Search

Chapter 15 of the book "Globalizing Feminist Bioethics: Crosscultural Perspectives," by Rosemarie Tong, Gwen Anderson and Aida Santos is presented. It explores the moral relativism and female genital circumcision. It discusses the relevance of social context in evaluating interventions. It offers five primary reasons for female genital cutting which include religious requirement, group identity, cleanliness and health, virginity and marriage goals such as greater sexual pleasure for men.

In her review of the health status and plight of children in the United States during the past few years, Barbara Starfield has focused on our nation's allocation of material resources to the care of sick children. She understands care to be the access to and the ministration of medical treatment, and the prevention of various physical and mental maladies regarding which children are at serious risk. Hence Starfield has tallied essential facts that reflect the extent of our nation's commitment to the care of sick children. She draws conclusions from her data like: "… children who clearly need more services because of their increased health problems are at a marked disadvantage in receiving them if public policy does not provide the means to help them" ([9], p. 6); furthermore, "It seems only fair that society now consider a major public policy initiative for children" ([9], p. 8). [ABSTRACT FROM AUTHOR]

At one time in our history, children were very important. Were it not for the labor they contributed, many families would not have risen above penury. To a considerable extent, we owe the success of our national growth over the first century of our nation to the children. We "rewarded" them with a system of public education that, with all of its problems, is still a model for most of the world [4]. [ABSTRACT FROM AUTHOR]

In ‘Loving the Chronically 111 Child: A Pediatrician's Perspective' [4], Thomas Irons exhorts his fellow physicians to rededicate themselves to the traditional but endangered values of service and love for their patients. These values are symbolized by and embodied in the house call, the healing touch, the soothing voice, and the listening ear, activities and skills central to the practice of an earlier generation of physicians. Irons identifies a number of major obstacles preventing today's physicians from achieving the ideals of service and love, including fragmentation in health care, limited access to care, paternalism, defensive medicine, retreat into science, and over-reliance on consultation. The latter four of these — paternalism, defensive medicine, retreat into science, and over-reliance on consultation — are described as attempts by the physician to avoid the vulnerability and pain which accompany identification with the patient and his suffering. I believe that physicians would do well to dedicate themselves to the ideals Irons has presented, and I agree that the obstacles he discusses seriously threaten the provision of compassionate care for chronically ill children. [ABSTRACT FROM AUTHOR]

The doctor-patient relationship has historically been viewed as the most important aspect of the practice of medicine. Indeed, in the preantibiotic era, medical training and practice often had little else to offer. The enormous scientific advances of this century, especially in the last three decades, however, have shifted that focus substantially. Likewise, there are few who would deny that the relationship is seriously threatened and needs our attention. [ABSTRACT FROM AUTHOR]

Myron Genel's explorations bring the idea of advocacy into question: What is it to be an advocate? In Roman times, "advocatus" was the term for a legal assistant or a councillor. It was derived from the Latin "advocare", to call or to summon one to a place, especially for council or aid. It also meant to avail oneself of someone, such as an assistant, witness, or counselor, in some cause. The formal and forensic valence of these usages is an ancient one. In English it continues to suggest a conflictual circumstance. As is conveyed by Genel's essay, advocacy intimates the intrusion of an authority into decisions by parents regarding their children. Under such circumstances, it is unlikely that there will be a single understanding of proper advocacy or of the authority of an advocate. [ABSTRACT FROM AUTHOR]

I have decided to address the role of the pediatrician as an advocate for children in the development of health and social policy. Since this is a very broad charge, and there are many other pediatricians who have labored long and valiantly as advocates for children, it would be presumptuous and misleading for me to attempt to represent them all. Suffice it to say that the efforts of these pediatricians in a variety of areas ranging from calling attention to the horrors of a nuclear holocaust to the eradication of dread diseases such as smallpox and polio would have to rank as among some of the most noteworthy in the past and at present. [ABSTRACT FROM AUTHOR]

This essay will be concerned with the question: must a good doctor also be a good person? More precisely, the question is: does the conception of what it takes to be a good doctor include as part of its meaning the requirement that he or she also be a morally good person? One can imagine asking the same sort of question about other roles or relationships: for example, does one need to be a morally good person to be a good friend, a good parent, a good child, a good judge, a good minister, or a good counselor? In the case of, say, a good chess player the answer would, of course, be NO. A person could be a good chess player but a thoroughly immoral person. As far as the others are concerned, the answer is more problematic. Such is the case of the good doctor. [ABSTRACT FROM AUTHOR]

Peter English's ‘"Not Miniature Men and Women‘: Abraham Jacobi's Vision of a New Medical Specialty a Century Ago" [1] provides important insights into the history of pediatrics. Using the writings and speeches of early pioneers in American pediatrics, he has described some of the arguments these leaders used to convince fellow physicians and the public of the need for a medical specialty whose sole concern was children. In recounting how early leaders in pediatrics demonstrated that children were not "miniature men and women," Dr. English necessarily covers a number of topics in a short space. He gives a very close-up view, from the perspective of the participants themselves. In this commentary, I will take a few steps back and survey more of the scene to gain a sense of how the arguments English presents fit into the larger picture of turn-of-the-century medicine and society. [ABSTRACT FROM AUTHOR]

It does not require special powers of observation to note when you move into the pediatric section of a hospital, clinic, or emergency room. Health providers have frequently abandoned ties and whites; they cover over their formal name tags with Smurf characters; and they decorate their instruments with attention-diverting animals. [ABSTRACT FROM AUTHOR]

Pediatrics is so thoroughly integrated into contemporary culture that it is hard to believe it only emerged as a medical specialty in the late nineteenth century. Until the eighteenth century, it was simply the women's task to attend to childbirth and to the care of young children. When women needed tha advice of an expert, they turned to the midwife for help. Perhaps, then, we ought to discuss the nurse, midwife and mother as paradigmatic pediatric professionals. But if we may be forgiven for limiting our field, we will consider the pediatrician as a representative for a number of pediatric health care specialties: nurses, social workers, and therapists. In this final section, then, we examine the growth of the specialty of pediatrics and inquire what special qualities may be important in taking care of the children. [ABSTRACT FROM AUTHOR]

William Ruddick leads us beyond a simple-minded appeal to the best interests of children in determining levels of treatment. Nothing ever happens to anyone only in terms of his best interests, nor should it. Treatment and care are provided to adults not just in terms of what would be best for them. Consideration is given as well, and correctly, to the financial, psychological, and social costs to others. Societies establish levels of treatment by also asking the question, how will particular policies of providing care affect the providers and those who pay for the care? Ruddick's "biographical" question for parents, "How will treatment affect our lives?", reminds us that families should be concerned about their own burdens as well. The best-interests standard as a single standard is unreasonable. It would suggest that choices about the best interests of children can be made apart from decisions regarding the best interests of their families and society. Taken in isolation, it would suggest that obligations to achieve the best interests of children are absolute and cannot be defeated by costs or by obligations to others. [ABSTRACT FROM AUTHOR]

To take decisive part in a child's medical care, parents must know what questions to ask physicians — and themselves. I wish to examine three questions often asked and answered in pediatric decisions, namely, (1)"What would I do if it were my child?" asked by physicians of themselves;(2)"What would you do if it were your child?" asked of physicians by parents of ill children;(3)"What is in the child's best interests?" asked by both physicians and parents. [ABSTRACT FROM AUTHOR]

Dan Brock argues persuasively that the general presumption of incompetence on the part of minors to decide about their medical care seems indefensible for children roughly above the age of 14 [1]. The presumption still exists and apparently remains strong in the law. But as Angela Holder points out [2], the courts are moving in the other direction. I am essentially in agreement with this, and find most of Brock's analysis of the notion of competence convincing. However, I am unconvinced that children at even earlier ages may not often have as much competence in this area as most adults. I stress this comparative judgment, because I think it is important that, in our concern for the well-being of children, we do not expect more from them than from adults in comparable situations. That having been said, I will argue that children nonetheless probably should not be given the authority to make such decisions, even though adults in similar situations should. That is, I will argue both that children have the necessary competence and that decisionmaking authority should not be extended to them. [ABSTRACT FROM AUTHOR]

What role should children play in decisionmaking about their health care?1 The doctrine of informed consent requires that medical treatment only be given to adults with their competent, informed and voluntary consent. The law, as well as common medical practice, presumes that adults are competent to decide about their medical treatment, though this presumption can be rebutted in particular instances. On the other hand, the law presumes that minors, who in most states are persons below the age of 18 years, are not competent to decide about their medical care; though with some exceptions to be noted below. For minors, the law generally holds that others, usually parents or guardians, are to decide for them about their medical treatment. The general presumption then in legal policy is that adults are entitled to decide about their medical care while children are not. However, medical practice, as we shall see, for good reason has often involved minors in decisionmaking about their care to a greater extent than the law seems to require. [ABSTRACT FROM AUTHOR]

The question of whether children should be given a role in decision-making concerning their own medical care is part of a broader question of how children should be treated in general. And for answering that we lack a clear and coherent framework. Falling as they do somewhere between adult humans and animals in terms of their capacities, but normally having from the moment of conception the potential to become adults, children constitute a category of living things unlike any other from the standpoint of the moral and conceptual problems their treatment raises. Improperly cared for, they tend to grow up incapable of relating normally and happily to other adults; overly cared for and kept dependent, they tend to grow up incapable of relating normally and happily to other adults. Few can agree what constitutes just the right kind and quality of care. [ABSTRACT FROM AUTHOR]