Iltis Ana S
Center for Bioethics, Health and Society and Department of Philosophy, Wake Forest University, Winston-Salem, NC 27109, USA.
J Med Philos. 2010 Oct;35(5):526-52. doi: 10.1093/jmp/jhq039. Epub 2010 Sep 5.
Within and among societies, there are competing understandings of the status of children, including debates over whether they can bear rights and, if so, which rights they bear and against whom, and their capacity to make decisions and be held responsible and accountable for actions. There also are different understandings of what constitutes a family; what authority parents have over and regarding their children; and what should happen to children who are without parents because of death, desertion, or imprisonment. These and other related debates reflect deep differences in worldviews, in how one understands the legitimate role of the state, in how one comes to know the proper way to raise children, and so on. The United Nations Convention on the Rights of the Child purports to reflect international convergence on the rights of children, on how decisions concerning children should be made, and on how children ought to be treated by the state and by their parents. This paper examines whether the Convention's framework for decision making concerning children is an appropriate framework for pediatric bioethics. Questions about how to make health care decisions for children ultimately are questions of who is in authority to make and judge such decisions. Establishing who is in authority, determining whether there are any limits to that authority and, if so, defining those limits should be the focus of efforts to develop and implement a pediatric decision-making framework.
在不同社会内部和之间，对于儿童的地位存在相互竞争的理解，包括关于他们是否能够享有权利的争论，如果可以，他们享有哪些权利以及针对谁享有这些权利，以及他们做出决策以及对行为负责和承担责任的能力。对于什么构成家庭、父母对其子女拥有何种权力以及对于因死亡、遗弃或监禁而失去父母的儿童应该如何处置，也存在不同的理解。这些以及其他相关的争论反映了世界观的深刻差异，反映在人们如何理解国家的合法角色、如何认识养育子女的正确方式等等方面。《联合国儿童权利公约》旨在反映国际社会在儿童权利、关于儿童的决策应如何做出以及国家和父母应如何对待儿童等方面的共识。本文探讨《公约》中关于儿童决策的框架是否是儿科生物伦理学的适当框架。关于如何为儿童做出医疗保健决策的问题最终是谁有权做出并评判此类决策的问题。确定谁有权限、确定该权限是否有任何限制，如果有，界定这些限制应该是制定和实施儿科决策框架的努力重点。
