Knowledge and moral authority in decision-making for incapable children

Even when we agree on the appropriate ethical principle(s) for paediatric decision-making, and we rarely do, parents can and do disagree with clinicians about how to interpret or apply these principles. How do we decide who is right when there is disagreement about what is ‘best’ for a child, or what constitutes significant harm? I believe we can answer these questions by shifting our gaze to the epistemic underpinnings of our moral judgments. In this paper I argue that the moral authority of both clinicians and parents is bound to their sphere of epistemic authority. When decisions turn on considerations outside of this sphere, their choices are constrained. First and foremost, knowledge(s) are shared in shared decision making. When knowledges are shared appropriately, and the epistemic authority of the parties involved is duly respected, the appropriate division of moral labour follows. These claims, if true, have a number of important implications the appreciation of which I believe to be useful for working through decisional conflicts in paediatric care.