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A five-year-old Newport girl was taken into care after her weight reached more than 10 stone. Medical causes for her obesity had been excluded and she had continued to gain weight despite her parents being warned that they were putting her health at risk.  She had weighed 10st 5lbs (66.1kg) – more than three times the weight of a healthy child her age. So in August 2012, and she was removed from her otherwise loving parents and put into foster care. By September 2013 her weight had fallen to 7st 7lb [49kg] which is still obese but a marked improvement. What ethical issues does this raise? Were social workers right to act in this way? What do you think?

Answer

This scenario can be looked at using the four pillars of medical ethics; beneficence [benefit], maleficence [harm], autonomy and justice. ethical scenarios arise when there is a conflict between these four principles.[See my book- Medical School Interviews The Knowledge  P24]

Autonomy v Justice [Rights versus Responsibility]: A 5 year old child does not really have autonomy because 5 is almost certainly too young for her to have a full understanding of the consequences of eating to such an excess. She does not have competence and therefore capacity to make choices about her diet. Usually parents have the right to make decisions about their children – autonomy is devolved to parents. They have the right to decide how to bring up their child. However no one really has the complete right to do what they want to. We all have a responsibility to those around us. Parents have the right to make bad decisions about their own health but do they have the right to significantly harm their child?

Harm versus Benefit. In general the courts look at the degree of harm and the degree of benefit of any action. Taking the child away from her parents will harm the child as they love her and she loves them. However they are not limiting her food intake despite being advised and warned that she will suffer severe physical, mental and social problems as a result. The harm- benefit ratio balance has to be carefully looked at and if it is thought that more good than harm will result then removing her from her parents would be in the girl’s overall best interests.

Slipppery slope. This concept is common in ethics. Taking a child away because she is fat because her parents have brought her up badly may create a slippery slope in which parents are judged and their children are removed for less than perfect parenting. Neglect [hard to define], alcoholism , affairs and divorce are all things that affect children.

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