Parents and children are asked to take on ever more responsibility without necessarily more obvious benefits or rights, except that it would appear that parents desire to continue with their parenting responsibilities and looking after their children, even in hospital (Casey, 1993). Parents see this not only as an ongoing burden but also as an ongoing parental right. Child health-care, in this context, becomes a shared responsibility between various pro-fessional and non-propro-fessional adults.
The child, too, has a measure of responsibility. Traditionally children have been absolved from full responsibility on the premise that they are not capable of being fully responsible and, therefore, cannot be accountable for their acts. According to French (1993), in order to qualify as a player of the responsibility barter game the player must be a member of the moral com-munity, which implies a particular level of moral and social development.
Presumably, players once ‘in the game’ can be voted out, or temporarily dis-qualify themselves by virtue of disease, unconsciousness or lack of sobriety.
But children are changing and in some areas of their lives are completely competent and responsible and in other areas highly dependent on adult
Responsibility of parents and children 115 guidance. It is probably safest overall to consider children as lacking full moral and social competence, unless proven otherwise in a particular case.
Children, additionally, have to prove that they possess relevant moral and social knowledge. In a practical example from health promotion, one could not hold children accountable for the maintenance of their own good dental health unless and until: first, they are capable of understanding the significance of daily oral hygiene and second, they have the requisite motor skills and intellectual ability to carry out daily dental hygiene and to plan an adequate nutritious diet.
One related question that troubles child sociologists, psychologists and moral philosophers concerns the nature of the loss of innocence ( James & Prout, 1990; Archard, 1993). Rephrased, the argument suggests that we should be concerned that the price of being held responsible for our actions means an automatic loss of ‘innocence’. Conversely, some would say that what a child does not know about harmful bacteria, for example, does not concern them; at least not directly. Personal knowledge brings with it personal responsibility and a loss of innocence.
French, however, points out that losing innocence is connected with gain-ing maturity and moral development, and that moral innocence is more akin to moral ‘virginity’ than moral purity. As he rightly points out, innocence is a matter of moral status, the status of someone not mature enough to be a fully ‘paid-up’ member of the moral community. It is not a condition that adults need, or indeed should yearn for, even though as he notes ‘innocence . . . is only valued by those who no longer possess it’ (French, 1993). More-over, the world’s children are only too aware of their losses and the altered state of childhood which they are forced to live out, often in grotesque circumstances. The children do not want the impossible nor are they hankering after an unrealistic dream. They want to attend school and to avoid serving in (adult) armies. They want to be free to play without the fear of mines and explosives, be free from adult prejudice and manipulation, and have equal access to healthcare (UNICEF, 2002). These are hardly the requests of unreasonable individuals.
Innocence absolves from responsibility, but only temporarily, as it is the duty and responsibility of adults who are collectively responsible before soci-ety, to instil in children the universal concepts of right and wrong and the nature of good and evil. Once ‘moral innocence’ is lost however, there is no going back: paradise can never be regained. Loss of moral ‘virginity’ is irrecov-erable, since knowledge about oneself can only, by definition, be an active ongoing process (French, 1993). Thus, an asthmatic child taught by parents and the community paediatric nurse to use an inhaler, cannot go back on this knowledge and behave as if they never knew what to do in the event of an asthmatic attack.
Most children guard their autonomy and newly learnt skills, and do not see them as a loss of innocence so much as necessary growth and a move in the direction of maturity and self-determination. For this reason, many
116 Working with Children: Accountability and Paediatric Nursing
children who are taught how to use an inhaler, or to administer their own insulin, will not take kindly to giving up this responsibility to a teacher or camp director when the class goes on an outing or a camping trip.
Additionally, with this responsibility comes the right to real – albeit limited – self-determination. It is difficult to argue with a child who has already been given responsibility as to why this responsibility should necessarily change and /or stop (Alderson, 1993).
Responsibility can therefore be seen as the most crucial element in the accountability equation, and one shared in proportion to moral development by children as well as adults. Thus, paediatric nurses in the course of their work are not only responsible for their own actions but also for the uphold-ing of parents’ ongouphold-ing responsibilities and the development of a child’s own sense of responsibility. Accountability, for paediatric nurses, rests on a delicate balance of their professional responsibilities with those of parents and children, where the child’s ‘responsibilities’ and self-determination will always be paramount, as it is the child who is at the centre of every paediatric nurse’s concerns.
Conclusion
As the children of the world proclaim:
Until others accept their responsibility to us, we will fight for our rights.
We have the will, the knowledge, the sensitivity and the dedication. . . . We are the children of the world, and despite our different backgrounds, we share a common reality. We are united by our struggle to make the world a better place for all. You call us the future, but we are also the present.
(UNICEF, 2002) Paediatric nurses everywhere should heed this call by children for adults to play their full responsible role in society and to start promoting and protecting the rights of children everywhere. It is the children themselves who are setting the professional agenda and calling adults to account for their failings to protect them and guide them. The children are prepared to:
‘promise to support the actions you [i.e. adults] take on behalf of children, [and] we also ask for your commitment and support in the actions we are taking, because children of the world are misunderstood’ (UNICEF, 2002).