What is a Child? Implications for Pediatric Ethics and Child Assent

Abstract: Our sense of what constitutes a child and the experience of childhood, is often taken for granted and rarely explicitly articulated, especially in medicine. On the one hand, and quite obviously, a child is a human person of a certain age (usually under 18). But on the other hand, if asked in a slightly different way—“What is the essence of a child?” or “What is important about childhood?”—we are challenged to make explicit certain notions that we rarely engage directly because what is significant or distinctive about childhood usually goes far beyond mere chronological age.

This presentation will argue that modern Western medicine has inherited (from numerous ancient and modern philosophical sources) a particular anthropology of the child: the child is a future rational, individuated and autonomous adult. However, this tacit understanding inadvertently constructs the child as being defined by deficiency (vis a vis the “adult”), a characterization which is both ontologically impoverished and normatively dangerous. By characterizing the primary work of childhood as growing into a certain type of adult, thereby constructing the child as a deficient adult, we overlook the important goods unique to childhood.

After tracing the philosophical roots of this version of a deficiency model, this thesis will be explored relative to the role that “assent” plays in pediatric ethics, arguing that “assent” as an ideal form of child participation in decision making actually de-centers the child, qua child and centers, instead, the future adult.