Parental reason-giving obligations in pediatrics: who owes what to whom and why?

There is ongoing controversy surrounding what ethical weight, if any, should be given to parents' reasons in the setting of disagreement about a child's treatment. Parents often readily explain their decisions without prompting. Yet this is not always the case. Some parents do not want to disclose their reasons, while others may struggle to articulate their reasoning. The question of whether parents have an obligation to share their reasons in pediatric decision-making has received limited attention in the bioethics literature. In this paper, we examine these tensions, aiming to clarify the stakes of reason-seeking and reason-giving practices in pediatrics. First, we briefly summarize prevailing views of parental obligations in philosophical and legal theories of the parental role. Second, we present two strong positions on whether parents have an obligation to share their reasons in pediatric decision-making and consider the implications of each. Third, we propose a more nuanced position that recognizes a pro tanto parental obligation. We offer six guiding considerations (disagreement, capacity concerns, parental discretion/harm to the child, complexity, preference sensitivity, and the burden of enacting the decision on others) and three relational features of decision-making that determine the presence and strength of a parental obligation to give reasons. By mapping the contours of parental reason-giving obligations, we seek to establish a stronger ethical foundation for exploration of the parental role and reasons in treatment disagreements.