Reconsidering Harm in Pediatric Ethics - Dignity, The Right To Play, and The Limits of Parental Authority

Abstract: Though widely accepted as a threshold in clinical pediatric ethics, Diekema’s harm principle or threshold has been criticized for the indeterminate nature of harm. Assessing a nonphysical harm related to a child’s development, for example, requires a more comprehensive understanding of the nature of harm vis-a-vis the good [life]. Thus, this paper will present a concept of the good that re-frames the notion of harm with attention to developmental harms such as those that thwart socialization or play. This will be achieved by first establishing the relationship between the good life and dignity, and then considering development and the right to play as essential characteristics of the good life outlined by the Capabilities Approach. ‘Right to play’ will then be considered in view of a clinical case in which a pediatric patient’s parents denied their child that essential right.

Vanessa Madrigal, MD, HEC-C – Director, Pediatric Ethics Program, Children's National Hospital