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Culture War Roundup for the week of July 3, 2023

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Medical ethics is a field I am interested in, and I came across an old article in particular in the New York Times that drew my attention lately

https://www.nytimes.com/2014/03/02/magazine/nursing-home-pitfalls.html?ref=theethicist&_r=0

The article in question in The Ethicist column describes a method used to keep dementia patients from wandering to unsafe areas by placing a black doormat in the way. According to the writer, the patients tend to perceive the doormat as a “hole” and feel deterred from passing, and raises the question about whether it is ethical to use one’s disability and/or fear to guide behaviour. In the columnist’s opinion, this application is ethical.

It got me thinking about the treatment given to individuals affected by the most common form of intellectual disability, that is called childhood (I say that half jokingly. Just half).

The fact that the aforementioned question about dementia patients is raised, in a world where adults guiding the behaviour of children through their lack of judgement is just a fact of life, is curious to me. Is there a good reason why childhood and intellectual impairments should be considered fundamentally different, and that the dilemmas of one should be considered separately from the other?

That is not to claim that the purposes and effects of a given treatment are uniform in every context. Of course, there are different degrees and forms of intellectual disabilities, each requiring different types of treatment. But it seems to me that it is relevant to question whether these differences in context justify the difference in treatment.

Right now I tend to think that disproportionately more regard is given to the autonomy of adults with an intellectual disability than to that of children

There’s probably a lot of interesting overlap, but a key distinction in my mind is that a child is the creation and heir of a parent. The parent has an evolutionary instinct to love their child and vice versa. So we allow for more freedom in how parents raise children because we assume that it is done with good intent, and we also assume a parent has certain rights about how to deal with children. Are these rights deserved? I think so, not out of any magical principle of fundamental rights necessarily, but because no one on earth is more likely to have your best interests in mind and be more invested in you than your parents. And no one will know your genetic inclinations more than your mom and dad. As such it makes sense to preserve the power of parents over children. In exceptional cases this power is taken away, which is also good. And if our society finds that parents have an insufficient interest in their kids, this is probably a symptom of a very deep problem that needs to be addressed, because there is nothing that should come more naturally to a human. This is one of the invisible problems of too much economic competition by the way: stressed adults are less interested in their kids and have less energy to spend on them, which leads to net negative consequences down the line, including expensive diseases like obesity and addiction.

Another distinction is that a child will one day be an adult and have decades of freedom. So their period of “indentureship” is brief. We are more okay with contracts that last a few years than one’s whole life.

It is true that children generally enjoy a level of goodwill and competence from their caretakers that other people with intellectual disabilities will hardly come across, and that there are differences in context that justify differences in treatment - most notably, that children will develop and have a long future ahead of them, while other people won't.

What I criticise is that there are many similarities between the different situations that do not seem to be widely acknowledged, and that people seem to have two separate sets of ethical rules for treting children or the intellectually disabled.

What I propose integrating more the discussion of ethical treatment of children and of the intellectually disabled as they are arguably of the same in nature, in order to improve both.

Maybe there could be benefits in introducing more elements of parenting to the treatment of the adult intellectually insufficient, and more elements of incentivized autonomy to the raising of children.

But as of right now I feel there is undue fragmentation in the ethical standards in the treatment of vulnerable people