research without therapeutic intent involving young children), or (2) are contrary to the expressed will of the child (e.g. the imposition of life-saving treatment on adolescents who have refused it), are authorised by parents or the state. The authorisation of these procedures is contentious because they breach the child’s bodily integrity while either (a) lacking a clear therapeutic purpose with regard to that child, or (b) being imposed even though refused by a possibly competent adolescent. Their controversial nature has lead to attempts to justify these procedures, generally by the application of ideal-type adult-child relationship theories. The four papers at the core of this thesis examine these legitimising propositions, but demonstrate that they are insufficiently robust to legitimise the acts in question. Instead, this thesis raises questions about inequality; about why it is deemed acceptable to take the tissue of the vulnerable incompetent but not the capable adult; or why it is appropriate to impose different tests of mental capacity on the adolescent and the adult, or of competence on the ‘criminal’ child and ‘innocent’ teenager. It is proposed that the reason that inequitable treatment can occur is because adults sit in a position of power and authority relative to children. The common themes in all four papers are thus the issues of power, inequality and fairness. There is also a focus on the use of language, and it is argued that terms are used in academic debate about children’s healthcare issues that lead to a lack of clarity and transparency in discussions about the imposition of unchosen healthcare burdens on vulnerable populations. If we hold that children are morally relevant beings deserving of respect then debates about matters that concern them should take place using language that avoids obfuscation and the cloaking of adult interests.
Keyword(s)
Children; Consent; Healthcare decision-making; Parents; Power