The child’s immediate and long-term interests
Consideration must always be given to both short- and long-term best interests of the child. A child that is at risk of harm or neglect may need to experience temporary disruption to their lives while they are moved to a safe location. However, in the long term this may prevent them from further harm and improve their opportunities in life.
There are no easy answers to such complex dilemmas, but a commitment to the best interests of the child provides a mechanism to help determine how to reconcile tensions, and ensure the realisation of children’s rights.
Activity 2.1: Acting in the best interests case study
Read the case study below, keeping in mind the four interlinked aspects introduced above in section 2.4.
If you are working with another person or in a group, discuss the questions below. Otherwise, try to answer the questions yourself before reading further.
Asha, aged 11 years, has had a history of continued ailment and, because of limited facilities, it took four years to diagnose her illness as leukemia. She has undergone numerous procedures that have controlled the spread of the cancer but these treatments have resulted in secondary complications including a hole in her heart. Her medical advisers say that to reach adulthood she will need a heart transplant but they cannot predict that this will be successful. Asha has said that she has had enough of medical procedures and does not want the transplant. She is supported by her parents. The doctors insist that they should proceed.
- What rights does Asha have in this situation?
- What are Asha’s views?
- What other needs does Asha have?
- What are Asha’s short- and long-term interests?
- In your view, are the doctors right to insist on this treatment?
Discussion
- You may have identified a number of rights that Asha has. She has a right to survival, a right to appropriate health services, and a right for her views to be taken into consideration. These rights are contained in both the UN Convention and the African Charter.
- Asha does not want to be operated on. She has undergone numerous procedures already and may be distressed by the thought of further medical intervention. Her experience to date may have given her a negative perception of medical facilities.
- Agreeing to Asha’s preference may be detrimental to her well-being. In this situation it may lead to further serious illness or even death. In such cases, the health worker, parents, or others, might have to help the child understand the effect of their decision and the advantage of taking the operation.
- Asha’s most immediate interests are to prevent distress and upset, but her right to survive is of greater importance. Consideration has to be given to her evolving capacities to take responsibility for decisions that will affect her future. You would need to decide if she genuinely understands the implications of the choices that need to be made.
- From the limited information available to you, it may not be possible for you to say with certainty whether the doctors made the right decision. They can consider Asha’s views and respond sensitively, ensuring that Asha understands the importance of the operation. They want to give Asha the best medical care to ensure her survival and they are willing to override her views and that of her parents if necessary to achieve this best interest. However, if the operation would be likely to cause significant distress and physical pain both during and afterwards, and was expected to prolong life for only a very short time, would the doctors still be right to insist? While the right to life is vitally important, the quality of life is an important factor to consider when making decisions in health care.
In determining the best interests of the child, there is often no easy right or wrong answer. Rather, consideration of the best interests can be a way of resolving difficult dilemmas and making judgments in complex situations. It provides a guiding principle to help you in those circumstances.
Balancing different rights