Eyes Wide Open: Surgery to Westernize the Eyes of an Asian Child

Alicia Ouellette

The Hastings Center Report. 2009;39(1):15-18. 

In This Article

Toward a New Paradigm

The case of eye-opening surgery for an adoptive Asian daughter should open our eyes to the need to reexamine the paradigm that defers to parental choices concerning health care for children when the medical intervention sought addresses the social, cultural, or aesthetic preferences of the parent rather than a medical condition in the child. A paradigm built around the conceptual framework of parent as trustee of the child's welfare would better protect a child from well-meaning but harmful parental decisions than does the current paradigm, with its emphasis on parental choice. The specifics of such a paradigm are beyond the scope of this essay, but certain guiding principles should apply.

First—as with any trustee—a parent's primary duty must be to protect and preserve what is held in trust. Second, the trustee parent must avoid self-dealing—that is, taking advantage of his position as trustee to serve his own interests. Third, the trustee parent may not engage in transactions that involve or create a conflict between his duty to protect the child and his personal interests. As with any trust situation, the trustee's power to exercise his discretion over the trusteeship should be afforded presumptive deference and remain beyond review except to the extent that its exercise is inconsistent with his duties to the child. Those trustee decisions that may constitute an abuse of trust—such as those that suggest self-dealing or that involve a conflict of interest—should be implemented only when reviewed and deemed appropriate by someone other than the trustee.

Applying these principles to medical decisions made by parents for children would maintain the deference given to decisions that are triggered by a physical or psychological need in a child. Decisions to use medicine or surgery to shape a child based on a parent's social, cultural, or aesthetic preferences—especially those that limit the child's ability to make significant choices central to his or her identity—would be treated differently. In such cases, a parent should have the burden of proving that his or her choice for the child will benefit the child in the long run.[15] The responsibility for evaluating such decisions might fall to a neutral third party, the physician, an ethics committee, or a court; but unless someone other than the parent finds convincing evidence that the proposed intervention will address an immediate need of the child's, the intervention should be put off until the child can make her own decision.

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