Parents, in normal circumstances, are the proper judges of what is in the child’s best interests, even where those decisions are made as a result of a non-mainstream world view and have serious consequences.
In the Middle Ages, the accepted view tended to be that infants that died without being baptised would either go to hell or fail to attain heaven and end up in limbo (1).
The intellectual background to this is interesting, but it is not a view that seems to be widely held now among Western Christians, probably for a variety of reasons both good and bad.
However mistaken we may now suppose the belief, many people at the time sincerely and rationally held that the infant’s welfare, and often its eternal destiny, rested on its being baptised.
A natural consequence of this belief was the desire to make sure all infants were baptised, including the children of Jewish parents. It makes complete sense, in that world view, to argue that for the sake of the children’s welfare, the children of “unbelievers” should be baptised against the will of their parents.
Aquinas insisted in the Summa Theologicae, that in fact non-Christian parents had the right to refuse baptism for their children. (2).
In modern thought, Aquinas emerges from this debate as the hero, the defender of human rights as we would see them, though his reasons for defending these rights are not the reasons a modern liberal would have.
But, thinking around this, I have come to think that the same argument, in modern times, ought to apply to the right of parents to choose what medical treatment a child has.
The easiest example is the controversial one of the Jehovah’s Witnesses and blood transfusions. I completely disagree with the Jehovah’s Witnesses on the point of blood transfusions: I believe it is bad theology in every way. But I don’t think the rest of us have the right to impose our world view on them – or on their children before their children are of an age to decide for themselves that they wish to consent to the mainstream world view and not that of their parents.
Just as the people of the middle ages believed that children’s welfare was best served by baptism, we think that their welfare is best served by having a blood transfusion when that is medically indicated. Just as it was wrong for the people of the Middle Ages to try to impose baptism on the children of those parents who did not think their children’s welfare best served by baptism, it is reasonable to argue that it is equally wrong to impose such medical treatment on the children of parents who do not think their welfare is best served by it.
It is an issue of world view. The parents do not believe this is ethical medical treatment, they believe it will compromise their child’s access to salvation, and they therefore do not believe their children will benefit from having it (3). This can only be challenged by demonstrating a different theology/world view, either that of the mainstream Christian churches (which would interpret those passages in scripture in a very different way) or that of the secular world, in putting the saving of earthly life before any other consideration (except a few issues regarding respecting other people’s rights (4)). The notion that a person’s biological life should be saved at almost any cost is a world view conviction. It is not a necessary or universally held belief; indeed, Christianity rejects it in theory in holding that one should die rather than deny Christ. To refuse to respect the ordinary medical decisions of parents because we don’t agree with their world view is difficult to justify within liberalism (5).
It is true that I don’t share much of the liberal understanding, as I have a world view which I believe to be incompatible with the individualism on which liberalism is based, and I hold that liberalism is rather deficient in explanatory power, but my theories give similar answers regarding personal freedom on matters of this sort (6). (In any case, it is possible to argue that a theory to which you don’t subscribe is being internally inconsistent according to its own principles).
Parents do a tough job, often under very difficult circumstances, practically and emotionally. Deciding what is in a child’s best interests, even in normal circumstances, is not easy. Courts and doctors are not infallible (7) any more than medieval theologians were, even within their own subject matter. They are certainly not infallible when it comes to questions of world view, which are not their expertise. To insist that children should be given medical treatment contrary to the parents’ wishes, where the parents have not forfeited their natural authority by deliberate abuse or malice towards the child, is to create a situation where children are regarded by society as detached from their families in a worrying way.
This is perhaps easier to illustrate in contexts other than medical autonomy. I remember an article in my council magazine that talked about wanting more children to have the chance to live with their families. Or people comment on the merits or otherwise of “giving parents more authority”. The assumption behind both those ways of thinking is that authority over the children does not primarily and automatically belong to the parents, but to representatives of the nation (local councillors, teachers, social workers), who have the authority to delegate it to parents if they so choose, and not if they don’t. Did anyone actually intend that, and if so, have they really thought through what it means?
While I have no precise answers as to when it is legitimate (8), I am not arguing that there is no situation in which a judge can overrule parents or a child be taken away from an abusive family. I do think there comes a point where the natural authority of the parents is forfeited by its misuse, and in that case, the child is a person in the wider community, and we have the duty to go to its aid, just as we would if their parents were absent through death or mentally incapacitated by illness. And I appreciate that the people involved in wanting to give medical treatment, or wanting to take a child away from a family, are desperately keen on looking after the child, and are not motivated by any ulterior motive.
However, I think that, among other things, we need to keep the stolen generation and the forced baptism of the children of non-Christian parents before our eyes as a society when considering what it is right to do and not do. The fact that the best interests of the child properly come first, over and above any individual rights of the parents in the child, does not in itself entitle us to appoint ourselves, or the nation state and its representatives, as the primary judges and defenders of what those best interests are. Parents are, under all normal circumstances, the proper judge of a minor child’s best interests. Believing we are right, or even actually being right in a particular case, does not entitle us to impose our decision on the child instead.
I don’t want to pretend the question is easy or simple; I have every respect for the fact that people come honestly to different conclusions on this matter for good reasons. However, despite the fact that it is radical, I have come to think that parents having a different world view, and/or a different idea of what will best serve the child’s welfare, is not, on its own, something that entitles our society to overrule their normal autonomy to say yes or no to medical treatment for their child, and that we should, socially and legally, respect the medical autonomy of these parents unless there is some other reason not to do so.
1.This gives a very wide range of possibilities as to the actual unpleasantness of their fate, complicated by the fact that Heaven, Hell, and similar, are not final destinations in Christianity (at least, not in a disembodied state), though in some ages this slips out of the intellectual picture. See: http://www.newadvent.org/cathen/09256a.htm for the history, note, however, that it is not up to date: https://www.britannica.com/topic/limbo-Roman-Catholic-theology. John Donne’s comments on the subject, interestingly, are very much in the “baptism is the normal means of grace but we can’t limit God’s power to it and claim he can’t save without it” line. (John Donne, 1572-1631 was an Anglican theologian; The Oxford Authors: John Donne, edited by John Carey, Oxford University Press 1990, page 328).
2. http://www.newadvent.org/summa/4068.htm#article10 (Note about reading Aquinas: he writes in an argumentative form, starting with arguments for the view he doesn’t hold; his own position is stated under the subheadings: “on the contrary” and “I answer that”).
3. This mostly comes from my memories of a conversation I had with someone who knocked on my door some years ago. See also https://www.jw.org/en/medical-library/blood-transfusion-bioethics-medical-law/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934270/ The latter discusses the denial of the right of competent adults to refuse medical treatment in life-threatening cases, which I have not previously heard discussed; I have taken for granted in this post that the wish of an adult to refuse treatment would be accepted without question, the only difficulty being the sort of emergency situation where treatment is necessary instantly and the wishes of the patient cannot be determined.
I’d point out that the arguments used for forcing blood transfusions on adults there could equally be used to justify forced abortion in similar circumstances.
To the “nobody can be deprived of life by their own parents” argument, I would reply that the parents are not depriving the child of life, but that it is a case of double effect, as in any case of the refusal of a good consequence on the grounds that the means are illegitimate. If parents refused to accept an organ taken from a live donor against that donor’s consent, or even a traded organ, for their child on ethical grounds despite the fact that the child would die without the transplant, I do not think it would be held that they were depriving the child of life. Disagreeing with the principles does not mean we should refuse to respect integrity.
4. We had some interesting debates on this at university. In my experience, most people with a secular world view, whose summary position is that anything is permissible to save a life, do in fact draw the line at, for instance, an organ transplant taken from a live donor contrary to their consent.
5. To go into the whole problem of liberalism and minors – the fact that it is difficult to accommodate children logically in a theory which doesn’t allow for the development of rationality within a tradition – would be too far out of the subject, but I am well aware of it as an issue of difference. Parental authority is something that tends to be justified by natural law theories of a particular type, and that liberals could challenge me here regarding their view by saying that parental autonomy is not part of their ideas. My response would be that if it is not possible to justify parental autonomy in matters such as medical treatment, it is almost certainly even more difficult to justify the nation state as having that authority instead. It should also be remembered that sauce for the goose is sauce for the gander: the right of the thirteen-year-old daughter of Roman Catholic parents to be prescribed the contraceptive pill contrary to her parents’ wishes, on the grounds that she has adequate capacity to make her own decision, is the right of the Jehovah’s Witness teenager of similar maturity to take the risk of refusing a blood transfusion on the same grounds.
6. I am a communitarian rather than a liberal, however, I agree, with some qualifications, with MacIntyre’s position that a nation state is not a type of community which can have an extensive shared notion of the common good. This tends to produce similar answers to those that liberalism would give on this type of question, despite the fact that the chain of reasoning by which they are reached is fundamentally different. (Stephen Mulhall and Adam Swift; Liberals and Communitarians; second edition; Blackwell Publishing 1996; pages 98-101). As far as liberalism goes, I am arguing that the denial of parental autonomy in cases like those of the Jehovah’s Witnesses is not consistent with the liberal position, even though I do not share the liberal position except coincidentally.
7. See John Stuart Mill; On Liberty; Penguin Classics 1985; p. 77-83.
8. To have a precise answer to this question would require a theory regarding exactly what authority properly appertains to the individual, the family, local community, and nation state, in what circumstances, and why, and that is a very complicated question.