"Children first" – Balancing conflicting interests and ethical obligations in paediatric decision-making

• Applicant: Dr. Anna Hirsch
• Subject Area: Practical Philosophy
• Term: since 2026
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 566343405

In paediatric decision-making a variety of different ethical conflicts occur, many of which are distinct from those in adult medicine. Conflicts arise between the interests and values of the parties involved, between different ethical obligations (towards the child, the parents, other patients, etc.), and between different interpretations of child well-being. Even before children can be considered decision-making competent, they have their own views of their well-being. Consequently, at least three perspectives on child well-being must be considered in paediatric decision-making: the perspective of the child patient, the parents’ perspective, and the professional perspective of the healthcare team. It is still not sufficiently clear how the different and often conflicting perspectives, interests, and ethical obligations should be balanced. Current debates, including those on gender reassignment therapies and the vaccination of children, emphasise the importance of this topic. Even though it is highlighted as one of the central issues in paediatric ethics, many questions have not yet been answered satisfactorily. How can we deal with these conflicts in an ethically sound way? How can we ensure that the child’s perspective is not neglected? Which aspects of child well-being should be taken into account, and how do they relate to each other and to the (evolving) autonomy of the child? What can help to balance conflicting interests and ethical obligations in paediatric decision-making? The project aims to make progress on these questions by addressing them in an integrated way. It is based on the hypothesis that a differentiated balancing framework is needed to deal with paediatric decision-making conflicts in an ethically sound way. In developing this framework, it is important not only to be aware of different actual conflicts, but also to analyse the ethically relevant concepts involved, such as child well-being and autonomy. Another hypothesis is that the child’s subjective perspective on well-being and their evolving autonomy should be considered earlier and more strongly than it is usually the case. A systematic analysis of cases reported in court decisions in Germany will help to identify typical conflicts arising in paediatric decision-making. It will show which ethical obligations and interests tend to conflict, and where a differentiated consideration of child well-being and autonomy can be helpful. Drawing on pertinent philosophical theories, I will elaborate the conceptual foundations of child well-being and the evolving autonomy of children for the paediatric context. By combining the findings from the case analysis and the philosophical-conceptual analyses, I will develop a balancing framework that can provide guidance in cases of conflicting interests and obligations, for example by specifying the relative weight of different perspectives on child well-being, the evolving autonomy of the child, and parents’ decision-making authority.

• DFG Programme: Research Grants
• International Connection: Canada
• Cooperation Partner: Professor Andrew Franklin-Hall, Ph.D.