Children’s place in society

Published on 21/03/2015 by admin

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Last modified 21/03/2015

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2 Children’s place in society

Lisa Jackson, Nandu Thalange

Chapter contents

Introduction

The United Nations Convention on the Rights of the Child

Rights of protection 
Rights of participation
Rights of provision

Parents’ and doctors’ responsibilities and the child’s best interests

Parents’ rights and responsibilities 
Physical punishment of children

Duties of medical confidentiality

Consent

Children living in poverty and marginalized groups

An international view 

Inequalities in child health

Marginalized groups of children

Ethnic minorities 
Children in lone-parent families
Refugee and asylum-seeking children

Why is this important?

Conclusion

Introduction

An inquisitive visitor from a remote, isolated society might wonder why the Society for Protection of Animals has a royal charter whereas the Society for Protection of Children does not; why restaurants and pubs feel it is necessary to say that children will be welcomed (if they are well behaved); and why teenagers with as much interest and appreciation of the political world around them as most adults are not allowed to vote for the people that govern them. Despite lip-service being paid to the importance of children, society in western developed countries is adult-centred, and children’s place in it is defined in terms of their relations with adults.

Society’s responsibilities towards children are complex and sometimes contradictory. Children are our future and so need to be nurtured and at the same time they are vulnerable and so deserve protection. Society can discharge these responsibilities by supporting families. If families put their children’s interests first and provide a stable, loving and stimulating environment, they will ensure the child’s future health, development and social well-being. But children are also individuals and ought to be able to participate in society in their own right. Balancing these principles may be difficult.

The United Nations Convention on the Rights of the Child

A good starting point is to think in terms of children’s rights. The 1990 UN Convention on the Rights of the Child (UNCRC) is the document on which the basis of children’s rights, and their place in society, are founded (see www.unhchr.ch). It has been ratified by every country in the world with the exceptions of Somalia and the United States of America.

The UNCRC is a ‘must know’ for all doctors caring for children. It explains the responsibilities we have as health professionals caring for children, and provides a means to disentangle some of the complex ethical problems encountered in the healthcare of children.

The UNCRC begins by describing underpinning principles:

• The interests of children are paramount

• Children have the right to be supported in their own families and communities, but are not their families’ ‘property’.

It then lays out articles that cover rights of protection, participation and of provision. Below are listed some of those of relevance to child health.

Rights of protection

The right:

• To life (article 6)

• Not to be separated from their parents against their will except where to remain with them would harm the child (article 9)

• To special protection such as fostering or adoption when children are deprived of their family environment (article 20).

These rights reiterate the importance of families for the welfare of children.

The right to be protected from:

• All forms of abuse (article 19)

• All forms of sexual exploitation (article 34)

• Economic exploitation (article 32)

• Exposure to illicit drugs (article 33).

These rights reflect the vulnerability of children and the responsibility of society to protect them. The most relevant for paediatric care are the articles protecting children from abuse, which includes physical, mental and emotional abuse, neglect, and sexual abuse and exploitation. Although paediatricians have a particular role in diagnosis and management, all doctors and healthcare workers have responsibilities for identification and prevention.

Rights of participation

• The right to an identity, i.e. a name, a family and a nationality (articles 7 and 8).

These may not seem relevant to healthcare but consider how many children change their surname, how often the surname a child answers to is different from the one stated on health records, and how often we call a child by a different name to the one they are familiar with.

• The right to express their views freely (articles 12 and 13)

• To have access to information (articles 13 and 17).

These are important general principles that are also directly relevant to children’s health. Children should know about their health and contribute to decisions about their healthcare. In order to do this we need to be able to speak to children, provide them with written information, and listen to what they are saying, all in ways that are developmentally appropriate.

• The right of disabled children to enjoy life and participate actively in society (article 23).

This article describes the rights of disabled children to special provisions, but its inclusion as a right of participation reflects the view that disabled children should have the same status as any other child, or indeed as any other person. Participation is seen here as a positive property, in contrast to the negative notion of handicap (which describes how children’s participation in society is limited by disability).

Rights of provision

• The right to the highest standard of health and the highest quality of healthcare attainable (article 24).

This article is the guiding principle for all those who care for the health of children. It describes the importance not only of treatment of illness, but of preventive and anticipatory measures, public health, nutrition, health promotion and information, all with an emphasis on primary healthcare.

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