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Controversial Topics on Children and Rationality: Ethical Issues on Children's Treatment Decision Making (2)

Updated on July 3, 2013
Making Decision for Singing!
Making Decision for Singing!

In my preview article, I have discussed that some ethical issue in making decision regarding children treatment. It is not like asking Kermit to steal cookie from Cookie Monster that simple (It is because Kermit and Cookie Monster are friends). Some holds that when children have the ability to understand the nature of treatment for them, their decision should be respected. Such view consists to autonomy principle, nonetheless.

Although these arguments are quite controversial, the ethical issue regarding decision-making to children is complicated and tricky.

In this article, I will show my objections that when we make decision to children regarding their treatment, the autonomy principle cannot fully explain what children want.

Children Decision Making

Children's Rationality is Questionable

First, there is a distinction between expressed wishes and true wishes. Although children may have ability to make a full and valid decision, their expressed wishes can possibly not a true reflection of their best interest, and it causes their wishes are not true at all.

To a large extent, children clearly lack of knowledge and experience of many professional treatments such as the effectiveness of the side effect of ECT (the damage of the brain). Their intentions, wishes, motives, emotions, and the whole structure of values toward the treatments may be less secure and stable than adults. In other words, children’s identities may be less securely than adults because they lack of experience and knowledge, and they may have less sense of connection, responsibility, and social constructed identity.

Moreover, since children and young people are highly lack of knowledge of certain treatments, they may possibly have less practice of decision-making, too. While children and young people’s identities are not yet fully formed, their expressed wishes are not fully reflected to what they really need and hence are not their true wishes.

Listen to me, I have better rationality than you.
Listen to me, I have better rationality than you. | Source

Adult has better Rationality than Children

Second, while children have less practice than adult in decision-making regarding their treatments, it also means that they may be less rational than adults.

According to the ethicist Donaldson, the notion of rationality is that it involves an adequate judgment of probable outcomes [Footnote 1]. Children are often less “calibrated” in judging probabilities and chances [Footnote 2] since they have less experience of making decisions and have less knowledge of the reality of the world than adults.

Further, Ronald Dworkin claims that as rational agents, people have rights and their rights should be respected [Footnote 3]. In fact, this claim is consistent to the concept of patient’s autonomy. While we take rationality as one of the conditions of autonomous choices [Footnote 4], children are actually less autonomous than adults.

Substantially, children’s sense of themselves as autonomous does not really reflect them autonomous or give them rights, and their decision may not be truly expressed. Although I agree that autonomy should be respected, in children cases are different because their values, rationality, and identity can be rapidly changed by various factors.

Parents always want their kids at best, but not like this extreme.
Parents always want their kids at best, but not like this extreme. | Source

Parents always want their children at best.

Third, the interest of parents in making decisions about their children’s welfare is important. This makes a significance difference between adults and children. One can holds that parents have rights and responsibilities to protect their children from harm, but parents are also trying to maximize their children’s welfare and want them to be good as well.

Particularly, in most cases parents have more knowledge, experience, and understanding of the effective treatments, they care deeply about their children and aim to children’s good. For example, if parents understand that ECT may damage their children’s brain, they can refuse the treatment on behalf of the children.

Obviously, parents know their children better than others, and they know what their children really need. Parents primarily want to ensure that their decisions can serve their children’s welfare at best. I believe that the claim will be implausible if one says that parents do not want their children best in any circumstances.


In my previous article with this article, I have shown the issue of having treatments regarding children. While children’s abilities can change rapidly in a short period of time, their decisions can be also changed rapidly. Although few cases show that children can make full consent if they have an ability of understanding, the issue is apparently more complicated.

Children can be sufficient understanding, but they certainly lack of experience or knowledge regarding the effective treatment. Parents and health care providers nonetheless often make decisions on behalf the children because they want to optimize children’s welfare, and they have better understanding and knowledge. Since they always want the children to be good at first, in my view, it is permissible for parents and health care providers to decide for the children regarding the treatments.


[1] Donaldson, M,Children’s minds.London: Fontana (1978).

[2] Dworkin, R.,Taking rights seriously. Oxford: Oxford University Press (1977).

[3] For example, Beauchamp and Childress both claim that rationality is one of the conditions of autonomous choices.

[4] Dickenson, D., & Jones, D.True wishes: the philosophy and developmental psychology of children’s informed consent.Psychology, Psychiatry, and Philosophy (1995) 2, p. 294.


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