Semáforo

The third set of interests are the relational interests of the child (Buchanan & Brock 1990, p.

247). Carl Elliot (2001) points out that a potential problem faced by the best interests standard is

177 that it focuses on the child as an individual only, not taking into account the localization of the child within a family [6]. In Elliot’s words:

“This can leave us with a kind of misplaced individualism, as if the only ethically important considerations are those that have to do with the child himself – intrinsic abilities like his intellect, his awareness, his physical abilities and so on. But this is an odd way to look at children, since what is most striking about children is not their intrinsic abilities but their dependence. Children exist in relationships of dependence on their families… It seems ungainly to try to consider children’s interests apart from the interests of their families because their interests are bound up together. This is more than simply saying that parents are best placed to judge the interests of their child; it is saying that very often their interests are the same. It would not be exaggerating to say that very often the worst thing that could happen to parents would be for something to happen to their children… What matters morally about a child is connected to the fact that they are loved by their parents, and what we value about human beings is not just their intellect but also their capacity for these deep human relationships” (Elliot 2001, p. 458-459).

Elliot’s point is that a child’s relational interests are extremely important, and that these interests are linked with a child’s position within the family. Parents are not just important as surrogate decision-makers; they are important as integral parts of the child’s best interests. The interests of the child are intricately interwoven with the interests of the parents, so that these interests are inseparable. Harming the child will harm the parents and harming the parents will harm the child. Thus, any complete account of the best interests of the child will have to take into account the vested interests the child has as a member of a family, and the relationship that the child has with the parents. The parent-child relationship is of substantial moral worth, and will need to be considered seriously as a separate set of interests of the child in question. So, the child does not only have interests as an isolated individual such as physical and developmental interests, but also interests that are bound up in the parent-child relationship. So much so, that an assault on the child will be an assault on the family unit, and an assault on the family unit will be an assault on the child.

The idea that the family unit has moral worth and is to be protected seems fairly widely acknowledged. One can see this for example in the declarations on human rights by the United Nations. In these documents the family unit is described as deserving of protection by all States and all societies. This protection and consideration given to the family unit is thought to transcend divisions of geography, state lines or local custom. A few of the relevant articles from the UN rights declarations will be cited as examples.

I clarify: the intention is not to invoke a rights-paradigm. Undoubtedly, the ethical paradigm of the UN declarations is rights-based, but that is not my focus here. What I intend to show is that the family unit is widely considered to carry moral weight and to be worthy of moral consideration and protection. The B&C principlist account is based on the idea of widely shared moral intuitions. By citing the UN and their injunctions I am illustrating the fact that families, and parent-child relationships in particular, are widely recognized moral entities, worthy of moral

178 consideration and protection. This is meant to strengthen my principlist argument by demonstrating that the moral worth ascribed to parent-child relationships is a widely shared moral judgment, and therefore rightfully included in the principlist argument that I am constructing. Note specifically that the UN argues for universal recognition of the moral worth of the family, and specifically the moral relationships that exist between parents and children. I agree; this, I would argue, is a widely shared moral judgment which should form part of our considered judgments as we weigh the principles.

Here are the relevant articles from the UN declaration on Human Rights:

UN Universal Declaration of Human Rights (United Nations 1948):

Article 16(3): “The family is the natural and fundamental group unit of society and is entitled to protection by society and the State.”

The Convention on the Rights of the Child, adopted by the United Nations General Assembly in 1990 (United Nations 1990):

Article 5: “States Parties shall respect the responsibilities, rights and duties of parents or, where applicable, the members of the extended family or community as provided for by local custom, legal guardians or other persons legally responsible for the child, to provide, in a manner consistent with the evolving capacities of the child, appropriate direction and guidance in the exercise by the child of the rights recognized in the present Convention.”

Article 7(1): “The child shall be registered immediately after birth and shall have the right from birth to a name, the right to acquire a nationality and, as far as possible, the right to know and be cared for by his or her parents.”

Article 9: “1. States Parties shall ensure that a child shall not be separated from his or her parents against their will, except when competent authorities subject to judicial review determine, in accordance with applicable law and procedures, that such separation is necessary for the best interests of the child. Such determination may be necessary in a particular case such as one involving abuse or neglect of the child by the parents, or one where the parents are living separately and a decision must be made as to the child's place of residence.

2. In any proceedings pursuant to paragraph 1 of the present article, all interested parties shall be given an opportunity to participate in the proceedings and make their views known.

3. States Parties shall respect the right of the child who is separated from one or both parents to maintain personal relations and direct contact with both parents on a regular basis, except if it is contrary to the child's best interests.

4. Where such separation results from any action initiated by a State Party, such as the detention, imprisonment, exile, deportation or death (including death arising from any cause while the person is in the custody of the State) of one or both parents or of the child, that State Party shall, upon request, provide the parents, the child or, if appropriate, another member of the family with

179 the essential information concerning the whereabouts of the absent member(s) of the family unless the provision of the information would be detrimental to the well-being of the child. States Parties shall further ensure that the submission of such a request shall of itself entail no adverse consequences for the person(s) concerned.”

It is evident that the family unit is widely seen as carrying considerable moral worth. The family unit is worth protecting. The reasons for this are clear when considering Elliot’s argument with regards to the place of the child in the family unit. The child’s interests are intertwined with the parents’ interests. From a principlist perspective, we may argue as follows. Parent-child relationships are considered to be of moral worth, and forms part of our moral starting point.

When we then consider beneficence and non-maleficence in relation to a child, it is important to also consider the parent-child relationship. Promoting parent-child bonds is an act of beneficence to the child, and avoiding actions that may strain or injure the parent-child relationship is an act of non-maleficence. Of course, this refers to normal, loving parent-child bonds. If a parent is abusive or if there is a substantial breakdown of the parent-child bond, the other interests of the child outweigh the moral considerations usually afforded to protecting parent-child relationships.

Now, when considering the familial interests of the child and measles vaccination, it appears that the moral weight lies on the side of vaccination. If a child is harmed the family is harmed.

Measles infection has the potential to cause harm to the child, and in turn harm to the parents, and eventually harm to the child’s relational interests. Suffering in the child will bring suffering to the child’s parents; thus the suffering is shared and multiplied, not only affecting one person.

Furthermore, if a child is severely disabled, as may happen with measles infection, the normal familial bonding and interaction may be hampered. Of course, if a child dies, these familial bonds are broken, leaving heartbroken parents behind.

Vaccinating against measles protects against a disease that may wreak havoc on the family unit and family attachments, and consequently vaccination protects the familial interests of the child.

It is also noteworthy that the parents of the child are protected from heartache and suffering that may result from measles infection in their child. All around, the child’s best interests and the family’s best interests seem to be protected through measles vaccination. In its turn, the risk of harm from measles vaccination is negligible, so that the child’s family and the child’s relational interests are not harmed through vaccinating.