Children, Ethics, and Modern Medicine

Conclusion: On Liberal Care

In Parts I and II of this book, I sought to draw broad contours of pediatric bioethics (Moralität ) as a framework for considering specific issues and experiences in the medical culture of pediatric care (Sittlichkeit ). Although Part I emphasized an ethics-distant orientation and Part II an ethics-near orientation to medical ethics, I sought to keep both orientations in focus in proceeding from theory to culture, from contours to cases. I want to conclude by isolating and commenting on a topic that is fundamental to both parts, namely, the family in private and public life. As we saw in Part I, there are strong, albeit qualified, reasons for respecting parental autonomy and family privacy. As we saw in Part II, there are good reasons for outsiders sometimes to intrude into a family’s internal affairs. Both of these facts remind us that parental autonomy has presumptive, but not absolute, weight in cases regarding a child’s welfare. Many parents make decisions for their children in fear and trembling, but what do we make of those who don’t? In Chapter 2, we saw why, and to what extent, parental autonomy ought to be respected, and now I want to identify reasons why the shield of family privacy should not be impenetrable. My reasons are moral, political, or a combination of both. Not all of them warrant intervention in the domestic lives of others, but each of them points to reasons why families are not immune from moral criticism, either from within or from without.1 Whether a child is raised by a married couple, a single parent, a divorced couple sharing custody rights, a gay or lesbian couple, an unmarried heterosexual couple , or grandparents, or in a women’s collective or a kibbutz, they have certain basic claims to protection and care. My ideas draw largely from liberal philosophy, especially the ideas of John Rawls, which is sometimes associated with promoting a high level of freedom and tolerance in nonpublic affairs—thereby making it difficult to evaluate or intrude in the domestic lives of families. Contrary to that imConclusion : On Liberal Care Conclusion | 269 pression, Rawls includes the family in the “basic structure” to which the principles of justice ought to apply.2 To be sure, Rawls does little to develop those ideas systematically, leaving untouched some obvious questions about whether and on what terms family privacy is to be respected. But liberal doctrine offers resources to prevent families from becoming small tyrannies, aspects of which I want to develop now. Here I will isolate several of Rawls’s claims and briefly develop their positive implications for an ethics and politics of the family, focusing on the rearing of children.3 The liberal understanding of care that I developed in Chapter 2 suggests how that might be possible, and why family privacy is not an absolute value in liberal social thought. There, I indicated that respect for parental autonomy must be understood within a framework defined by adult responsibilities and the duty to care. I argued, among other things, that respect for parental autonomy must be constrained by virtues and norms, especially benevolence and beneficence. Family privacy is not an incorrigible principle, and liberal social critics have reasons to insist that it be qualified. Viewed normatively in liberal terms, the family is (1) a school of personal moral development, (2) an equitable, intimate social grouping, (3) a source of personal self-worth, (4) an aid to opportunity, and (5) a school for political citizenship. Each of these ideas merits comment. First, the family is expected to facilitate the moral development and education of children, and in that regard it is a central institution in any society .4 Amending Rawls’s language, let us say that families should impart a “sense of care,” a strong desire to act on virtues that dispose us to attend to others’ needs. We acquire such virtues, Rawls observes, as we develop moral sentiments that are first nurtured in family settings. Although Rawls’s attention to moral development in the much-neglected third section of A Theory of Justice focuses on acquiring a “sense of justice,” much of what he says also explains how we develop the virtues and duties of care.5 Those ideas, in turn, shed light on the role of the family in imparting civic virtues, blurring the boundaries between public and private life. Given that the family can nurture sentiments of justice and care, so important to our common life...