The importance of global bioethics to paediatric health care

The paradigm of values adopted by the global health community has a palpable, albeit often unseen, impact on patient health care. In this Viewpoint, we investigate an inherent tension in the core values of medical ethics and clinical practice that could explain why paediatric health care faces resource constraints despite compelling economic and societal imperatives to prioritise child health and wellbeing. The dominant narrative in the philosophy of medicine tends to disproportionately underscore values of independence and self-determination, which becomes problematic in the context of paediatric patients, who by their very nature epitomise vulnerability and dependence. A double-jeopardy situation arises when disadvantaged children see their inherent dependence leveraged against them. We illustrate this predicament through specific examples relating to rights and obligations and to autonomy. Alternative value perspectives-communitarianism and relational autonomy-might offer more robust protection for vulnerable children. A shift away from the dominant narrative towards a more explicit and inclusive discussion of values is necessary. Such a shift requires giving a legitimate platform to diverse perspectives, with the presumption that collective moral progress is possible; this endeavour is embodied by global bioethics. Successful implementation of global bioethics, in turn, hinges on close collaboration between practicing clinicians and bioethicists. Taking global bioethics seriously and actively pursuing collaboration could help the global health community achieve more equitable health care.

Ethics, Poverty and Children's Vulnerability

This paper is concerned with child poverty from an ethical perspective and applies the normative concept of vulnerability for this purpose. The first part of the paper will briefly outline children's particular vulnerability and distinguish important aspects of this. Then the concept will be applied to child poverty and it will be shown that child poverty is a corrosive situational vulnerability, with many severe consequences. In this part of the paper normative reasoning and empirical literature will be brought together. Then, the next section will establish why this increased vulnerability of poor children and the harm to their well-being and well-becoming, which they suffer for this reason, are of ethical concern. It will be discussed that child poverty is a structural problem based on social, political and economic factors. The concluding section will then briefly outline why it is imperative to protect children from the vulnerabilities associated with poverty.