Do Parents’ Reasons Matter? The Ethical Significance and Implications of Reason-Giving in Pediatric Ethics

Abstract: In pediatrics, most acknowledge that parents’ reasons for requesting or refusing medical interventions matter pragmatically; attending to parents’ reasons is important for partnering effectively with families. Yet some dispute that parents’ reasons matter normatively. Indeed, parents’ reasons for requesting or refusing an intervention are often deemed ethically irrelevant to whether the decision poses serious risk of significant harm to the child or falls within the zone of parental discretion (Diekema 2004; Gillam 2016). Despite some discussion of whether and how parents’ reasons matter in the pediatric ethics literature, controversy surrounding this issue persists.

In this presentation, we bring together ethicists and clinicians from four pediatric hospitals to explore the ethical significance and implications of parents’ reasons in pediatric decision making. Panelist 1 will introduce the topic and present a hypothetical case to illustrate how parents’ reasons can transform ethical analyses. Panelist 2 will analyze how reasons typically function in pediatric ethics, including summarizing key arguments for and against granting parents’ reasons ethical weight when evaluating decisions. Panelist 3 will discuss what sorts of reasons parents offer in practice and how clinicians might respond to those reasons. Panelist 4 will explore the role reason-giving might play in fostering physician-parent relationships and the obligations each party may have relative to their reasons for certain decisions. Panelist 1 will then present preliminary data from a qualitative study exploring clinicians' and ethicists' views on this topic, before moderating guided Q&A with the audience.