Addendum Re. Using Medical Methods to Determine the Age of Unaccompanied Refugee Children

After my post on this issue a few days ago, I've debated the issue with a number of people from within medicine and also bioethics in different fora.

Due to the presence of significant uncertainties of the methods debated, my suggestion was that use of this methods should be amended by the following methodological rule (assuming 18 to be the age of adulthood, if it is different we may simply insert another variable for that):

... for any method, M, for the assessment of the age of a person, P, with a margin of error +/- X years, M is taken to indicate adulthood if, and only if, its result is 18+X years or higher, and otherwise taken to indicate childhood

Here are a few points that may be added to the complexities of this particular issue:

1. The nature of the uncertanties
Some have argued to me that the methods are not only uncertain in a way possible to describe in terms of a margin of error. One reason for this put to me is that besides the usual margin of error within the dimension of a variable, there is also the background confidence interval behind this margin, and the known effect of having this confidence deteriorate considerably when aggregated population probabilities are projected onto individual cases. I, of course, do not deny that there is also this source of uncertainty, but as far as I can see, my formula above can easily include that: X can be the aggregation of both these uncertainties (this was my original thought as well). This probably means that X becomes considerably larger than 4 (the number used in the example in the original post, based on claims by critics of the model). However, this in no way undermines my suggestion, as this will probably mean that all unaccompanied refugee children will most likely be determined to be children (and, if there are any people like that, in addition a number of refugee adults who falsely claim to be children). That is, the best interest of children, as well as the proper priority of legal provisions is upheld. Suppose, for instance, that the margin of error, accounting for all sources of uncertainty, becomes +/- 15 years. Then my rule says that P is to be considered an adult if, and only if, M finds P to be 33 years or more.

Another claim has been that some of the methods depend on the existence of relevant tables and charts or background data, and that such are missing in this case, meaning that the methods are not really uncertain, there is no method at all. The bewildering thing is that the same people are at the same time officially repeating the argument that the methods are uncertain and have unacceptably wide margins of error. These two claims are, of course, inconsistent; if it's not possible to have any result at all, there is no margin of error, and if there is a margin of error there is some results that create this margin. If it turns out that, in fact, the variable X (accounting for all kinds of sources of uncertainty), cannot be given any empirically based numerical estimate, I concede that my rule is inapplicable. However, if even an interval numerical estimate can be grounded, my rule can be used, by simply adding (supported by the same basic principles as before) that, the high extreme of this interval should be used to define X (in order to err in the right direction). Again, this may mean that the method will determine all tested as children, but, as already argued, it is difficult to see what the ethical or legal problem with that would be.

2. Professional Health Care Ethics and Ethics
Another aspect that has been raised is the fact that my suggestions means that health care professionals pragmatically accommodate to flawed public policies in the best interest of concerned parties (i.e. the children). This is wrong, some say, health care professionals should demand to regulate themselves and never do anything they themselves collegially don't find suitable to do, not even if this is harming third parties. Some have even gone so far at to claim that it is irresponsible of a health care professional to ever act the slightest in any other interest than his or her patient's.

The latter would, of course, mean that we would have to abandon all public health practices, communicable disease management, forensic medicine, large segments of insurance and sports medicine, and not least the involvement of doctors in issuing certificates underlying decisions by public authorities, such as sick leave or work-related disability benefits, and so on. Since health care professional organisations have as yet made no move whatsoever in such directions, I trust that this is not the line underlying the criticism in the present case. In other words, formalised professional health care ethics already accepts a number of cases where medical methods are used to other ends than the best interest of patients and many of these uses are being pragmatically accommodated to still make the best out of an imperfect thing. A very clear illustration is the assessment of "ability to work" nowadays made routinely by medical doctors in many countries, strategically adapted not to harm their patients while still abiding by required formalities.

It is thus unclear to what extent the principle of never doing anything to right the wrongs of public policies is a part of professional health care ethics. Even more unclear is if, had it been such a part, it would have been ethically defensible. To illustrate with the issue at hand, suppose that the health care professional community was to refuse to participate in the practice decided by the Swedish government. This may have three outcomes: (a) the government and parliament creates a legal room for some other class of officials to use the methods (not using my rule), (b) no method is used, (c) alternative suggested methods based on psychological models are used.

• If (c) is the outcome, the issue reappears, as also these methods can be expected to have margins of error, sources of uncertainty and so on. Then my rule can be used to secure that determinations err in the right direction.

• If (a) is the outcome, the results for the persons concerned, namely the children, is worse than if the profession had chosen to participate, using my rule to secure that they act solely in the best interest of the children, although also accommodating societal requests.

• If (b) is the outcome, the situation stands that unaccompanied refugee children where there is uncertainty as to whether or not they are children, will not be given their rights as children.

Now, compare this with (d): health professionals decide to pragmatically accommodate, and use the methods, amended by my rule.

• If (d) is the outcome, the concerned children's interests and Sweden's legal needs are better served than if any of (a) and (b). If these children are seen as patients, it would then be in their best interest to go for (d) rather than (a) or (b). If there is an option (c), this is even better, provided that my rule is used, but if not it may be better for the patients to go for (d).

3. The Ethics of Clean Hands, Politics of Power and Professional Integrity as Strategic Tool
Against this form of reasoning, some debaters I've talked to have claimed that the downsides for refugee children of the options (a) and (b) (as well as (c) without my rule) cannot be laid at the door of health professionals, but is the sole moral responsibility of the government. That is, they apply the standard of an "ethics of clean hands", denouncing responsibility for bad outcomes they could have avoided by acting differently just because the same is true of some other acting party (here, the government). This is like when the car driver, displeased with the rule that gives pedestrians priority at crosswalks, blames the government while electing to run people over, who cross motivated by the rule. Not very splendid ethics, I'd say.

Another version of this reasoning instead comes in the form of a political power bidding in the name of professional autonomy. It is simply the claim that health professionals should insist on the right to decide for themselves what standards they act on. While this is understandable (we all would like the privilege not to give a damn about the opinions of others, don't we?), it either comes without any underlying defense, or is compatible with sometimes choosing to compromise with other parts, interests and powers in society. As mentioned, the latter seems what in fact is happening in a number of areas, so then the question moves to what reasons pro or contra are present in the area at hand. Here, I have argued that (d) is the superior position.

The same outcome seems to ensue when analysing a final (and, to my view, better) variant of this sort of argument. Instead of an empty insistence on professional autonomy at all cost, this argument points to the political importance of professional integrity as a strategic tool in certain areas. The most obvious of these are torture, capital punishment and military interrogation. Here, the profession has adopted zero tolerance policies, which are thought to have an accumulated preventive effect, as these practices in various ways "need" the participation of doctors. However, this point does not demonstrate that age determination of unaccompanied refugee children belongs to this set of absolutely prohibited practices. As those who criticise the presently proposed methods also say that they could accept methods with a better degree of precision and exactness, it doesn't seem that they are trying to argue this in the present case. Which is understandable, as that would mean arguing against any claim to special considerations of the interests and rights of children.

In sum, therefore, unless it is demonstrated that there is no method at all that could produce any sort of empirically grounded numerical estimate (even in the form of a wide interval) in this area, my suggestion holds up to scrutiny. In fact, it is better supported by both professional health care ethics and more general ethical analysis, than alternative suggestions.

***

On Using Physiological or Biomedical Methods to Determine the Age of Unaccompanied Refugee Children

  In my country, there has for some time been a lot of political debate around how to handle the rising number of refugees from, primarily, Syria/Iraq, Afghanistan and North Africa. This as the pressure on border EU member states, and the impossible situation of trying to hold back people on the run from intolerable circumstances that I blogged about not so far ago, has meant that much more people are now entering Sweden to seek asylum in a short time, as most other member states are unwilling to participate in a scheme of sharing the economic and logistical load it means to process these requests in a way required by human rights and international agreements, as well as legal security. For, while there is no such thing as a right to have asylum, to seek it is an absolute international legal right, and already this means that a receiving country has a lot of obligations. And one group of refugee people towards which such obligations are especially strict are unaccompanied children, and many of these who actually arrive to Sweden are mostly in their teens, usually lacking certifiable identity documentation.

Now, yesterday, the Swedish government, pressed by the logistic and organisational pressure, declared that the already announced difficulties had now become intolerable, and that a number of measures was to be put into place to complement the already a few weeks back instigated active border controls (which, until then, had been non-existent in accordance with the so-called Schengen accord on free internal EU mobility). The move is very controversial, and many doubt that the logistical and organisational reasons cited are the only ones behind it, if nothing else, worries about how political opinion will shift in the presence of my country's anti-immigration, semi-racist party, the Sweden Democrats (see here, here and here), are bound to have played a part, as these are presently laying mostly low to wait things out after some botched attempts to take the initiative, and being actively ignored by the other parties, as it has announced that its only idea is to close the borders entirely. One thing is entirely clear, though, the problem behind the decision is neither one of money, nor one of space, Sweden has plenty and plenty of both of those, and neith is it about "volumes", as the term goes, but mostly about flow; not how many people arrive, but how many arrive in a short time.

 One of the measures decreed by the Government concerns the unaccompanied refugee children, and it is to (re)start using certain physiological or biomedical methods to ascertain the age of these children. No one is debating the need for such ascertaining, but the debate is about this particular proposal, as many Swedish medical specialists (for two international sources, see here and here) also the medical research specialist organisation Swedish Society of Medicine, point out that the proposed methods are very uncertain and have wide margins of error, up to 4 years plus or minus. This means that the risk is imminent that a child of 14 is determined to be an adult, and that Sweden would thus knowingly risk to default on its particularly strong and demanding obligations towards children. The fact that there is also a risk that some 21-year olds come to enjoy these special protections and care is a non-issue in that light. However, the government seems insistent, so what should be done? General refusal of doctors and other medical staff to participate in what has been proved to be unprofessional practice? (as they would seem to be required to do by the Swedish health and Medical Services Act)? This is certainly a live option from a medical ethical standpoint as well, although it also means that most unaccompanied refugee children are left without proof of age.

However, there is another solution, which would satisfy both the government's decree, the worries from the point of view, the need for unaccompanied refugee children to have their age ascertained, and the overwhelming reason to have Swedish policy abide by its own legal standards. This solution is, moreover, applicable to any method for this purpose. It rests on the assumption that for Sweden to meet its own legal requirements is a primary consideration that trumps other reasons and interests in this area. This means that overestimating a refugee child's age and assess this person as adult is far worse than underestimating a refugee adult's age and assess this person as a child. Based on this premise, we may now argue that, therefore, using a method for age assessment in this area that is uncertain, we should use it in a way that makes us err in the right direction. That is, to the extent that we draw faulty conclusions, these should rather be the wrongful classification of adults as children than the wrongful classification of children as adults. this rules gives us access to a simple mathematical solution to the conundrum: we simply adjust the conclusions drawn with the help of the method in light of its uncertainties, so that we are certain to err in the right direction. Thus, for any method, M, for the assessment of the age of a person, P, with a margin of error +/- X years, M is taken to indicate adulthood if, and only if, its result is 18+X years or higher, and otherwise taken to indicate childhood. Regarding the methods cited earlier, this would mean that a person who is apparently an unaccompanied refugee child (who lacks reliable documents), is concluded to be a child, as long as these methods do not declare the age to be 22 years or higher.

As said, this solution makes it possible to abide by the governmental decision, while acting inside medical professional and ethical boundaries, and while both securing the need of refugee children to have their age determined to claim their rights, and the paramount need for the state of Sweden to honour its own legal and international obligations.

Due to debates related to this post in other fora, here's an addendum I made a few days later.

***

Now Online: Special Symposium of Public Health Ethics: New Media, Risky Behaviour and Children

All good to those who wait, it's said, and in this case this certainly holds up to scrutiny...

 

Yesterday afternoon, a special symposium in this year's first issue of the journal Public Health Ethics, guest-edited by myself and my colleague Karl Persson de Fine Licht, on the topic of New Media, Risky Behaviour and Children, went online after about 2 years of work, starting with this call for papers. In addition, the call came out of a preceding European project, running 2011-12, taking off as an original idea at a workshop we held in Gothenburg in October 2011. We are, of course, mighty grateful to the PHE editors-in-chief duo of Angus Dawson and Marcel Verweij, who accepted our proposal, remained committed to it and has offered all support needed under way.

The full table of content looks like this:

Introduction 
Christian Munthe and Karl Persson de Fine Licht
Editorial: New Media and Risky Behavior of Children and Young People: Ethics and Policy Implications. Introducing the Themes and Pushing for More 

Original articles
Julika Loss, Verena Lindacher, and Janina Curbach
Do Social Networking Sites Enhance the Attractiveness of Risky Health Behavior? Impression Management in Adolescents’ Communication on Facebook and its Ethical Implications

Joakim Forsemalm
Consolidated Youth Jury: Alcohol Prevention for Young People from Matters of Fact to Matters of Concern. A Swedish Case Report
  
K. P. Mehta, J. Coveney, P. Ward, and E. Handsley
Parents’ and Children’s Perceptions of the Ethics of Marketing Energy-Dense Nutrient-Poor Foods on the Internet: Implications for Policy to Restrict Children’s Exposure 

Boudewijn de Bruin
Alcohol in the Media and Young People: What Do We Need for Liberal Policy-making?

Case Discussion  

Kate L. Mandeville, Matthew Harris, H. Lucy Thomas, Yimmy Chow, and Claude Seng 

Using Social Networking Sites for Communicable Disease Control: Innovative Contact Tracing or Breach of Confidentiality?

Jasper Littmann and Anthony Kessel 

Accounting for the Costs of Contact Tracing through Social Networks  

André Krom 

From Facebook to Tracebook: A Justified Means to Prevent Infection Risks? 

Mart L. Stein, Babette O. Rump, Mirjam E. E. Kretzschmar, and Jim E. van Steenbergen 

Social Networking Sites as a Tool for Contact Tracing: Urge for Ethical Framework for Normative Guidance

David M. Shaw 

Communicating About Communicable Diseases on Facebook: Whisper, Don’t Shout  

Thomas Ploug and Søren Holm 

Take Not a Musket to Kill a Butterfly—Ensuring the Proportionality of Measures Used in Disease Control on the Internet

Now, I would myself very much have preferred to have the entire issue open access, for anyone to probe, but since that would cost about €1500 / article, and there are 11 articles in the symposium, there was no financially feasible way of managing this. One of the contributions is open access, due to it having been written in a context where funding for that objective has been available, but this is normally not the case for ethicists, social scientists and practitioners – unlike our more wealthy cousins within clinical and laboratory health science, I might add.

For access, your best bet is through a university library, a student or staff at a university with access, or you can try contacting individual authors and/or look around for so-called postprints posted in public archives.

Legalised Euthanasia for Children Regardless of Age in Belgium: The Actual Law in English

The past few days we have heard the reports of the change made to the Belgian (permissive, but also restrictive) euthanasia law that makes it include children of all ages among those who may lawfully receive medical help to end their lives. For instance here, here, here and here. None, however, have had access to or quoted any actual English translation of the new law. Thanks to my colleague Kristof Van Assche at the Vrije Universiteit Brussel's Faculty of Law and Criminology, I'm now happy to be able provide one for interested readers, with the following disclaimer: This is Kristof's own provisional translation, based on this English version of the original law and his own added translations of the made changes. Kristof posted it in the closed Facebook group for bioethics scholars, Bioethics International, and gave me permission to share it with a wider audience in this way. Here comes screenshots from the original post just referred to:

And here, to make quotation easier, is the text in plain text:
 

Law of 28 May 2002 on Euthanasia, amended by the Law of 13 February 2014 – Consolidated version [changes in brackets]

Chapter II: Conditions and procedure

Section 3

§1. The physician who performs euthanasia commits no criminal offence when he/she has verified that:
- the patient is a legally competent adult, a legally competent emancipated minor, [or a minor with the capacity of discernment] and is conscious at the moment of making the request;
- the request is voluntary, well-considered and repeated, and is not the result of any external pressure;
- the adult or emancipated minor patient is in a medically futile condition of constant and unbearable physical or mental suffering that cannot be alleviated, and that results from a serious and incurable disorder caused by illness or accident;
- [the minor with the capacity of discernment is in a medically futile condition of constant and unbearable physical suffering that cannot be alleviated and that will result in death in the short term, and that results from a serious and incurable disorder caused by illness or accident;]
and when he/she has respected the conditions and procedure as provided in this Act.

§2. Without prejudice to any additional conditions that the physician may wish to attach to his/her intervention, he/she must in advance and in each case:
1) inform the patient about his/her health condition and life expectancy, discuss with the patient his/her request for euthanasia and the possible therapeutic and palliative courses of action and their consequences. Together with the patient, the physician must come the belief that there is no reasonable alternative to the patient’s situation and that the patient’s request is completely voluntary;
2) be certain of the constant physical or mental suffering of the patient and of the durable nature of his/her request. To this end, the physician has several conversations with the patient spread out over a reasonable period of time, taking into account the progress of the condition of the patient;
3) consult another physician about the serious and incurable nature of the disorder and inform him/her about the reasons for this consultation. The consulted physician reviews the medical record, examines the patient and must be certain of the patient’s constant and unbearable physical or mental suffering that cannot be alleviated. He/she drafts a report on his/her findings.
The consulted physician must be independent of the patient as well as of the treating physician and must be competent to give an opinion about the disorder in question. The treating physician informs the patient about the results of this consultation;
4) if there is a nursing team that has regular contact with the patient, discuss the request of the patient with the team or its members;
5) if the patient so desires, discuss the request of the patient with his/her relatives appointed by him/her;
6) ensures that the patient has had the opportunity to discuss his/her request with the persons that he/she wanted to meet;
7) [when the patient is an unemancipated minor, consult, in addition, a child psychiatrist or a psychologist, and inform him about the reasons for this consultation.
The consulted specialist takes note of the medical record, examines the patient, verifies the capacity of discernment of the minor and certifies this in writing.
The treating physician informs the patient and his or her legal representatives of the outcome of this consultation.
At a meeting with the legal representatives of the minor, the treating physician provides them with all the information specified in §2, 1° in and verifies that they agree with the request of the minor patient.]

§3. […]

§4. The request of the patient [and, if the patient is a minor, also the agreement of the legal representatives] have to be put in writing. The document is drawn up, dated and signed by the patient himself/herself. If the patient is not capable of doing this, the document is drawn up by an adult person who is designated by the patient and must not have any material interest in the death of the patient.
This person indicates that the patient is incapable of putting his/her request in writing and indicates the reasons why. In such case the request is drawn up in the presence of the physician and the said person mentions the name of the physician on the document. This document must be annexed to the medical record.
The patient may revoke his/her request at any time, in which case the document is removed from the medical record and returned to the patient.

[§4/1. After the physician has treated the request of the patient, the persons concerned are offered the possibility of psychological assistance.]

My most sincere thanks to Kristof for allowing me to share.

Continuing Official Catholic Confusion on the Morality of Child Molestation, Rape and Pedophilia

A new Pope has just been elected and immediately, one of the very cardinals that took part in the election-process (the so-called Conclave) is on the news making a massive fool of himself, as well as illustrating that the complete confusion and ethical morass within the official Catholic institutional establishment has not become any less than before. I have from time to time commented just a little bit on the amazing stupidity and deepest immorality of central official institutions and representatives of the Catholic Church when it comes to its dealing with allegations of systematic sexual child abuse against their own clergy. I am therefore not very surprised at this latest piece of folly that is reported in my country's leading daily this morning (here):

In a BBC interview, the Arch Bishop of Durban, one Wilfrid Fox Napier, states that child molesters and rapists are not properly to be held criminally responsible for their actions. While I'm not at all surprised that a Catholic Cardinal and Arch Bishop holds and expresses such an opinion – even less so since he represents the South African wing of the Church, known since before for airing massively confused official statements on sexual morality – I do have a few things to say about the way in which he tries to support it.

Here is what he says on the matter, quoting from the BBC interview:

'Cardinal Napier referred to paedophilia as "a psychological condition, a disorder".
"What do you do with disorders? You've got to try and put them right.
"If I - as a normal being - choose to break the law, knowing that I'm breaking the law, then I think I need to be punished."
He said he knew at least two priests, who became paedophiles after themselves being abused as children.

"Now don't tell me that those people are criminally responsible like somebody who chooses to do something like that. I don't think you can really take the position and say that person deserves to be punished. He was himself damaged."'

 Let us break down the argument in steps. Adding some hidden premises that are apparently assumed by the good Arch Bishop, the most likely (and potential least faulty) version would look something like this. It is rather complicated and partly sophisticated, and therefore needs to be presented in separate bundles of deductions, where I have put the important conclusions in bold type:

1. Pedophilia is a psychological disorder
2. Psychological disorders are conditions and not actions
3. People cannot be properly held criminally responsible for anything else than those of their actions that break the law
4. People cannot be properly held criminally responsible for being pedophiles

5. Sexual child abuse is caused by pedophilia

6. If an action that breaks the law is caused by a psychological disorder for which he/she cannot properly be held criminally responsible, then the person who performs it does not know that he/she is thereby breaking the law
7. If a person performs an unlawful action without knowing that it is against the law, then he/she cannot properly be held criminally responsible for performing that action.
8. If a person performs an action as a result of pedophilia, then he/she cannot properly be held criminally responsible for performing that action
9. No one can properly be held criminally responsible for sexual child abuse.

10. If an action that breaks the law is caused by a psychological disorder for which he/she cannot properly be held criminally responsible, then the person who performs it has not chosen to perform it
11. If a person performs an unlawful action without choosing to do so, then he/she cannot properly be held criminally responsible for performing that action.
12. Same as 8
13 Same as 9

14. Therefore (by 4, 5, 9 and 13): No one can properly be held criminally responsible for sexual child abuse

It is quite easy to spot the gaps, as well as the sinister rhetorical tricks employed, in this argument. To begin with the latter, the basis of Mr. Napier's argument is the completely plausible claim that pedophilia is a psychological disorder and that the criminal law system should not punish people for  having disorders. On this, I presume, we may all agree – pedophilia is in this respect no different from, e.g. psychopathy or kleptomania or, for that matter, the flu, being taller than 2 metres or shortsightedness. The law holds people people responsible for what they do – possibly in combination with why they did it – not for what they are. This is trivia, which the dear Bishop tries to create an impression having bearing on whether or not we should be held responsible for our actions.

However, as soon as the first step in that direction is taken (premise 5), trouble begins. For, as a matter of fact, it is by no means obviously true that sexual child abuse is caused by pedophilia. The thing is, you see, that it is rather the case that to the extent that someone is a pedophile in the sense that makes it into a disorder this simply means that they are prone to sexually abuse children, and the only indicator of that is that they in fact do so. That is, if someone is a pedophile in the sense of a disorder, then this is partly constituted by having on at least some occasion sexually abused a child. Similar things hold for many other psychological conditions that may be held out as disorders, such as sadism. Now, you might object that we may imagine someone who harbours sexual desires directed at children, but does not act on them – at least not in the form of actual abuse (but, e.g. fantasy only) and that such a person should be called a pedophile. Sure, I'd say, we may very well do so, but in that case, premise 1 of the argument becomes implausible, since what makes it sensible to say that a pedophile suffers from a psychological disorder is that this person does not direct his/her actions properly on the basis of prudence or social, moral or legal norms. It may further be observed, that if we thus would weaken the concept of pedophilia, premises 6 and 10 would be severely weakened as well. So, if this argument is to work, we need to hold on to a strong concept of pedophilia, where it means simply tendency to sexually abuse children and that, of course, does not tell us that pedophilia causes sexual child abuse, merely that acts sexual child abuse is an indicator of the mentioned tendency – i.e. pedophilia. The cause of the actions of sexual child abuse is not revealed.

However, just as the weaker concept of pedophilia would make trouble for premises 6 and 10, we can now see that also the stronger would – besides invalidating premise 5 that is. For the tendency to sexually molest children when provided with a (from the perpetrator's point of view) fitting opportunity would not, it seems to me, provide any reason to believe that a person having such a tendency is either unable to understand or know that sexual child abuse is against the law, or incapable of choosing to sexually abuse children. On the contrary, this tendency whereby the person selects certain occasions to perform acts of sexual child abuse, in fact supports the notion of them both knowing very well that it is against the law and performing acts of reasoning to make decisions about when to try to get away with the unlawful act and when not to. In short neither the fact that your actions result from an urge, or that they result from a tendency in virtue of past actions, invalidates that you may properly be held legally responsible for them. This is perfectly consistent with accepting the claim that such a person is not to be properly held criminally responsible for said urge or tendency, but for his/her actions.

So, why is the dear bishop making such a flawed argument? One explanation is, of course, the he is himself confused. However, a much more charitable and less insulting explanation is that he is doing his best to do what catholic officials always seem to be doing when the topic of sexual child abuse by clergy is raised – namely to protect his peers and defend the way in which the Catholic Church has been handling these things – that is, shielding hard criminals from the criminal justice system and on many occasions providing them with the opportunity to go on destroying the lives of children and youngsters in their care.

To see how this fits Mr. Napier's line of argument, we can inspect some possible corollaries (sub-conclusions) of its alleged conclusion (14). If 14 is true, it follows:

15. No Catholic clergy can properly be held criminally responsible for sexual child abuse

And if we for a moment forget that, legally and morally, we should all report suspected unlawful acts to the proper authorities, so that they can be investigated and decided on according to due process, thereby protecting legal security and rule of law, it would also follow:

16. The Catholic Church or its representatives are under no obligation to report suspected cases of sexual child abuse by clergy

So, as usual it comes down to the usual thing: trying to get away with it.

New book chapter available open access: The Best Interest of Children and the Basis of Family Policy: The issue of reproductive caring units

As some of you may recall, a little while ago, I flagged a forthcoming book called Families: Beyond the Nuclear Ideal (edited by daniela Cutas and Sarah Chan and published by Bloomsbury Academic in its Science, Ethics and Society series), where I have a chapter, together with my colleague Thomas Hartvigsson. What I was perhaps not entirely clear about is that, in fact, this chapter and – indeed! – the rest of the book is avaliable open access for reading and non-commercial sharing under a Creative Commons lisence, while the book can also be purchased as both hardcopy and e-book in the regular fashion. To me, a rather clever solution for trying to combine the commercial requirements of running a publishing business and still satisfy the very sound and strong arguments for having all sort of research material and academic output freely available for anyone.

Our chapter is called "The Best Interest of Children and the Basis of Family Policy: The issue of reproductive caring units" and deals with an issue that we introduce, thus:

The notion of the best interest of children figures prominently in family and reproductive policy discussions and there is a considerable body of empirical research attempting to connect the interests of children to how families and society interact. Most of this research regards the effects of societal responses to perceived problems in families, thus underlying policy on interventions such as adoption, foster care and temporary assumption of custodianship, but also support structures that help families cope with various challenges. However, reference to the best interest of children can also be applied to a more basic issue in family policy, namely that of what is to be considered a family in the first place. This issue does not raise any questions regarding the proper conditions for when society should intervene in or change the family context of a child. Rather, it is about what social configurations should be recognized as a potentially fitting context for children to enter into and (if all goes well) eventually develop into adulthood within. Any social configuration so recognized constitutes what we will call a reproductive caring unit (RCU). An RCU is a social configuration such that society's default institutional arrangements allow it to have (by sexual and artificial reproduction, adoption, and combinations of these), care for and/or guard children – the approved RCUs thereby being the basic ‘menu’ of what families with children there may be in society. Opinions on what should be allowed to be an RCU will frame any further discussion of the questions already mentioned, but also policies having further implications for, for example, the practices of adoption and reproductive technology, as well as regulation of custody in the event of separation or parental disagreement.

There is a communicative problem involved in talking about this issue in terms of the word ‘family’, however. Due to a combination of biological necessities, socio-economic and developmental circumstances, prejudice and custom, people around the world tend to associate this term with the presence of romantic or sexual relationships (between adults) and/or genetic links (between adults and children). However, the question indicated above does not necessarily imply such things to be in place in the case of a legitimate RCU. What should be awarded the standing of a family in this sense, then, may be something that many people find strange to call a family. At the same time, if you ask the question whether a single mother and her adopted child, or four adult siblings living together and caring for a foster child could constitute fitting social arrangements for children to enter and develop within, people would not (we presume) rule out this question as empty just because the word ‘family’ seems odd to apply to them. Rather, we suggest, social configurations within which children are raised are called ‘families’ as we tend to view them as legitimate RCUs. Thus, to the extent that there are reasons to allow RCUs not involving the ingredients of romantic/sexual relations or genetic linkage, this will be a reason to change linguistic practice.

The question we want to address, then, is about what is implied by arguments in terms of the best interest of children for the issue of what should be allowed to be a family in the sense of an RCU. This is a question not about particular cases, but about general institutional arrangements. Society needs policies as to what RCUs to allow and within these frames, any single initially legitimate RCU may be found unfitting for serving this purpose, just as in the case with dysfunctional ‘nuclear families’. Arguments about what is in the best interest of the concerned children in such cases can (and should) be brought to bear on this issue. However, as will be seen, these arguments involve quite different considerations compared to when assessments in terms of the best interest of children are applied to the issue of RCUs.

If you feel tempted by this, please just click on the chapter link, and read it in its entirety, as well as the other contributions to this book, by authors such as Adrienne Asch, David Gurnham, Paul D. Hastings, Kerry Lynn Macintosh, Julie McCandless, Melinda Roberts, Joanna E. Scheib, Mary Lyndon Shanley, Naura Irene Strassberg, and several others.

And if you like that, please consider buying the book, or at least liking its Facebook page, or in other ways contributing to spreading awareness of its availability. Thank you!

Families – Beyond the Nuclear Ideal...

...is the title of a book soon to be released by Bloomsbury Academic as part of its Science, Ethics and Innovation series, edited by Daniela Cutas and Sarah Chan, with one chapter contributed by myself and Thomas Hartvigsson (on how to apply the best interest of children standard to the issue of what sort of families to allow), plus others by, e.g., Adrienne Asch, Melinda Roberts, Kerry Lynn Macintosh and a number of other distinguished scholars in whose company I'm very proud to be.

 

In the words of the presentation by the editors, this book....

...examines, through a multidisciplinary lens, the possibilities offered by relationships and family forms that challenge the nuclear family ideal, and some of the arguments that recommend or disqualify these as legitimate units in our societies.

That children should be conceived naturally, born to and raised by their two young, heterosexual, married to each other, genetic parents; that this relationship between parents is also the ideal relationship between romantic or sexual partners; and that romance and sexual intimacy ought to be at the core of our closest personal relationships -- all these elements converge towards the ideal of the nuclear family.

The authors consider a range of relationship and family structures that depart from this ideal: polyamory and polygamy, single and polyparenting, parenting by gay and lesbian couples, as well as families created through current and prospective modes of assisted human reproduction such as surrogate motherhood, donor insemination, and reproductive cloning.

And the full table of contents runs like this:

Chapter 1: Daniela Cutas and Sarah Chan, Introduction: Perspectives on Private and Family Life
Chapter 2: Julie McCandless, The Role of Sexual Partnership in UK Family Law: the Case of Legal Parenthood

Chapter 3: Mianna Lotz, The Two-Parent Limitation in ART Parentage Law: Old Fashioned Law for New-Fashioned Families
Chapter 4: Christian Munthe and Thomas Hartvigsson, The Best Interest of Children and the Basis of Family Policy: The Issue of Reproductive Caring Units
Chapter 5: Joanna Scheib and Paul Hastings, Donor-conceived Children Raised by Lesbian Couples: Socialization and Development in a New Form of Planned Family
Chapter 6: David Gurnham, Donor-conception as a ‘Dangerous Supplement’ to the Nuclear Family: What can we learn from parents’ stories?
Chapter 7: Susanna Graham, Choosing Single Motherhood? Single Women Negotiating the Nuclear Family Ideal
Chapter 8: Mary Shanley and Sujatha Jesudason, Surrogacy: Reinscribing or Pluralizing Understandings of Family?
Chapter 9: Adrienne Asch, Licensing Parents: Regulating Assisted Reproduction
Chapter 10: Simon Căbulea May, Liberal Feminism and the Ethics of Polygamy
Chapter 11: Maura Irene Strassberg, Distinguishing Polygamy and Polyamory Under the Criminal Law
Chapter 12: Dossie Easton, Sex and Relationships: reflections on living outside the box  

Chapter 13: Kerry Lynn Macintosh, Human Cloning and the Family in the New Millenium  

Chapter 14: Melinda Roberts, Moral and Legal Constraints on Human Reproductive Cloning

 

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