Isra Black

Children are treated differently compared to adults in many domains, including in health care, education, employment, and criminal justice. The differential treatment of children—to adults, and in the case of younger children and adolescents, to each other—makes it both practically and theoretically important to examine the justification of when and why this treatment is permissible. Because the justifications of children’s differential treatment typically appeal to foundational normative considerations—matters of autonomy, responsibility, and well-being—they provoke considerable controversy and disagreement in law and ethics, especially, though not exclusively in the contexts of health care, sexual relations, and criminal justice. Consenting Children brings together philosophers and academic lawyers to grapple with these matters and domains and to share disciplinary and interdisciplinary insights and understanding. The volume’s contributors engage in deep and fruitful discussions of children’s consent and responsibility, decision-making capacity and best interests, as well as the role, powers, and duties of parents and state institutions. The volume lays the groundwork for future engagement in the legal and philosophical literature with the controversies raised by children’s autonomy, responsibility, and well-being, and the myriad interactions between them concerning children’s consent.

In "Treating Adolescents Differently", Anthony Skelton, Isra Black, and Lisa Forsberg develop a well-being-based justification of the asymmetrical treatment of adolescent consent and refusal in the context of health-care to justify the differential and paternalistic treatment of adolescents more generally. The core of Skelton, Black, and Forsberg’s view is a variabilist theory of what is fundamentally and non-instrumentally prudentially good for adolescents, which includes the prudential value of what they call shielding—or the value of being insulated from full responsibility for their choices. This theory of well-being, they argue, explains why adolescents may be treated differentially and paternalistically in numerous domains. It is good for them to be shielded because it allows for a variety of freedom from making certain kinds of decisions in the absence of a safety net provided by others in supportive and caring relationships. Skelton, Black, and Forsberg argue that their account of the justification of differential and paternalistic treatment of adolescents has attractive implications for a range of cases and holds up well in the face of philosophical criticism.

The purpose of the introduction to Consenting Children is to acquaint readers with the themes explored in the volume, to provide readers with a summary of the chapters comprising it, and to situate its contributions. Our ambition is for the volume’s contributions to lay the groundwork for future engagement in the legal and philosophical literature with the controversies raised by arguments about children’s autonomy, responsibility, and well-being, and the myriad interactions between them. We anticipate that the chapters in this volume will serve as an indispensable critical reference for scholars working in the broad range of disciplines dealing with the treatment of children. We hope, further, that the volume demonstrates the potential of the study of children to generate insights into thinking about consent, autonomy, responsibility, and well-being more broadly.

This article is about the information relevant to decision-making capacity in refusal of life-prolonging medical treatment cases. We examine the degree to which the phenomenology of the options available to the agent—what the relevant states of affairs will feel like for them—forms part of the capacity-relevant information in the law of England and Wales, and how this informational basis varies across adolescent and adult medical treatment cases. We identify an important doctrinal phenomenon. In the leading authorities, the courts appear to count the first-personal phenomenology of the available options among the information that adolescents seeking to refuse life-prolonging treatment must understand and appreciate in order to possess capacity; adults are not held to this (higher) standard. We evaluate this differential treatment in light of philosophical work on transformative choice—decisions involving options whose sensory character, and effect on our values and preferences, are grasped only through experience itself.

Adolescents are routinely treated differently to adults, even when they possess similar capacities. In this article, we explore the justification for one case of differential treatment of adolescents. We attempt to make philosophical sense of the concurrent consents doctrine in law: adolescents found to have decision-making capacity have the power to consent to—and thereby, all else being equal, permit—their own medical treatment, but they lack the power always to refuse treatment and so render it impermissible. Other parties, that is, individuals who exercise parental responsibility or a court, retain the authority to consent on an adolescent’s behalf. We explore four defences of the doctrine. We reject two attempts to defend the asymmetry in the power to consent to and refuse medical treatment by reference to transitional paternalism. We then consider and reject a stage of life justification. Finally, we articulate a justification based on the distinctiveness of adolescent well-being.

Some form of assisted dying (voluntary euthanasia and/or assisted suicide) is lawful in the Netherlands, Belgium, Oregon, and Switzerland. In order to be lawful in these jurisdictions, a valid request must precede the provision of assistance to die. Non-adherence to the criteria for valid requests for assisted dying may be a trigger for civil and/or criminal liability, as well as disciplinary sanctions where the assistor is a medical professional. In this article, we review the criteria and evidence in respect of requests for assisted dying in the Netherlands, Belgium, Oregon, and Switzerland, with the aim of establishing whether individuals who receive assisted dying do so on the basis of valid requests. We conclude that the evidence suggests that individuals who receive assisted dying in the four jurisdictions examined do so on the basis of valid requests and third parties who assist death do not act unlawfully. However, further research on the elements that may undermine the validity of requests for assisted dying is warranted. More research on the reasons why requests for assisted dying are refused is also desirable.

We explore the ethics of using motivational interviewing, an evidence-based, client-centred and directional counselling method, in conversations with next of kin about deceased solid organ donation. After briefly introducing MI and providing some context around organ transplantation and next of kin consent, we describe how MI might be implemented in this setting, with the hypothesis that MI has the potential to bring about a modest yet significant increase in next of kin consent rates. We subsequently consider the objection that using MI in this context would be manipulative. Although we cannot guarantee that MI would never be used in a problematically manipulative fashion, we conclude that its use would, nevertheless, be permissible as a potential means to increase next of kin consent to deceased solid organ donation. We propose that MI be trialled in consent situations with next of kin in nations where there is widespread public support for organ donation.