Children are largely ignored in medical ethics, which concentrates on adults with capacities that children lack (including competence, or rationality). This thesis answers how medical decisions should be made for unquestionably incompetent children. The dominant approach to medical ethics in the West depends on respect for autonomy and this distorts medical ethics for children in two ways. Firstly, parental decisions for children may be taken to have the same authority as respect for autonomy. Secondly, theories of general well-being have focused on adult’s well-being with an endorsement of the components of that well-being by the adult themselves. This has hindered the development of an objective, impartial, conception of interests, arguably, the best fit for making decisions for very young children. I argue that although children are clearly demarcated from adults in medical ethics, there is not a clear explanation of why this is. For young children others must make decisions or be prepared to override the child’s decisions. More recently, the distinction between adults and children have become blurred, exemplified by the use of terms such as ‘young person’. Children’s rights at best draw attention to children and their interests, but do not help in resolving the medical treatment of incompetent children. The most promising approach depends on articulating an account of children’s interests. For several reasons the best interests standard is not defensible. I argue that a reasoned, or reasonable, agreement upon the child’s interests should determine medical treatment. Neither the child’s parents (nor the clinicians) can be taken to have an incorrigible grasp of the child’s interests, all should justify the reasons for their choices.
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