Abstract

This chapter addresses the ethical challenges posed by caring for cognitively impaired children whose illnesses bring them repeatedly to intensive care. It argues that the central difficulty arises not from their impairment but from assumptions that wrongly equate diminished cognition with diminished value. Non-consequentialist ethics easily grounds a doctor’s obligation to treat such children with respect, but consequentialist approaches risk misvaluation by expressing personal worth exclusively in terms of capacities for benefit, preference or autonomy.The chapter distinguishes between two forms of valuation often confused in debates about ventilation: the value of the person, which is constant, and the value of prolonging life, which varies with the burdens and benefits of the interventions needed to do so. Cognitive impairment may affect what actions serve a child’s interests, but it does not alter the child’s inherent worth; to deny intensive care categorically on cognitive grounds is therefore to commit the same adult-normative error that underpins arguments for infanticide.Turning to rationing, parental authority and the role of courts, the chapter argues for an age-neutral ethic in which decisions emerge from dialogue between medical and parental expertise, directed solely to expressing the child’s objective and subjective interests. Cognitive impairment neither diminishes a child’s capacity to suffer nor licenses avoidable harm; ethical systems must therefore prevent prolonged suffering caused by adult disagreement or procedural delay.