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Indeterminacy and the normative basis of the harm threshold for overriding parental decisions: a response to Birchley
  1. Rosalind J McDougall1,2
  1. 1Centre for Health Equity, University of Melbourne, Melbourne, Victoria, Australia
  2. 2Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
  1. Correspondence to Dr Rosalind J McDougall, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, VIC 3010, Australia; rmcdo{at}


Birchley's critique of the harm threshold for overriding parental decisions is successful in demonstrating that the harm threshold, like the best interests standard, suffers from the problem of indeterminacy. However, his focus on critiquing empirical rather than normative arguments for the harm threshold means that his broad conclusion that it is ‘ill-judged’ is not justified. Advocates of the harm threshold can accept that the concept of harm to a child is indeterminate, yet still invoke strong normative arguments for this way of responding to parental decisions that conflict with medical recommendations. I suggest that Birchley's discussion, rather than showing that the harm threshold is mistaken, instead highlights the importance of developing a comprehensive account of children's interests, for proponents of a best interests approach and for advocates of the harm threshold.

  • Children
  • Minors/Parental Consent
  • Paediatrics

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