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In recent years parents and medical teams treating ill children have been increasingly unable to agree on medical treatment. This has been demonstrated by a mounting number of cases where the courts have been asked to decide a child's medical care. This paper considers the application of the dominant approach within Western medical ethics - the four principles approach - to children. The four principles are respect for autonomy, beneficence, non-maleficence and justice.
The four principles approach was developed by Beauchamp and Childress and has achieved prominence, at least partly, as a result of their authoritative book which is almost the bible of medical ethics. 1 Perhaps another reason why the four principles approach is dominant is the straight-forwardness of it. The four principles are akin to rules to be applied in each situation, which may appeal to doctors and nurses brought up in the scientific tradition. The principles are perhaps regarded in the same way as the facts of evidence based medicine and are more attractive to the scientifically trained mind than are the more vague recommendations of other ethical approaches. As an example, consider the requirements of a virtue ethics approach: "the virtuous person perceives a situation, judges what is right and wants to act accordingly because it is in her disposition to act well." 2 The four principles are more direct, concrete and action-guiding than is, for example, a virtue ethics approach.
One of the standard cases of medical ethics is the child of Jehovah's Witness parents, urgently needing a blood transfusion following a road accident. 3 This case is used as one of four paradigm cases that Gillon uses in a festschrift edition of the Journal of Medical Ethics (October 2003) devoted to methods, to argue that the four principles approach is the best way to analyse and resolve ethical problems in medicine.
"...Ranaan Gillon analyses this case using what he has described as the 'four principles plus scope approach', concluding that the surgeon, if he cannot obtain parental consent to save the child's life is morally right (and probably legally right) to override their refusal and administer a blood transfusion on the grounds (briefly summarised) that the child does not fall within the scope of the principle of respect for...