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The harm threshold and parents’ obligation to benefit their children
  1. Giles Birchley
  1. Correspondence to Dr Giles Birchley, Centre for Ethics in Medicine, University of Bristol, Canygne Hall, 39 Whatley Road, Clifton, Bristol, UK; giles.birchley{at}


In an earlier paper entitled Harm is all you need?, I used an analysis of English law to claim that the harm threshold was an unsuitable mediator of the best interests test when deciding if parental decisions should be overruled. In this paper I respond to a number of commentaries of that paper, and extend my discussion to consider the claim that the harm threshold gives appropriate normative weight to the interests of parents. While I accept that parents have some rights over their children, I argue these are dependent on parents’ duties to benefit their children. While many such benefits are understood pluralistically, and are thus within parents’ ambit to decide, I claim that health benefits are ordinally different, because they play a foundational role in the flourishing of an individual. In the light of this, clinicians have the moral authority to override parental refusals, although in some cases abstaining from exercising this authority may be a pragmatic way to maintain parental engagement and ensure our ability to benefit the child in future.

  • Children
  • Clinical Ethics
  • Decision-making
  • Paediatrics
  • Minors/Parental Consent

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