wma 7-2.indd - World Medical Association

Medical Ethics, Human Rights and Socio-medical affairs
Person Centred Pediatric Care
James Appleyard
Each child is a unique individual. Each
child is conceived within and delivered
from their mother. Each child is influenced
uniquely by their father, the wider family,
the culture of the local community and the
nation state. The infant grows and develops
through childhood and adolescence into an
adult within five areas - mentally, physically,
intellectually emotionally and spiritually.
In those children nurtured in an environment
of love, joy and peace, their spiritual
dimension will widen. They are more likely
to survive the journey to adulthood and the
significantly different physiological, psychological
and pathogenic features which occur
at the different ages.
The paper looks at how this person centred
paradigm effects the individual child and the
community in which he or she lives and the
harmful consequences of “depersonalization”.
At first thought such a paradigm seems vague
and without much scientific credibility.
But in a comparative study by Cigdem
Kagitcibasi and colleagues, the motivations
for child rearing by 20,000 parents from
9 countries were assessed as “valuable” in
three domains – economic, social and psychological
[1]:
• the “economic” reason which involved the
material benefits that children may bring
both when they are children and when
they grow up, to be a security in old age;
• the “Social” reasons which are related to
the general social acceptance that normal
adults are given when they have children,
and the desire for continuation of the
family;
• the “Psychological” intention for the fulfilment
of children – with love, joy, pride
and companionship.
In those countries whose mothers viewed
their children to fulfil their own individual
potential with love, joy pride and companionship
had the best child survival rates
Poverty breeds disease and disease causes
poverty. Disease in just one family member
may have disastrous effects on the children
through loss of care and reduced family income,
causing older children to leave school
to support the family. The tragedy of the
AIDS orphans is all too apparent in Africa.
Poor families compensate for children’s
deaths by having a large number of children,
with the expectation that sufficient will survive
to care for the parents in their old age.
Large families simply cannot afford education
and health care for each child. Conversely
reduction in mortality can be a spur
to reducing fertility rates. The evidence linking
fertility levels to infants under the age of
1 yr and child mortality under 5 is powerful.
Countries who have infant mortality rates
of less than 20 have an average total fertility
rate of 1.7 children. In countries which have
infant mortality rates of over 100 have an
average total fertility rate of 6.2. children.
When children are valued in their own right
rather than for utilitarian purposes, family
size is smaller. This demonstrates the importance
given to each individual child on
the survival of the community
The mother’s education is clearly another
important factor but one which is also associated
with the family’s increased earning
capacity. The clear message is that looking
after children means less and not more
mouths to feed, better education, healthier
adults and improved economic progress
Yet UNICEF’s statistics reveal that some
10 million children worldwide are not adequately
cared for [2]. They die under the
age of 5years, mainly unnecessarily, from
treatable illnesses and from lack of local,
national and international will to recognise
the importance of each child as an individual
person
At international level the overwhelming majority
of countries have signed up to Article
24 of the 1989 United Nations Convention
on the Rights of the Child. This recognises
the right of the child to the enjoyment of
the highest attainable standard of health
and to facilities for the treatment of illness
and rehabilitation of health, and states that
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