Vaccination News Home Page                                            subscribe Vaccination NewsLetter

http://jme.bmjjournals.com/cgi/content/abstract/28/1/10

Full Text of this Article Reprint (PDF) Version of this Article Email this link to a friend eLetters: Submit a response to this article Similar articles found in: JME Online PubMed PubMed Citation Search Medline for articles by: Hodges, F M || Van Howe, R S Alert me when: new articles cite this article   Download to Citation Manager

Collections under which this article appears: Other Ethics Informed Consent

J Med Ethics 2002;28:10-16
© 2002 Journal of Medical Ethics
 

Prophylactic interventions on children: balancing human rights with public health

F M Hodges¹, J S Svoboda² and R S Van Howe³

¹ Department of History, Yale University, New Haven, Connecticut, USA
² Attorneys for the Rights of the Child, Berkeley, California, USA
³ Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, USA

Correspondence to:
Dr F M Hodges, Department of History, Yale University, PO Box 208324, New Haven, CT 06520-8324;
frederick.hodges@yale.edu

Bioethics committees have issued guidelines that medical interventions should be permissible only in cases of clinically verifiable disease, deformity, or injury. Furthermore, once the existence of one or more of these requirements has been proven, the proposed therapeutic procedure must reasonably be expected to result in a net benefit to the patient. As an exception to this rule, some prophylactic interventions might be performed on individuals "in their best interests" or with the aim of averting an urgent and potentially calamitous public health danger. In order to invoke these exceptions, a stringent set of criteria must first be satisfied. Additionally, where the proposed prophylactic intervention is intended for children, who are unlikely to be able to provide a meaningfully informed consent, a heightened scrutiny of any such measures is required. We argue that children should not be subjected to prophylactic interventions "in their best interests" or for public health reasons when there exist effective and conservative alternative interventions, such as behavioural modification, that individuals could employ as competent adolescents or adults to avoid adverse health outcomes. Applying these criteria, we consider the specific examples of prophylactic mastectomy, immunisations, cosmetic ear surgery, and circumcision.

Keywords: Ethics ; informed consent ; mastectomy ; immunisations ; circumcision, prophylactic surgery

Copyright © 2002 by the Institute of Medical Ethics.

Vaccination News Home Page

ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.