According to various accounts, intervention in pediatric decisions is justified either by the best interests standard or by the harm principle. While these principles have various nuances that distinguish them from each other, they are similar in the sense that both focus primarily on the features of parental decisions that justify intervention, rather than on the competency or authority of the parties that intervene. Accounts of these principles effectively suggest that intervention in pediatric decision making is warranted for both physicians and the state under precisely the same circumstances. This essay argues that there are substantial differences in the competencies and authorities of physicians and the state, and that the principles that guide their interventions should also be conceived differently. While both the best interests standard and the harm principle effectively incorporate important aspects of physicians’ ethical obligations, neither adequately reflects the state’s ethical obligations. In contrast to physicians, the state has major obligations of distributive justice and neutrality that should form an integral part of any proposed ethical principles guiding state intervention in pediatric decision making. The differences are illustrated by examining recent cases involving parental refusal of chemotherapy in aboriginal Canadian communities and parental refusal of blood transfusions by Jehovah’s Witnesses.

中文翻译：

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儿科医疗保健中的干预原则：医师与国家之间的差异。

根据各种说法，以最佳利益标准或伤害原则来证明对儿科决策的干预是合理的。这些原则虽然有细微差别，使它们彼此区别开来，但它们在某种意义上是相似的，它们都主要关注父母干预决定干预的正当性，而不是干预各方的能力或权威。这些原则的说明有效地表明，在完全相同的情况下，对医生和国家都应干预儿科决策。本文认为，医师和国家的能力和权威之间存在实质性差异，并且指导其干预的原则也应有不同的构想。尽管最高利益标准和损害原则都有效地纳入了医生道德义务的重要方面，但两者均不能充分反映国家的道德义务。与医师相反，国家承担分配正义和中立性的主要义务，应构成指导国家干预儿科决策的任何拟议伦理原则的组成部分。通过检查最近的案例来说明这种差异，这些案例涉及父母在加拿大原住民社区拒绝接受化学疗法以及耶和华见证人在父母拒绝接受输血方面。该州负有分配正义和中立性的主要义务，应构成任何指导国家干预儿科决策的拟议道德原则的组成部分。通过检查最近的案例来说明这种差异，这些案例涉及父母在加拿大原住民社区拒绝接受化学疗法以及耶和华见证人在父母拒绝接受输血方面。该州负有分配正义和中立性的主要义务，应构成任何指导国家干预儿科决策的拟议道德原则的组成部分。通过检查最近的案例来说明这种差异，这些案例涉及父母在加拿大原住民社区拒绝接受化学疗法以及耶和华见证人在父母拒绝接受输血方面。