1 School of Population Health, University of Auckland, Private Bag 9201 Auckland, New Zealand
In many jurisdictions, the state funds and/or provides child health advice. Advice is characterised by its discretionary quality: unlike laws or directives, recipients are free to choose whether to follow advice. Thus, state provision of child health advice is often seen as a way of informing and supporting parents, rather than as a means by which the state sets standards or regulates parental practice.
Recently in New Zealand, criminal proceedings have been brought against some parents of babies whose deaths were attributed to Sudden Unexpected Death in Infancy (SUDI), on the basis that they did not follow advice to refrain from co-sleeping.
This paper presents these cases and argues that they both reveal and contribute to the normative hardening of child health advice and increasing specification of parental obligations. The implications of this for child health advice are considered. Drawing upon the publicity principle as developed by Lon Fuller, I argue that fairness requires that, if child health advice is to be enforceable, it should not be presented as advice. I suggest that more transparency about the discretion attached to child health advice may foster fruitful debate about the nature and extent of parental obligations and allow broader social determinants of child health outcomes to enter into public debate. The ethical and political issues explored in this paper are by no means unique to SUDI prevention, and the arguments developed here have wide implications for health promotion.
Monique Jonas is a Senior Lecturer in Ethics at the School of Population Health at the University of Auckland, New Zealand. Her research focuses upon ethical and political aspects of child-rearing and the relationship between the family and the state. Other research themes include the ethics of advice-giving, distributive and procedural justice in health, and competence and consent. She teaches health care ethics and bioethics.