New York City College of Technology, CUNY, 300 Jay Street, N611, Brooklyn, NY, 11201, USA.
Theor Med Bioeth. 2019 Aug;40(4):279-297. doi: 10.1007/s11017-019-09497-6.
According to various accounts, intervention in pediatric decisions is justified either by the best interests standard or by the harm principle. While these principles have various nuances that distinguish them from each other, they are similar in the sense that both focus primarily on the features of parental decisions that justify intervention, rather than on the competency or authority of the parties that intervene. Accounts of these principles effectively suggest that intervention in pediatric decision making is warranted for both physicians and the state under precisely the same circumstances. This essay argues that there are substantial differences in the competencies and authorities of physicians and the state, and that the principles that guide their interventions should also be conceived differently. While both the best interests standard and the harm principle effectively incorporate important aspects of physicians' ethical obligations, neither adequately reflects the state's ethical obligations. In contrast to physicians, the state has major obligations of distributive justice and neutrality that should form an integral part of any proposed ethical principles guiding state intervention in pediatric decision making. The differences are illustrated by examining recent cases involving parental refusal of chemotherapy in aboriginal Canadian communities and parental refusal of blood transfusions by Jehovah's Witnesses.
根据各种说法，干预儿科决策的理由要么是符合最佳利益标准，要么是符合伤害原则。虽然这些原则在细节上有所不同，但它们的相似之处在于，两者都主要关注父母决策中值得干预的特征，而不是干预方的能力或权威。这些原则的解释实际上表明，在完全相同的情况下，医生和国家都有理由干预儿科决策。本文认为，医生和国家的能力和权威存在很大差异，指导他们干预的原则也应该有所不同。虽然最佳利益标准和伤害原则都有效地包含了医生道德义务的重要方面，但两者都没有充分反映国家的道德义务。与医生不同，国家有分配正义和中立性的主要义务，这些义务应该成为任何指导国家干预儿科决策的拟议伦理原则的一个组成部分。通过检查最近涉及加拿大原住民社区父母拒绝化疗和耶和华见证人父母拒绝输血的案例，可以说明这些差异。
