Department of Philosophy, University of Colorado at Boulder, Boulder, Colorado.
Bioethics. 2020 Jun;34(5):502-508. doi: 10.1111/bioe.12686. Epub 2019 Nov 7.
Children are presumptively regarded as incompetent to make their own medical decisions, and the responsibility for making such decisions typically falls to parents. Parental authority is not unlimited, however, and ethical guidelines identifying appropriate bounds on this authority are needed. One proposal currently gaining support is the harm threshold (HT), which asserts that the state may only legitimately intervene in parental decision-making when serious and preventable harm to children is likely. This paper considers two questions: in virtue of what underlying principle or property does the HT gain its purported justification?; and does this underlying principle or property ground the HT as its proponents conceive of it? I identify two separate grounds represented in the literature: (a) J.S. Mill's Harm Principle; and (b) the liberty interests of parents. I find that the HT is not sufficiently grounded in either of these, revealing a substantial conceptual difficulty for its advocates.
儿童被推定为没有能力做出自己的医疗决定，而做出此类决定的责任通常落在父母身上。然而，父母的权力并非无限的，需要制定确定这种权力适当界限的道德准则。目前得到支持的一个建议是伤害门槛（HT），该建议主张，只有在儿童可能遭受严重和可预防的伤害时，国家才可以合法地干预父母的决策。本文考虑了两个问题：HT 通过什么潜在的原则或属性获得其所谓的正当性？以及这个潜在的原则或属性是否为 HT 提供了其支持者所设想的基础？我在文献中发现了两个独立的基础：（a）J.S.密尔的伤害原则；以及（b）父母的自由权益。我发现 HT 在这两者中都没有得到充分的支持，这揭示了其支持者面临的一个实质性的概念困难。
