Children, Families, and Health Care Decision-Making

By Cranston, Bob | Ethics & Medicine, Summer 2003 | Go to article overview

Children, Families, and Health Care Decision-Making


Cranston, Bob, Ethics & Medicine


Children, Families, and Health Care Decision-Making Lainie Friedman Ross Oxford, UK: Oxford University Press, 2002 ISBN 0-19-925154-1, 216 pp., paperback, $19.95

This is not a "Me, too!" book. A number of books have been written on medical ethics decision-making in the context of society, at a policy level, and in regard to particular clinical decisions. The majority of these focus on broad societal issues, including biotechnology and reproductive concerns. Case study books most frequently deal with reproduction, abortion, or adult medical case scenarios. Lainie Friedman Ross provides us with the first major book-length discussion of decision making with children and their families. She does an admirable job of covering this important topic in an original, engaging manner.

Much of this work resulted from Ross's doctoral thesis, which she produced after completion of her medical degree and paediatric residency. She brings to it the skills of both an astute philosopher and a compassionate paediatrician. Growing up in and continuing to espouse a relatively secular, Jewish mindset, she nonetheless identifies Paul Ramsey and a 'Christian Ethics' course at Princeton as important in her original interest in medical ethics. While this work is not Christian in orientation, many of her principles are compatible with a Christian worldview and frequently at odds with an established liberal, primarily child-focused approach to paediatric decision making.

Ross argues that a child empowerment model, such as that espoused by then First Lady Hillary Clinton and others, fails on three counts. First, it fails to recognise the child's need to obtain necessary skills and virtues. Second, it fails to recognise the parents' role in helping to define the child's well being and conception of the good. Third, it fails to respect the parent's interest in child rearing. In its place she offers a model of 'constrained parental autonomy.'

To frame her thesis, she incorporates four necessary assumptions in her argument. First, she 'assumes that children are members of intimate families.' She elaborates only briefly on this complex assumption, but her model clearly includes the heterosexual, two-spouse model as legitimate and statistically the most usual. Second, she assumes 'that the child's biological parents have and should have primary child-rearing responsibility.' Third, she assumes that 'the family is an important institution in the lives of most people...' Finally, she assumes that in general 'all children are incompetent to make health care decisions and that they should not have presumptive decision-making autonomy. …

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