Ethics and the endangerment of children’s bodies

Gunter Graf &
Gottfried Schweiger
Ethics and the
Endangerment of
Children’s Bodies

Ethics and the Endangerment
of Children’s Bodies

Gunter Graf • Gottfried Schweiger
Ethics and the
Endangerment of
Children’s Bodies

ISBN 978-3-319-40212-3 ISBN 978-3-319-40213-0 (eBook)
DOI 10.1007/978-3-319-40213-0
Library of Congress Control Number: 2016954255
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Gunter Graf
Centre for Ethics and Poverty Research,
University of Salzburg
Salzburg, Austria
Gottfried Schweiger
Centre for Ethics and Poverty Research,
University of Salzburg
Salzburg, Austria

v
This is the second book that we have written together and we can more
or less replicate the acknowledgments of the last one. This book is the
product of hard work over a long period of time. We thank our colleagues
with whom we discussed our ideas and arguments and who helped us to
write a better book. In particular we want to thank our dear colleague
Mar Cabezas for her support, her help, her thoughts, and her encour-
agement. Without her this book would not have been possible. We also
want to thank our home institutions, the Centre for Ethics and Poverty
Research (CEPR) at the University of Salzburg and the international
research center for social and ethical questions (ifz). We received much
support from these institutions and the people working there, especially
the current head of the CEPR, Andreas Koch, and its former head and
current deputy head, Clemens Sedmak. They supported us to pursue this
work over the past months and we hope that the product justifies their
trust in us. We also thank the reviewers, who provided us with helpful
feedback. We further thank the Austrian Science Fund (FWF) for fund-
ing our research project “Social Justice and Child Poverty” (P 26480).
Although the issues in this book extend the focus on child poverty, we
see it as a natural part of this project, not only because poverty is one
important social factor for the violation of children’s bodily integrity.
Acknowledgements

vi Acknowledgements
We also want to thank the people at Palgrave Macmillan, Grace Jackson
and Brendan George, who supported this project. Finally, we hope that
our work is a contribution to the philosophical discussion but also helps
to make the world a better place for children.

vii
1 Introduction 1
2 Children’s Bodily Integrity: Justice and Child Well-Being
in Affluent Societies 19
3 Body and Eating 77
4 Body and Sexuality 143
5 Body and Violence 207
6 Conclusions: Ethical Policies for Safeguarding Children 265
Index 281
Contents

1© The Author(s) 2017
G. Graf, G. Schweiger, Ethics and the Endangerment of Children’s
Bodies, DOI 10.1007/978-3-319-40213-0_1
1
Introduction
This book is concerned with the endangerment of children’s bodies in
affluent societies. It aims to analyse and address injustices that threaten
the bodily integrity of children and to discuss the societal responsibili-
ties that follow. Children’s bodily integrity is an important part of their
physical and mental well-being and well-becoming.1
However, it can be
severely violated through various threats during childhood. Children’s
bodies are particularly vulnerable and bodily damage not only affects
children’s short and long-term physical health but can also cause mental
damage and lead to distortions in the development of the self. This book
comprehensively reviews and criticizes these violations of children’s bodily
integrity, with the aim of contributing to our understanding of them as
forms of injustice, and hence moral harms. It is as such a philosophical
book on ethics with a normative scope and not a piece of quantitative
scientific literature that presents original empirical data. In this introduc-
tion we will answer two questions before giving a brief overview of the
structure of this book. The questions are: What are our aims and what do
we want to achieve? How do we proceed in order to achieve them?
1
We will define both terms in the next chapter.

1.1 The Aims and Scope of this Book
Our book is focused on ethics and thus our main aim is an ethical one:
we seek to clarify what is morally wrong about the violation of children’s
bodily integrity as it happens today in affluent societies. This is a very
broad field of enquiry and thus we decided to focus our discussions
around specific examples of violation. We have clustered these examples
around three topics: eating, sexuality, and violence. Within the topic of
eating we will focus on obesity and eating disorders, within sexuality we
will focus on sexualization and sexual abuse, and, finally, within the topic
of violence we will focus on physical abuse and violence between children.
We are well aware that these topics only represent a small selection within
the broad of field of injustices that children face today. We selected these
topics in order to have enough room to examine them in detail—our aim
for depth—but also to cover a spectrum of the threats to bodily integrity
that children face—our aim for width. With our selection, we do not
make any judgement regarding the ranking of severity of these viola-
tions, in the sense that we view them as more severe than, for example,
child poverty. However, as we will show, all the chosen topics represent
in themselves severe injustices in that they violate the bodily integrity of
children and cause long-lasting effects on their well-being. That makes
them worthwhile subjects for a thorough ethical evaluation, with a strong
focus on counter-measures to secure and protect children from them. We
assume that most readers will agree that obesity and eating disorders, the
sexualization of childhood and sexual abuse, as well as physical abuse and
violence between children, all constitute a moral imperative, and that
we, as individuals and as societies, ought to do something about them.
Why then write a book about something where we find almost universal
agreement? Should we have not focused on moral dilemmas which divide
opinion, or issues that are underrepresented in the literature, that people
care less about?
Our answer is twofold: the first part refers to the fact that even though
there is universal agreement that these violations of children’s bodily
integrity are immoral there is a philosophical need to substantiate this
common understanding. This is especially important since we find that
the answers become more difficult as one looks closer at the details. Also,
2 Ethics and the Endangerment of Children’s Bodies

within the moral consensus on children’s bodily integrity we can find
many questionable assumptions, for example about the nature of child-
hood, the value of the family, and the tasks of the state. A philosophical,
in this case ethical, examination digs deeper into the human instinct and
aims to present a coherent and detailed argument as to why these issues
represent violations of bodily integrity and what moral responsibilities
follow from this. The second part of our answer is that especially in regard
to the responsibilities and obligations that come with these injustices it
is very likely to find disagreement in the public view and also among
policy makers (and philosophers). Yes, most will agree that a child that is
sexually abused is wronged, yet what follows from that? Most will agree
that the perpetrator should be punished, but what other claims does the
child have? Does the state have an obligation to compensate the child and
support him or her throughout his or her life? Furthermore the causes
are disputed: can we really claim that child abuse is detached from the
societal environment in which it happens? What responsibilities of pre-
vention exist? How do we balance such prevention measures with other
values such as privacy? To say that the violation of children’s bodily integ-
rity is morally wrong is only the first part of the answer that we need to
give, and the issues go beyond that. Over the course of this book we will
show that affluent societies fail children in many ways, and this cannot be
attributed only to the anomalous misbehaviour of individuals—rather, it
is the society, the state, and its institutions that fail children on a large
scale. Another issue that we are interested in is to critically examine the
moral panics that surround children’s bodies in modern affluent societies.
An ethical evaluation of any kind demands the existence of an ethi-
cal framework which is based on normative reasoning. Such reasoning
is distinct from all other scientific enquiry when it comes to its rela-
tion to the real world. As Onora O’Neill—as well as many others—has
sufficiently argued, normative theory is interested in the world because
it wants to change it and not to explain (“Erklären”) or to understand
(“Verstehen”) it (O’Neill 2009). Furthermore, while for all other lines of
scientific enquiry the world can be used to test underlying assumptions
and theorems, this is not possible for normative principles. Such princi-
ples are not falsified if the world is different. Nonetheless, the relationship
between ethical theory and the real world is not a one-way street, in that
1 Introduction 3

we only need to aim to adapt the real world to the principles we set out
in ethical theory. We believe that philosophers should consider the “real
world”—and the constraints it puts on actions—especially within ethical
theory. We should aim for theories that fit the “real world”. Therefore this
is what we aim to accomplish with our ethical framework.
Our framework is that of the capability approach, and within that we
will argue for a partial theory of justice for children (Schweiger and Graf
2015). We will clarify all necessary details in the next chapter, providing
only a brief outline here. We understand the partial theory of justice as a
tool to detect injustices in the lives of children, and it can give us guid-
ance as to how we should react to these injustices. For it is not necessary,
or indeed possible, that the theory has all the answers to all questions
regarding what justice demands for children. To summarize, we are only
interested in what we need to know to deal with the issues at hand, which
is first and foremost how bodily integrity is part of justice for children
and how it should be conceptualized from a capability perspective. This
brings us to another important point that the reader should bear in mind:
this is an ethics book that aims to balance discussions of normative the-
ory with the evaluation of real-world problems. Due to this we cannot
devote as much space to our normative theory as one might hope for.
This is a necessary trade-off that is present in all ventures of applied eth-
ics, whether it is in bioethics, business ethics, or political philosophy. The
ethical theory we present in this book is admittedly incomplete in terms
of width and depth compared to an ethical theory laid out over hundreds
of pages in a book that focuses solely on that task. Still, we hope that
at least all central claims of our ethical framework are backed up by the
arguments we will bring forward, and we do not claim to have the theory
fully fleshed out. A key aim of this book is to enhance the debate about
the capability approach as a theory of justice for children, following up
on our earlier work in our book on child poverty. This is especially impor-
tant as there is little, if any, ethical literature on children’s bodily integrity
as part of justice for children within the capability approach, or indeed in
general. In this manner we hope to improve our understanding of these
highly important dimensions of children’s well-being and well-becoming,
and to show that we need to be careful in the design of our theories of
justice for children.

In summary, the aim of this book is to investigate from an ethical
point of view the violation of bodily integrity of children with a focus
on the issues of eating, sexuality, and violence. We aim to draw conclu-
sions that are relevant for policy making and for the actions of important
agents in the lives of these children. This constitutes the third aim of
this book, which we share with others who have preceded us and tried
to apply ethics to the “real world”, such as Jonathan Wolff and Avner
De-Shalit in their book on disadvantage (Wolff and de-Shalit 2007). As
they rightly state, in our opinion, the task of applied ethics—or political
philosophy—cannot and should not be to formulate abstract principles
alone. Instead they argue that one should aim to formulate theories in
such a way—or apply them in such a way—that they can say something
useful about the “real world”, applying moral grounding to current social
problems. We believe that ethicists should not be satisfied with merely
naming what is wrong about the world but should also try to improve
our understanding about how we could change things for the better. That
goal comes with certain obstacles: obviously, such advice depends to a
large extent on the problem that must be addressed. If one examines
lying and comes to the conclusion that it is morally wrong to lie, then
one level of advice could be to simply state that nobody should lie. That
conclusion is very general and reductionist. Another ethicist examines
a clinical case, for example whether or not a severely ill child should be
allowed to terminate their own treatment. Her advice could be to allow
that specific child to make that decision and she could argue for that in
front of the clinic’s ethics committee or give advice to the involved doc-
tors, judges, and parents. Based on this case the ethicist could also aim
to draw more general conclusions for all severely ill children, and draft
guidelines on how to handle future cases or even propose how the laws
should incorporate her insight on that topic. So, there are many different
levels on which such advice can be given and many different potential
agents can be involved. The policy advice that we want to give is mostly
on a general level and it is not context-specific, although we presuppose a
highly developed, affluent society which is not crippled by war and pov-
erty, that has a well-functioning administration and political system. But
we will also deal with other relevant agents of justice, as we term them.
In fact, one key task that we face is to give a reasonable systematization
1 Introduction 5

of the potential agents of justice and determine how responsibilities can
be attributed to them.
One major difficulty in the ethics field is that most ethicists have no
direct connection to those who are relevant for the problems they reflect
upon. Some work directly with medical personnel or decision makers
but most do not, especially if their area of expertise is concerned with the
design of our social and political institutions. This is also one difficulty
that we ourselves face. Neither are we ourselves politicians nor are we
advising any of them in a particular country. So for whom are we writing
this book then? Is there reasonable hope that politicians will read it? We
do not have false hopes and believe that politicians will read our book
and change policies and make the world a better place for children. Not
only (it is said) do politicians seldom read philosophy books, but even
if they do their policies are likely more influenced by party mechanics,
opinion polls, and lobby groups. For this reason we are not aiming our
focus at a certain political context or legislation. We do not analyse in
detail the differences between Germany, France, and the United States.
We also do not aim to draft new legislation nor will we propose guide-
lines for social workers or medical personnel. That is not the level of our
enquiry. If it were the case that we could only cover one very specific
issue, we would need to examine much more literature and legislation
and also detail the political process that could enact the change. Our
aim is much more modest and, as we believe, it is also closer to what
philosophers can do best. We aim to provide general guidelines as to how
responsibilities should be distributed and on which ethical basis poli-
cies should be drafted. We already stated that we will focus on affluent
societies, which is an umbrella term, and that we will discuss evidence
from different countries and regarding different age groups. Based on
that we will come to general ethical conclusions that can and should be
used to design policies, but we will not draft them ourselves. This process
needs more input than we can provide and—another ethically important
point—also needs democratic public deliberation, which incidentally we
believe should include children to a much greater extent than it does
today (Lansdown 2001).
At last, we want to say something about the subjects of this book, to
discuss children and their characteristics. As we will argue in more detail

later on, the concept of childhood is a contested one and it is far from
a simple biological category. This is also reflected throughout the book
where we critically reflect on notions of innocence or incompetence that
are often attributed to children. In general, our understanding of chil-
dren for the purpose of narrowing down the population we are concerned
with in this book is a pragmatic one and we follow the United Nations
Declaration on the Rights of the Child, which states that a child is every
born person under the age of eighteen. By that we exclude persons who
are not born yet, though we are aware that there are several issues sur-
rounding their bodily integrity, especially as it is so closely interwoven
with the bodily integrity of the mother. And we also acknowledge that
we deal with a very heterogeneous group of human beings, including
toddlers, who are more or less completely dependent on their care-givers,
as well as teenagers, who are active agents of their lives with a wide range
of competencies. Furthermore, the topics we will examine also have a
strong gender dimension, which we are aware of and which we will reflect
upon: girls are more frequently, and in a different way, victimized than
boys. The pressures of sexualization, thinness, or beauty are different for
boys and girls, even though it is not only girls who are affected. Likewise,
the way in which violence affects girls, and how girls perceive themselves
as potential victims as they grow up, also shapes girls’ bodily integrity.
We will explore how to introduce gender-sensitive dimensions to, on the
one hand, capture gender-specific violations of the bodily integrity of
boys and girls and intersex children, and, on the other, translate children’s
rights into concrete policies for safeguarding and protecting them with
their specific needs and vulnerabilities.
1.2 The Methodology of this Book
This brings us to the second question of this introduction: how do we
proceed in this book, what is our methodology? How do we plan to
achieve the aims laid out? Let us begin with the ethical framework, which
we already mentioned. There is some dispute within the applied ethics
field as to whether or not finished theories should be applied to a prob-
lem or question or if it would be better to look at the question and come
1 Introduction 7

up with the ethical theory as we proceed. Since we will outline our ethical
framework before we address the topics at hand, we believe that there are
good reasons against such bottom-up “anti-theory” approaches, at least
in their extreme forms. It seems implausible to us that ethical evaluations
of social problems such as domestic violence and neglect can be made
without having a normative theory in the background that tells us what
we owe children in the first place. The task of having such an ethical
framework is to provide us with guidance and justification for the evalua-
tive claims we make. That does not mean that such an ethical framework
does not need to be context-sensitive and that the process of applying it
to a social problem comes without any difficulties. On the contrary, there
are some difficulties we face but they should not trick us into the conclu-
sion that we do not need a theory at all. We want to apply that normative
framework to the questions that we want to answer; for example: What is
unjust about childhood obesity? Who should we hold responsible? What
should our policies regarding it look like? Obviously this involves leaving
the terrain of pure ethics, or to rephrase, connecting our ethical consid-
erations with knowledge about the “real world”, particularly about the
problems that we are interested in. Childhood obesity exists primarily in
affluent societies and the varied knowledge we have today about its causes,
effects, and the best ways to prevent and treat it is not philosophical in
nature. It is not something we can learn from the ethics books we read
and from reflecting on ethics as we are trained to do. This is knowledge
that we gather from outside our field, that we rely upon to be produced by
other researchers who specialize in such questions. Every ethical approach
to practical problems is in need of such externally derived knowledge.
If you want to say something useful in medical ethics, you need some
knowledge about medicine, probably medical law, and, very importantly,
you need to specify if you want to say something about a particular case,
a set of cases, or a general rule. Our enquiry is not located on the level of
the individual case and hence we will not discuss such individual cases
in the course of this book, as is common for example in medical ethics.
Our normative framework is a partial theory of justice which is interested
in governing rules and institutions rather than individual behaviour and
actions. We will discuss this further later; now we want to focus on the
question about the access we have—as philosophers—to the problems we

want to discuss. Let us begin by distinguishing the three types of knowl-
edge one can have about a social problem: first-person, second-person,
and third-person knowledge (Sedmak 2013). First-person knowledge is
simply everything that a person knows because he or she has experienced
it firsthand. For example, one of the authors of this book has first-person
knowledge about being a father, and the other one has first-person knowl-
edge about attending the finale of a European Championship in soccer.
Second-person knowledge is the kind of knowledge we gain if we are told
by someone we know about something that person has experienced. It is
dialogical. So the author of this book who was not at that soccer match
has gained that knowledge because he listened to the story. Finally, third-
person knowledge we want to characterize as being knowledge that aims
to eliminate the subjective factor as much as possible. It aims for objectiv-
ity. Second-person and third-person knowledge are closer to each other
than they are to first-person knowledge because they are both external
sources, but they are different not only by degree. Second-person knowl-
edge depends on recognition and wanting to understanding the other,
how he or she felt, how he or she experienced a situation, how he or she
interpreted it. If the soccer game was great or boring, if it was something
the person would want to do again, and so forth. These are the aspects
of second-person knowledge which are unimportant for the third-person
perspective, which aims for objectivity that cannot be reached in regard
to such subjective experiences as being bored or excited.
Having made this distinction between different types of knowledge it
becomes evident that ethics can use all of these. A philosopher can dis-
cuss problems that he or she knows firsthand, that he or she knows about
because a friend or relative has talked about them, and he or she can also
reflect on problems that he or she only knows from a third, less subjective
source like the news or a scientific article. For questions of social ethics or
justice a particular form of third-person knowledge is of high interest: sci-
entific knowledge. This is of interest because scientific knowledge about
the world is trustworthy and reliable, and that is something that we look
for. Let us illustrate this point: we live in a world in which global poverty
is a massive problem. What we know about global poverty is that it causes
the deaths of millions of people and is harmful for hundreds of millions
of people in various ways. It is this kind of knowledge that we can only
1 Introduction 9

gather from scientific research; we can neither personally see how many
people are poor on a global scale, nor can we be told about it by others
(only if they themselves refer to third-person knowledge in terms of sci-
entific data). The ethical judgement we make on global poverty is heav-
ily dependent on such knowledge about the extent, causes, and effects
of poverty. If a study shows that trade agreements are one of the major
causes of global poverty, this gives us good reason to criticize trade agree-
ments and to argue from an ethical point of view for their change. But
if scientific knowledge were to show that the existing trade agreements
are in favour of the poor and that other causes are responsible for the
prevalence of global poverty, we would need to revise our conclusion
and come to offer different policy advice. The same is true for the ethical
judgement about the good or bad nature of poverty itself. If, hypotheti-
cally, a new study were to come out and prove that poverty has no impact
on health—in reality we know for certain that it has—this would remove
one major ethical concern. The point we want to make is this: applied
ethics needs to have a reliable source and access to the social problems it
discusses, and on the level of social ethics and justice this means having
access to knowledge about the extent, causes, and effects of the problem
in question, and how it is embedded in the rules and institutions of that
social context.
In this book we will therefore rely primarily on third-person knowl-
edge. We will discuss studies from medicine, psychology, and the social
sciences that provide us with knowledge about the social problems in
question. We as philosophers rely on this knowledge and we cannot pro-
duce it ourselves, but it is not our role to do so. We view this inter-
disciplinary engagement as a feasible and productive division of labour
between the sciences and philosophy. But this also comes at a certain
price. One aspect of this is that we are dependent on what has already
been researched. Most research that we rely upon in this study has also
been not undertaken from a capability perspective (Robeyns 2006).
Furthermore, we need to consider the issue of uncertainty, in the sense of
inconclusiveness and in the sense of fallibility.
It would be easier to answer many questions within ethics if there were
no uncertainties in the knowledge of our world. We want to distinguish
two important types of uncertainty which we have to deal with. First, the

knowledge produced by the social sciences and also medicine and psy-
chology is often inconclusive and contested. This has to do with the many
different variables that scientists have to deal with and the complexities
of the problem. Consider, for example, obesity during childhood, a topic
we will explore in much more detail in the next chapter of this book.
Even today there is no commonly shared knowledge about the reasons
why some children become obese while others do not, and what the full
effects of childhood obesity are. There is some evidence that suggests that
the effects are harsh and negative, but there are also studies that find only
weak effects. It is well known that a single study only represents a frac-
tion of the knowledge that is needed to fully understand a phenomenon
like childhood obesity and how it should be treated. This is why medical
scientists are looking for evidence by compiling many different studies
via meta-analysis. The technique is certainly a fruitful way to limit uncer-
tainties, but even meta-analyses are not able to eliminate them: they are
only as good as the underlying research that is analysed, and there is some
room for error in producing meta-analyses and in the interpretation of
the heterogeneity within the analysed data. Taboos about subjects such as
the sexuality of children are not only present in daily life but also within
research, and these can lead to knowledge gaps. Additionally, there are
research trends that tend to focus on specific questions and leave aside
other areas. Furthermore, although this problem is not so relevant for our
approach here, the linkage between clinical practice and scientific knowl-
edge is often messy and not straightforward (Greenhalgh et al. 2014).
A second type of uncertainty we face in applied ethics is that of the
identification and explanation of causes of certain social phenomena. In
the social sciences there are many different explanations for such phe-
nomena as violence within families, the different behaviour of girls and
boys, or the existence of child poverty. For all these cases we can assume
that many factors (social, economic, political, cultural…) come into
play, which are hard to disentangle and which are also in constant flux.
Still, such factors influence the individual but they most often do not
determine his or her behaviour or beliefs. We know that most children
who live in poverty will be poor as adults but some escape and often we
do not know the exact reasons for those differences. This makes it hard
to evaluate a certain condition of a child’s life and also to devise policy
1 Introduction 11

recommendations. Scientific research can work to limit uncertainties in
this respect by providing us with improved knowledge, but some grey
areas and unanswered questions will always remain—and some people
such as Lisa Herzog argue that these grey areas should remain for ethical
reasons because the production of this knowledge would demand intru-
sive research into the lives of many, possibly all, people (Herzog 2012).
To summarize, we have to deal with an uncertainty that is to some
extent built into all knowledge about the world and hence also present in
all scientific knowledge about the phenomena we are interested in. Every
piece of such knowledge is potentially fallible and can turn out to be false.
We do not want or need to take a particular stance on the underlying
epistemological questions, but most would agree with us that at least some
of the knowledge we have now about children’s lives in the areas of nutri-
tion, sexuality, and violence is fallible and will likely be revised as research
progresses. It is certainly possible that other, hopefully better concepts of
child development will emerge and that we will understand much better
how, for example, child poverty influences brain development and what
effects that can have in later life. We might also have to revise our current
understanding of the best treatments for victims of abuse because medical
knowledge will improve. And we might also come to a point where we can
narrow down how gender roles present in the media influence children’s
lives, or perhaps we will learn that we have overestimated this influence.
In this respect applied ethics is also fallible, although this is not straight-
forwardly true for all its aspects. We already discussed briefly the relation
between normative theory and the real world—and thus in turn also our
scientific knowledge about the real world—and we stated that there is a
dialectical relation between them. The normative theory is not untouched
if empirical knowledge changes, but it can also not be expected that it can
be falsified as it is the case with an empirical theory. The most dramatic
influence will happen on the level of the application of the normative
theory to the social phenomena and on the level of policy recommenda-
tion. If we criticize the food industry for tricking children into eating
unhealthy food by targeting them with advertisements, we have to adapt
that criticism as soon as the balance of evidence suggests that this food
is either not unhealthy at all or that the advertisement has no influence
on the eating choices of children. Then we have to shift our criticism,

while the normative background assumption that children should not be
tricked into eating unhealthy food still stands.
We want to briefly state how we will proceed in each chapter. We will
follow a three-step process that aims to answer these questions: (1) What
do we know about the problem, its causes, extent, and depth? For that we
will provide a thorough overview of the topic, and discuss its conceptual-
ization and also uncertainties within the research. We want to understand
what we know about it, but we will also not refrain from interpreting
this knowledge already and linking it to other possible explanations that
might be found in the make-up of affluent societies. (2) What ethical
issues are involved and how do these affect children’s bodily integrity,
their well-being, and their well-becoming? As we will set out, the bodily
integrity of children has many dimensions such as health, agency, and
positive self-relations, and we examine how the issue in question affects
them. We want to understand what it does to children, and we will also
aim to differentiate our conclusions with respect to gender and age to the
best of our ability. For this step we will also refine our concept of bodily
integrity and our ethical framework as necessary. (3) How should society
and the state respond? This step of the process also demands a relinking
of our ethical framework with empirical research and other research on
policy responses in order to establish how the problem at hand should be
dealt with or can be prevented. Every time we aim for a thorough analysis
of the different agents and actors involved and what kind of responsibility
they share in relation to the victimized children.
The last point we want to make regarding the application of our ethi-
cal framework to issues of injustice in the lives of children is concerned
with the context-sensitivity of that framework, which is needed to detect
injustices and properly evaluate them. We already stated that the relation
between ethical theory and the “real world” is not a one-way street and
that we also need to consider the “real world” in designing the ethical
framework itself. But what does that mean? Two aspects are important
here: the first one is that the ethical theory we will lay out in the next
chapter aims to be realistic and to incorporate as much knowledge about
the “real world” as needed. Since it is still a theory on a rather abstract
level, which is not concerned with a concrete problem at this point, the
input of the “real world” is limited on that level. We are also not aiming
1 Introduction 13

for a complete theory of justice for children but only a partial one, mean-
ing one that sets out the basic tenets but leaves enough room for specifi-
cation later on (Nussbaum 2011). This specification later on is the second
aspect that is important for us. It implies that we will further develop our
ethical framework in each chapter and apply and interpret third-person
knowledge about the issue at hand in order to achieve further clarifica-
tion. We will examine the concept of bodily integrity in the next chapter
and we will argue how it is composed on the general level, but we will
further differentiate it and provide more detail in the following chap-
ters, for example how sexual agency is an important dimension of bodily
integrity or to have choice over one’s eating behaviour. In this respect our
approach is not a “high ethical theory” but a mid-level theory. By this
we aim to give a deeper understanding of our general claim that if chil-
dren’s bodily integrity is violated this injustice often leads to a corrosive
disadvantage which affects adversely many other dimensions of children’s
well-being and well-becoming over the whole life course.
To sum up, first we need to identify the problem as it presents itself
through scientific knowledge, political or public debate, or the articula-
tion of the victims. Then the ethical issues connected to it need to be
identified and clarified. What kind of ethically relevant harm is done to
children and how does it threaten their well-being/well-becoming and
bodily integrity? In order to do so, it is necessary to devote enough space
to the specification of the relevant capabilities in order to provide a solid
benchmark. In this sense our approach is problem-driven and is open
to adapt the normative framework as necessary. Finally, the third task
demands that the responsible stakeholders be identified as well as the
moral obligations that should be attributed to them by virtue of the crite-
ria of their involvement with the problem, their role in its causation, and
their potential to realize justice for the threatened children.
1.3 Overview of the Book
The focus of our book is the ethical, justice-based evaluation of three
main areas concerning different serious threats and dangers that target
children’s capability of bodily integrity in affluent societies, namely: (1)

body and eating, (2) body and sexuality, and (3) body and violence. All
of them are unique in their characteristics as well as in how they affect
children’s lives and the harm they cause. Our application of the capa-
bility approach to all of these issues is structured along three questions
that we will address through each chapter, explicitly: (a) What are the
causes, extent, and depth of the problem? (b) What ethical issues are
involved and how does the threat in question violate children’s bodily
integrity in its three dimensions of health, agency, and self-relations? (c)
How should certain agents of justice, in particular the state, respond? We
therefore aim to combine the available theoretical and empirical knowl-
edge around these issues with a thorough ethical analysis. This book com-
prises six chapters.
In the second chapter we introduce and argue for our normative frame-
work, which is a (partial) theory of justice for children based within the
capability approach. We will be concerned with questions of children’s
particularity, which differentiates them from adults, and thus examine
childhood as a phase of development, in particular of autonomy, and
increased vulnerability. Then we will argue for certain modifications of the
capability approach to fit better for children, and focus on the concept of
developing capabilities for that task. Since bodily integrity is at the heart
of this book, we will further scrutinize this concept as a set of capabilities
involving health, agency, and self-relations. We will also explore the issue
of gender in relation to bodily integrity, which will be present throughout
the book. Finally, we will explore the concept of agents of justice for chil-
dren and how responsibilities can be attributed to them, based on various
grounds. We will follow here largely the social connection model of Iris
Young, in which she distinguishes causality, power, profit and interest,
and reasonable grounds to hold an agent responsible.
The third chapter will focus on the endangerment of children’s bod-
ies in relation to eating and nutrition. In the first part of the chapter, we
will describe the available evidence on childhood obesity and discuss its
effects on the health, agency, and self-relations of the affected children.
We will show that childhood obesity is associated with many disadvan-
tages, which in part stem from the “nature” of the disease, but to a con-
siderable extent also from the social perception of obese and overweight
children and the attached stigmas. We will then turn to the role of the
1 Introduction 15

family and the state and show that there are good reasons to see both
as the main agents of justice with shared and interwoven responsibili-
ties in relation to obese children. At the centre of the second part of the
section are eating disorders with a focus on Anorexia Nervosa, Bulimia
Nervosa and Binge-Eating Disorder, which have many harmful effects on
the bodily integrity of children in all its dimensions. We will discuss the
social embedding of these conditions and address one agent of justice in
more detail: the media.
The fourth chapter is concerned with children’s capability of sexual-
ity as part of their bodily integrity. Since childhood sexuality is a highly
contested and taboo issue we will first examine scientific knowledge
about the sexual agency of children and how it develops and changes
over time. Then we will focus on two different threats to children’s
bodily integrity: the sexualization of childhood and sexual abuse. While
the first one is situated on a societal and cultural level, dealing with
such issues as the negative influence of the media, the ubiquitous avail-
ability of pornography, or the advertisement of unrealistic body ideals,
the second issue of sexual abuse is located on the interpersonal level,
although social factors are also important for its understanding and
ethical critique.
In chapter five we will turn our attention to the issue of violence, and
focus on physical abuse, which occurs mainly within the family, and vio-
lence between peers, which takes place in settings of leisure, in public,
and particularly in schools. We will argue that both are problematic,
often not primarily because of the physical injuries but because of the
effects on the children’s agency and self-relations. Abuse and other forms
of violence have a negative impact on the self-trust and self-esteem of
children and set in motion a cycle of anxiety and fear, which can lead to
internalizing and externalizing behaviours.
Inthefinalchapter,wewilldrawsevenconclusionsbasedonourresearch
and findings. We will argue that justice-based and justice-oriented policy
making faces several difficulties because of disagreement about ethical
arguments as well as uncertainties in the empirical evidence. The differ-
ent dimensions of children’s capability of bodily integrity and the differ-
ent and changing threats that children face demand a multifaceted and

multilateral approach to their protection, which must encompass the par-
ents and the state. Finally, it is necessary to acknowledge that children’s
bodily integrity is only one dimension which is important for their well-
being and well-becoming. The protection of bodily integrity is thus one
piece of the puzzle.
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1 Introduction 17

19© The Author(s) 2017
G. Graf, G. Schweiger, Ethics and the Endangerment of Children’s
Bodies, DOI 10.1007/978-3-319-40213-0_2
2
Children’s Bodily Integrity: Justice
and Child Well-Being in Afﬂuent
Societies
For an ethical assessment of the situation of children in affluent societies,
which we undertake in this book, there needs to be an ethical theory in
the background. Ethics, as we understand it, is the discipline that reflects
on, systematizes, defends, and recommends what is morally good or bad,
right or wrong, and just or unjust. As such, it comprises many branches
and subdisciplines with a variety of theories at different levels. Some of
them focus mainly on individuals and are interested in how they should
act in certain circumstances. Others, however, put the social or political
level at the centre and are more concerned with how this wider con-
text, which transcends the individual, is relevant for the moral outcomes
in a society. In this book, we cannot discuss all theories that are avail-
able and give a detailed account of them, nor can we hope to solve the
wide-ranging philosophical disputes that exist between them. Rather, we
would like to employ one particular approach, which we believe to be
particularly useful for our purposes: the capability approach, as pioneered
by Amartya Sen (1980, 1992, 2009) and Martha Nussbaum (2000,
2011). It has become one of the leading normative frameworks for think-
ing about justice, development, and inequality, and is therefore one of
the theories operating more at the social and political, rather than the

individual, level. This is also the perspective that we think appropriate for
what we would like to achieve, given that we are not so much interested
in individual acts of wrongdoing, but more the question of how moral
challenges appear on the societal level and what can be done to address
them by modifying social institutions or making changes at the policy
level.
While the capability approach, like most other ethical theories and
theories of justice, was developed in relation to adults, on which most of
the literature still focuses, there have been promising attempts to adapt
it to the situation of children, both at a theoretical and practical level
(Biggeri et al. 2011; Dixon and Nussbaum 2012; Schweiger and Graf
2015). These attempts have shown that the approach offers significant
potential in this regard and, more concretely, can provide the conceptual
basis for formulating justice-based entitlements of children. In a nutshell,
the central claim of a capability approach to justice for children, as we
propose here, is that each and every child is entitled to well-being and
well-becoming, concepts that have to be grasped first and foremost via
the notions of (developing) functionings and capabilities. In this chapter,
we will explain this claim in more detail. To that end, it will be necessary
to explore the notion of childhood, to flesh out the concepts of (devel-
oping) functionings and capabilities, as well as comment on how they
should be selected in the case of children. Only then will we be able to
introduce the developing capability located at the centre of our approach,
which will guide us throughout the course of this book towards our eval-
uations, namely, that of bodily integrity. We will conclude the chapter
with an outline of our theory of responsibilities, which will be further
refined and applied in the chapters to come.
Before turning towards the details of our theory, let us briefly com-
ment on the meta-question about what kind of theoretical framework
the capability approach, as we understand it, is and where it fits in the
current influential debate on ideal and non-ideal theories in political phi-
losophy. In doing so, we do not want to make a general assessment of
the theoretical standing of the capability approach, which is discussed in
different versions and difficult to classify under only one heading. Rather,
the following considerations are specific to our usage of the approach,
which is identical to neither Nussbaum’s nor Sen’s formulation of it.

In recent years, there has been a growing interest from political phi-
losophers in interrogating the methodologies they use to construct their
theories and develop recommendations and prescriptions. In particular,
there has been an intensive and still ongoing debate on how abstract
philosophical theorizing connects to the “real world” and how it is able
to guide policies making the world a better place. In line with the aim
of this book, these debates are relevant given that we offer an ethical
analysis of some of the threats that children are currently facing in the
“real world”. They are not constructed in philosophical thought experi-
ments, but effectively occur in our societies. It is therefore crucial to have
an ethical framework that fits our purposes and is close enough to these
problems, such that it helps with understanding and evaluating them, as
well as developing solutions for them. The discussion on the subject of
ideal vs. non-ideal theories is complex and there are certainly different
ways in which the differences between them can be conceived. However,
some distinctions made by Laura Valentini are particularly helpful for
structuring the discussion, which we will use in order to clarify where our
own approach is situated (Valentini 2012). According to Valentini, there
are at least three different meanings of the terms “ideal” and “non-ideal”,
which matter in current discussions, and we would like to briefly relate
our approach to each one of them.
Let us start with the first meaning, in relation to the ideal vs. non-
ideal debate, as discussed by Valentini. From this perspective, the cen-
tral concept is compliance. For Rawls, ideal theory is designed according
to the assumption that “[E]veryone is presumed to act justly and to do
his part in upholding just institutions” (Rawls 1971, 8).1
He does not
elaborate much on the problem of what should be done in those cir-
cumstances where full compliance is not achieved—circumstances which
belong to non-ideal-theory and in which the responsibilities of agents of
justice might not be easily inferred from ideal theory (Miller 2011). Now,
the problems we investigate in the course of our book typically occur in
contexts where full compliance is not fulfilled—indeed, many of them
1
According to Rawls, ideal theorizing works with the additional assumption that natural and his-
torical conditions are favourable (Rawls 1971, 110). However, this second assumption is not so
central here and will be neglected.
2 Children’s Bodily Integrity: Justice and Child Well-Being... 21

are the result of unjust behaviour or neglect on the part of one or more
agents of justice. It will therefore be necessary to work with an account of
responsibilities, which has to be applied to the specific problem at hand
and considers the empirical knowledge that is available. In turn, we do
not work with a “master principle”, which gives us the answer for all the
situations we investigate, but instead we try to specify what can be rea-
sonably demanded of certain agents of justice in the relevant field. Later,
in this chapter, we explain our account of responsibilities in more detail.
What matters for now is that our approach is clearly in the “non-ideal
field” when looking at the debate from the perspective of compliance.
The second meaning in relation to ideal theory compared to non-ideal
theory relates to the difference between utopian and (more or less) realist
theories. While the previously discussed meaning centred on the notion
of compliance, the essential notion here is feasibility. In this sense, ideal
theories are not concerned, or only to a very minor degree, with feasibil-
ity constraints on principles of justice. Philosophers like G. A. Cohen,
for example, defend the view that “the question for political philosophy
is not what we should do but what we should think, even when what we
should think makes no practical difference” (Cohen 2003, 243). It is a
“pure” theory, which is developed in detachment from the social ills and
injustices that we encounter in our societies. Non-ideal realist theories,
on the other hand, stress that feasibility constraints have to be introduced
in order to live up to the complexities of injustices as they actually hap-
pen, because only then are prescriptions likely to be effective. Again, our
approach is closer to non-ideal, or realist, theories in this regard, since our
goal is to discuss those threats to childhood that are close to the current
state of our societies. However, it is important as well that some normative
background assumptions are integrated into our theory. If this element is
missing or too weak, an ethical theory loses its “bite” and is at risk of
accepting or even justifying the status quo. This is also why non-ideal theo-
ries have to work with some normative assumptions and claims, which is
why we will soon introduce some criteria and principles in this chapter
that serve as the normative anchor points in our theory. In this sense, our
approach combines a casuistic perspective (bottom-up) with a principal-
istic one (top-down). They allow us to evaluate current social phenomena
and make prescriptions in a context-sensitive way, balancing normative

ideals and reality constraints. This brings us to the third perspective from
which the ideal/non-ideal debate can be approached: that ideal theories
can be described as “end-state theories”, while non-ideal theories can be
characterized as “transitional theories”. End-state theories, as John Rawls
put it, define an objective, an aim that is worth striving for as a society
(Rawls 1999, 90). Non-ideal theory, by contrast, “asks how this long-
term goal might be achieved, or worked toward, usually in gradual steps.
It looks for policies and courses of action that are morally permissible
and politically possible as well as likely to be effective” (Rawls 1999, 89).
Rawls still assumes that the conception of a desirable end-state is a pre-
requisite for transition, an assumption that has been criticized by Amartya
Sen, for example (Sen 2009). We do not want to go into depth about the
complexity of this discussion, which is still ongoing (e.g., Simmons 2010;
Wiens 2012). However, as will become clear, our approach is closer to a
transitional, rather than an end-state, one. The normative assumptions
that we make serve to identify and criticize injustices that children face.
For this, however, it will not be necessary to describe in detail the end-
state that we have in mind. Instead, some rather abstract concepts and
principles, which will be specified “on the go” and in close relation to the
context and subject matter they get applied to, will suffice to guide us in
our analysis. In summary, we see the capability approach as a theory that,
in all three meanings, is closer to non-ideal than to ideal theorizing. It is,
first and foremost, a tool to reflect on “real-world” injustices and offer
guidelines for improvement. But, in doing so, normative assumptions
have to be made, which have to be adapted to the context they are applied
to. In any case, it is important to acknowledge that the normative reason-
ing we conduct in this book has the function of improving the status quo
by suggesting new paths to explore in order to implement, on the one
hand, the social awareness of the threats cornering childhood and, on the
other, the efficiency of the agents of justice involved. Practical constraints
are important to acknowledge for effective policies, but they must not
undermine the fact that, typically, there is space for making the world a
better place. In this sense, our approach is connected to a certain vision
and, because of this, some might prefer to call it a “mid-level”, instead of
fully non-ideal, theory. But let us now move a step forward and analyse
the concept of childhood with its complexities and different meanings.

2.1 The Concept of Childhood
In this book, we are concerned with the endangerment of children’s
bodies in affluent societies. We must therefore construct our normative
theory in a way that does justice to our main target group: children. In
line with probably the most influential political document on children,
the United Nations (UN) Convention on the Rights of the Child (UN
1989), we will understand children as persons between 0 and 18 years
of age. However, such a pragmatic definition can only be the starting
point for our discussions, since the multidisciplinary research in recent
decades shows that the concept of childhood is not an easy one. It can
be approached from a variety of perspectives and should not be reduced
to biological and psychological factors. In philosophy, these varieties of
childhood are not always taken seriously, while there is a certain tendency
to discuss the normative status of children with rather simplistic concepts
of childhood in mind. For the purposes of this book, however, it is crucial
to dig deeper, as well as acknowledge the social embeddedness of child-
hood and its heterogeneity. Only then will it be possible to analyse the
threats to children’s bodies to an adequate extent.
There are two broad points that we would like to address here. First, we
would like to draw attention to the fact that childhood is, in an important
sense, socially constructed and that a normative analysis of the endanger-
ment of children’s bodies has to be aware of these constructions as well as
the many normative, cultural, and social assumptions that are implicit in
the concept of childhood. Second, however, we will defend the view that
there are certain morally relevant features that can be used to justify a spe-
cial moral status of children compared to adults. We will argue that the
notions of vulnerability and autonomy are of particular relevance here. In
particular, vulnerability is linked to risks of misinterpretation and ideo-
logical misuse, which have been extensively discussed in the sociological
literature (e.g., James and Prout 2005; Meyer 2007), but hardly acknowl-
edged in the philosophical literature on children (Graf 2015). Still, it is a
notion that has considerable normative weight and, when interpreted in
the right way, helps to justify the special status of children.
Let us start with the social construction of childhood. As pointed out
by many researchers, the norms and values associated with the early years

of human life vary strongly between different cultures and throughout
history. Childhood should therefore best be characterized as a cultur-
ally changeable interpretive frame for understanding a certain life period
(James and Prout 2005, 8). Similar to the distinction between sex and
gender, as introduced by feminist theory, it is important to acknowl-
edge that biological facts alone cannot adequately explain the social roles
attributed to children. In fact, empirical research shows that a variety of
sometimes contradictory conceptions of childhood can be found in dif-
ferent societies. They differ in their assessment of when childhood begins
and ends, how it should be divided, and which dimensions are relevant
when distinguishing it from adulthood (Qvortrup 2005a). Furthermore,
there are differing assessments of what is appropriate for children from
a moral point of view. To give an example, depending on the respective
society and cultural context, the moral evaluation of working children
ranges from being unacceptable to being a duty that children should ful-
fil. This finding about the strong social component in any conception of
childhood implies another feature: the way in which children are seen
and treated in a given society is changeable. Social relationships, and the
norms and values associated with them, are not fixed once and for all by
biological and psychological laws, but can be reconstituted on a differ-
ent basis—or reconstructed, as it is often referred to in the literature—
through various channels of social change. Now, in modern affluent
societies, there are some important discourses at work in the construction
of childhood, which shape how we understand children and how we jus-
tify social practices in relation to them. As an analysis of this issue shows,
there is a variety of discourses that are relevant here: among others, the
discourse of evil, the discourse of innocence, the discourse of rights, the
discourse of neediness, and the discourse of romanticizing childhood
(James et al. 1998; Moore 2015).
As Anneke Meyer argues, the predominance of a certain discourse is
linked to different social issues (Meyer 2007). To provide an example,
if children are victims of crimes, the discourse of innocence dominates,
while the discourse of evil tends to be deployed if children are the perpe-
trators (Kitzinger 2005; Valentine 1996). Within this diagnosis, it is also
important to emphasize the context and the danger of oversimplifica-
tion, given that the literature points out that violence against children

is often ignored and that especially older children are in danger of being
confronted by victim-blaming arguments. Indeed, in many policy con-
texts, the language of rights or needs prevails, which indicates yet more
discourses. One must therefore be careful with general assessments of
the social construction(s) of childhood, since there is always the need
to contextualize, including within the same society. However, the afore-
mentioned discourse on the innocence and vulnerability of children has
frequently been pointed out to be of particular force and, from a socio-
logical point of view, it has constantly been criticized over the last few
decades and linked to the idea that it weakens children as a group and
leads to an unjustified low social status. Authors such as Berry Mayall or
Leena Alanen have drawn on insights from feminism and gender studies,
applying them to the case of children (Mayall 2002; Alanen 2005). They
characterize children, for example, as “a minority social group, whose
wrongs need righting” (Mayall 2002, 9), and claim that the marginaliza-
tion of children is often justified in a very similar way to that experienced
by women, but on the basis that generation has replaced gender as the axis
of distinction in an unequal power relationship. Fragility, vulnerability,
a lack of strength, and inferiority in knowledge and working skills, they
argue, are in both cases categories that justify these groups’ dependency
on another, dominant one. Shortly, we will give arguments that this anal-
ogy between women and children does not hold in all aspects, as there
are differences between children and other social minority groups. Let
us note, however, that children in the affluent societies we are concerned
with hardly have the opportunity to organize themselves on an aggre-
gate, societal, and political level (Qvortrup 2005b, 84), which is easy to
understand for young children, but which largely is the case for older
children as well, who may have the competences needed for more politi-
cal participation. Even if there have been changes in the last 30 years,
children’s interests are in most cases still represented and defended not by
themselves but by adults speaking for them (Mayall 1994). Particularly
in school, one of the most important institutions in a child’s life, unequal
power relations are obvious—not just between a specific class and its
teachers, but more generally, in that the institution as a whole sets stan-
dards of normality and development that cannot be questioned by the
pupils (Mayall 1994, 3). Empirical investigations also show that children

“see themselves as a group vis-à-vis the adult group, and as a group whose
rights are both neglected and rejected” (Mayall 2002, 21), which is a
relationship recognized by almost every age group, from five-year-olds
to adolescents (Axford 2012, 6; Mayall 2002, 136). Furthermore, the
poor quality of some services for children and the continued prevalence
of child poverty indicate the weak social position of children (Schweiger
and Graf 2015). But these disadvantages, or so it is sometimes claimed
in the sociological literature on children, are first and foremost caused by
the way we organize our society, including the norms that prevail, and
not by the “natural incompetence” of children.
In some respects, we agree with the sketched analysis about the social
construction of childhood and some of its problematic implications for
children’s social status in modern affluent societies. It is certainly true
that general discourses about innocence and vulnerabilities can lead to
an unjustified powerlessness of children and oppression, which should
be avoided. However, from an ethical point of view, there are charac-
teristics of children that are morally significant and justify some forms
of paternalism towards them. In fact, some—morally relevant—features
of children lead to a special moral status2
that distinguishes them from
other social groups that are not granted equal rights. There are certainly
insights from gender and minority studies which help to understand the
social position of children and identify injustices they are facing. But,
at the same time, while the wrongness of oppression and dominancy
against both groups have the key factors in common, there are big dif-
ferences between, for example, what is wrong with paternalism towards
women compared to paternalism towards children. How these morally
relevant features of children ought to translate into social rules and norms
depends on the context in question, and there is room for a variety of
outcomes. Nevertheless, it is important to acknowledge that children are
not simply small adults; indeed, there are good moral reasons3
to construct
differences between childhood and adulthood, which get reflected in the
2
Although we lack the space to delve into the debate about the variety and scope of a naturalistic
fallacy, a good study can be found in Curry (2006).
3
Again, as this book focuses on applied ethics, we cannot provide a detailed account of the current
meta-ethical debates on moral reasons (external and internal ones) and relativism. However, some
good studies on the topic are (Korsgaard 1993; McDowell 1995; Williams 1985).

institutions, norms, and laws of a society. These reasons, however, always
have to be put into context, scrutinized about what they in fact implicate,
and must not be abused in pursuit of an interpretation that gives children
no voice or an unconditioned “ruling” of adults over them. Rather, they
emphasize the great responsibility that adults and the wider society have
towards children and their well-being and well-becoming.
We would like to suggest that there are two main characteristics of chil-
dren which are particularly important in this regard: vulnerability and (a
lack of) autonomy. These two characteristics are prominently discussed
in the philosophical literature on children4
and also relate in many ways
to other important considerations that contribute to a special status of
children, such as their potential to develop their capacities or the absence
of certain competences—characteristics that we would like to address
from the perspective of vulnerability and autonomy. Vulnerability and (a
lack of) autonomy are also related in many aspects and it is possible to
discuss the latter as only one aspect of the former and not as a different,
equally important category (Giesinger 2007). However, we will analyse
them separately. The main reason for that is not a fundamental disagree-
ment on a conceptual level with the just mentioned account by Giesinger.
Rather, as we perceive it, the issue of autonomy has been discussed widely
in the philosophical literature about children and their moral status with-
out explicit or only vague reference to the notion of vulnerability. By
separating the two concepts in our analyses, we want to do justice to this
fact and stress the different implications they have, although it will also
become clear that in many ways they are interconnected. Let us begin by
discussing the special vulnerability of children.
As should have become clear from the above, we are well aware of
the dangers behind the concept of vulnerability and the many ways it
can be used to weaken the position of children more than needed. At
the same time, it is a key concept for getting the ethical reasoning about
children right. Children are—as a group and on average—more vul-
nerable than adults. This does not mean that every child differs in this
regard from every adult, but that, typically and on average, comparisons
4
There are many issues in relation to the vulnerability and autonomy of children, which we can
only address very briefly because they differ from the main focus in this book.

between members of these groups yield to this result, which justifies,
from a philosophical perspective, a general distinction of these groups
and the social institution of childhood. Note, however, that we are not
saying here that the question of a justified age limit is already settled.
There might be good reasons to set a different one to the age of 18 years,
which is accepted in most affluent countries; indeed, there may even be
reasons to modify it according to social and cultural circumstances or
developments. Furthermore, for children as a group, further distinctions
need to be drawn since children develop gradually and, in turn, move
ever closer to the moral status of adults. Nevertheless, we suggest that
considerations of vulnerability generally justify a split between children
and adults and that the age of 18 seems to be a good approximation, at
least for the developed countries we have in mind in this book, which is
something that is reflected in our usage of a definition of children that is
in line with the UN Convention on the Rights of the Child.
It is important to acknowledge that vulnerability is a key feature of
every human being, and this is also a very important starting point for the
capability approach (Nussbaum 2006). No one is absolutely safe from
being violated or suffering damage to one’s body, mind, or social posi-
tion. Children, however, have a special vulnerability, which goes beyond
the one they share with all others.5
This special vulnerability is particu-
larly striking in the first years of a child’s life, although it gradually loses
its force in the developmental process. First, their bodies are typically
smaller and weaker than those of adults. Therefore, they face more dif-
ficulties in protecting themselves against danger and are not in a posi-
tion to endure the strains that are generally not problematic for adults.
There are many forms of physical violence and distress which are of no
real problem to adults but can have serious or even deadly consequences
for children—just think about battered child syndrome or the influence
that external factors, such as toxic chemicals in the environment, can
have on the physical development of children (Landrigan and Goldman
5
Children are not the only group with a special vulnerability, although, as Martha Nussbaum
notes, they share some, but certainly not all, features with persons with disabilities (Dixon and
Nussbaum 2012). One important difference between children and disabled persons is that the
phase of childhood is one of development, which normally leads to a stage of healthy adulthood,
while persons with disabilities have, in most cases, no such developmental phase ahead of them.

2011). Second, the psychological condition of children is usually more
sensitive compared to that of adults. Childhood is decisive for the devel-
opment of the self and one’s personality, while negative experiences dur-
ing this phase are likely to cause lasting damage. As an example, there is
evidence that early attachment security is related to measures involving
emotional health, self-esteem, agency and self-confidence, positive affect,
ego resiliency, and social competence in interactions with peers, teach-
ers, camp counselors, romantic partners, and others (Thompson 2007).
Children who are not able to develop secure attachments are therefore
disadvantaged in key areas of mental and emotional well-being and, in
turn, extremely vulnerable in this regard. Third, children are socially vul-
nerable. This form of vulnerability partly stems from their special needs,
incapacities, and the other forms of vulnerability we have just mentioned.
However, there are many other influences that make children socially vul-
nerable and connect to the way childhood is framed in modern societies.
Economic, legal, and political institutions are structured by norms which
treat children differently from adults. Children have a limited access to
the labour market, there are different sets of rights that apply to them,
especially regarding autonomy rights, while their political participation
is restricted as well. On the one hand, there are good reasons for many
of these differences, which are linked to protection and education, for
example. Given the immature and developing nature of children, it is
reasonable to have a protected phase at the beginning of every human
being’s life, in which development is supported and where taking full
responsible and liability for one’s actions is yet to come. In other words,
social vulnerabilities are intertwined with how children are—their nature,
if you will—and they also occur in a society that designs its institutions to
be in the best interests of the child. On the other hand, these differences
can make children powerless. If a child is not allowed to work and gain
her own income, she is dependent on others (typically, her parents), and
if those she is dependent on cannot provide for her, there is not much she
can do to avoid poverty. Similarly, the different legal status of children
reinforces their powerlessness. Children have different legal rights than
adults and, in general, parents have far-reaching powers to control and
shape the lives of their children. In situations where parents do not act in
the child’s best interest, these asymmetries certainly make it difficult for

children to enforce legal claims against their parents, because of the nature
of children’s and parental rights, and the ways that the legal system usu-
ally works. In conclusion, social vulnerabilities make children powerless
in many aspects; however, it would be shortsighted and morally dubious
to argue that it is a valuable goal to strive for social reforms which abolish
the aforementioned differences between children and adults. Due to the
special vulnerabilities of children, it is reasonable to construct childhood
and adulthood as phases of life governed by different norms and rules,
which in turn are reflected in social institutions.
Now let us turn to children’s lack of autonomy and how this reflects
upon their special moral status.6
Most normative theories, including the
capability approach, agree that autonomy is of significant value in a per-
son’s life, while one of society’s most important aims is to guarantee that
everyone can live a life she deems appropriate. In fact, respecting a person
is closely connected to respecting her choices and her way of life, with-
out trying to interfere paternalistically. However, it is generally assumed
that autonomous choices and decisions have certain prerequisites. David
Archard, for example, suggests that autonomy is composed of at least
three elements, rationality, maturity, and independence, which have to
be satisfied to a certain degree in order for a person to be seen as autono-
mous (Archard 2004, 93). In other approaches to autonomy, additional
features play an important role: for example, a person’s capacity to carry
out genuinely voluntary acts of will or possess the capacity for reflective
or moral agency (Franklin-Hall 2013). According to the standard philo-
sophical view, children lack these characteristics or competences and, as
a consequence, it is justified to deny them the capacity to make decisions
for themselves and to act on them; they are not able to effectively govern
their conduct by reason and concerns of morality, which means they can
be treated paternalistically without disrespecting them. Let us further
look into this argument concerning the lack of autonomy of children by
addressing three specific points.
6
Without doubt, autonomy is the most researched issue in the philosophical literature on children.
Some consensus has emerged that children neither completely lack autonomy nor are they autono-
mous on the same level as adults. Again, children differ greatly in their autonomy, which is itself a
developing feature. Many aspects are discussed in Archard and Macleod (2002) and Bagattini
(2014).

First, the argument that children lack certain skills and competencies
necessary for being classified as autonomous agents is certainly convinc-
ing if we look at young children. In the first years of life, it is certainly not
the case that the prerequisites for autonomy are fulfilled. Their cognitive
and emotional abilities, as well as their preference structures, need time
to develop, and only with a certain degree of maturity is it reasonable to
attribute a will of their own to them; for example, a toddler cannot sim-
ply deliberate over his goals in life, the best ways to realize them, and the
values in the background of his decisions. However, not all children are
toddlers. In fact, the category of children is an extremely heterogeneous
one, which consists of individuals differing in the competences relevant
to autonomy. The period of childhood is characterized by dynamic devel-
opments in all relevant categories (be they physical, mental, emotional,
or social) and therefore it is necessary to allow children different levels of
freedom as they grow older. In fact, morality certainly implies that chil-
dren of different ages and levels of maturity have to be treated differently
in relation to what they are free to do. A toddler demands a different
consideration than a teenager; indeed, it is humiliating or degrading if
these differences are not recognized sufficiently. The question, therefore,
about which kinds of freedom children should enjoy cannot be answered
generally; rather, it must take into account the age and maturity of the
child. However, another distinction within the concept of autonomy
more helpfully addresses this particular subject: that between the local
and global autonomy of children (Franklin-Hall 2013). Local autonomy
refers to individual choices and actions, whereas global autonomy is
understood as the ability to determine which kind of life someone wants
to live or how she directs her life as a whole. Even young children are
able to make choices in specific areas of their lives, for example when
they decide between different games they would like to play, such that it
is crucial to give them enough room for such choices. Giving them this
local autonomy means respecting their agency and, additionally, gives
them the opportunity to practise their abilities as choosers. At the same
time, their actions can be controlled to a reasonable degree, avoiding risks
that arise when options for choice are not restricted to certain domains
and ranges which are adequate for the child’s competences and experi-
ences. Global autonomy is different. In this context, it is really about

the person’s choice to live a life that she has reason to value. Naturally,
this presupposes many more sophisticated abilities than multiple vari-
ants of local autonomy, while it is clear that young children cannot be
said to be autonomous in this sense. However, by exercising their local
autonomy, which can happen in different degrees of complexity, children
improve their abilities in relation to global autonomy, which they are
finally granted in adulthood.
Second, there are certainly children, especially older ones, who are at
least as competent as many adults when it comes to the characteristics
that are typically deemed relevant for autonomy. Does this mean that
they have to be granted the same autonomous rights as adults? At this
point, the philosophical discussion is controversial. On the one hand, it
seems that differentiations based on age are arbitrary from a moral point
of view and difficult to defend. For example, if it can be shown—such as
by a test—that a child possesses the same relevant autonomous relevant
competencies as an adult, it could be argued that she ought to enjoy the
same freedoms. On the other hand, interesting arguments have been pro-
vided that childhood, as a life stage, has its own value and function, which
justifies, to some extent, the paternalistic treatment of children, even if
they have the same level of competences as adults whom we do not treat
paternalistically (Franklin-Hall 2013; J. Anderson and Claassen 2012).
Anderson and Claassen, for instance, introduce the notion of a “regime
of childhood”, which comprises a complex set of norms and practices,
institutional arrangements, guiding ideals, and so on that determine the
status of being a child. In the modern regime of childhood present in
Western societies, crucial aspects include an orientation towards autono-
mous development, limited liability for children, and parental supervi-
sory responsibilities. The phase of childhood should therefore be seen as a
protected life stage, with opportunities to learn, in which one is guided by
others and not fully responsible for one’s actions and decisions. With the
transition from childhood to adulthood, other norms and guiding prin-
ciples come into play, including that one is now an autonomous being
who determines their own way of life. In any case, the point is that it is
valuable for a society and its members to have these distinct “regimes”
governed by different rules, which essentially prepare everyone for life
as an autonomous being and through which autonomy is actually lived.

But why should the membership of one of these regimes be determined
by an age limit, rather than a competence test? Besides, when considering
the established reasons that such tests would be difficult to administer,
unreliable, or likely to be biased (Archard 2004, 85–90), Anderson and
Claassen provide some further arguments in favour of a fixed age limit
marking the end of childhood and the start of adulthood respectively,
which is tantamount to denying competent children an adult-like auton-
omy: (a) it contributes to stable expectations with respect to the parent-
child relationship and gives stabilizing points of reference to the already
complex process of guiding a teenager on her way to adulthood; (b) it
avoids the risk that passing such a test becomes a competition, which cre-
ates pressure for many children and feelings of failure for those who fail
the test, leading to all the negative consequences that characterize peer
relationships; and (c) it works against inequality, since it is likely that
children from stable and wealthy family backgrounds would on average
qualify more often for an earlier transition from childhood into adult-
hood. We believe that, with their “regimes of childhood”, Anderson and
Claassen introduce an important concept into the discussion. Later on,
we will see that some threats that we discuss in this book, such as eating
disorders, are most relevant for teenagers who sometimes have high levels
of competence. However, the idea of childhood as a special social status
backs up the claim that some agents of justice have a moral duty to inter-
vene, even if this duty might not be present in the case of adults.
In conclusion, the special vulnerability of children, as well as their
experience as beings within a process of developing autonomy, justifies
and demands certain kinds of paternalism towards children. As we have
already mentioned, such an approach includes dangers of misinterpreta-
tions and misuse, but, children are still not small adults and a normative
theory has to acknowledge that. At the same time, it must be emphasized
that the agency of children and their points of view have to be valued. As
Harry Brighouse has argued, children’s views are valuable in determining
what is in their best interests and, as such, he attributes to them a con-
sultative function. However, he denies them the right to be authoritative
regarding what is in fact best for them (Brighouse 2003). We agree with
this analysis, but would like to make two additional points. First, in the
process of growing up and due to the child’s increasing competences,

the consultative function of their views should increase in significance as
well; what teenagers would like to do with their lives matters a lot and
must not easily be overruled by their parents or other authorities. Second,
apart from any consultative function, there is another reason why we
should grant children a right to be heard. Everyone who has a point
of view should have the right to express it, independent of any purely
instrumental reasons (Archard and Skivenes 2009).
The particular vulnerability and lack of autonomy experienced by chil-
dren provide the background to further questions about their rights and
duties, along with the rights and duties of their care-givers, the state, and
other agents in their lives (for example, Archard 2004; Brighouse and
Swift 2014; Macleod 2007). In the following sections of this chapter, we
will try to sketch out a theory of justice for children based on the capa-
bility approach, with a focus on the capability of bodily integrity, which
answers some of these questions.
2.2 The Capability Approach and Children
Simply put, the basic claim of a capability approach to justice for chil-
dren, as we defend it, is that every child is entitled to well-being and well-
becoming, which are notions that are best grasped via a child’s developing
functionings and capabilities. Since we—as do most others—under-
stand the capability approach as a human rights approach (Dixon and
Nussbaum 2012), we can put this in other words using the language of
rights: all children have a right to well-being and well-becoming, which
translates into rights to all those capabilities that are central aspects of
that right. To explain this claim, we will first briefly introduce the capa-
bility approach on a general level, then turn to the necessary adjustments
that have to be made for bringing justice to the special characteristics of
children.
Probably the most central feature of the capability approach, as dis-
cussed in the literature, is the demand that human capabilities are the
central category of making evaluative judgements and assessing a person’s
position in society. But what are capabilities? As Nussbaum put it, they
are the answers to the question “What is this person able to do and to be?”

(Nussbaum 2011, 20). In other words, capabilities are best understood as
a person’s effective opportunities to undertake the actions and activities
that she wants to engage in, and to establish an identity that comple-
ments her ideals and aspirations (Robeyns 2005, 95). Typically, in the
capability approach, this basic idea is expressed via another conceptual
category: functionings. Functionings are the different activities and states
that constitute a person’s life—the “doings” and “beings” a human being
enjoys. As such, they range from rather trivial activities, such as watch-
ing commercials or going for a walk, to fundamental aspects of well-
being, such as being healthy, being adequately nourished, having shelter,
or participating in the life of the community. Functionings depend on
goods and resources, but they should be distinguished from them. To
give an example, if one is to be adequately nourished, she certainly needs
the right amount and type of food (the resource in question), but being
in this state (having the functioning) refers to something different. In
this case, the resource has already been transformed in a direct aspect of
one’s life, which cannot be reduced to possessing a few vegetables and
fruits. With this conceptual basis in the background, having a capability
can be expressed differently. It means being able to function not only in
theory, but taking account of one’s social and political environment as
well as one’s physical and psychological condition; capabilities are real
freedoms to function in particular ways, taking into account both the
characteristics of the individual and the context in which she is embed-
ded. There are three additional points we would like to make concerning
the notions of functionings and capabilities. First, capabilities are closely
connected to freedom of choice, while functionings refer to already real-
ized “beings” and “doings”. Guaranteeing a person a capability is there-
fore fundamentally different from guaranteeing her a functioning. While
giving a person a capability means only to create the conditions in which
a certain choice is possible (which may be rejected by the person), giving
her a functioning means to control such that a certain aspect of her life is
effectively realized; the choice and will of the person in question does not
receive any consideration. Second, it is generally important to consider a
person’s functionings and capabilities in relation to their interconnected-
ness. Often, choosing one functioning (and realizing a capability) has
to be done at the expense of another, and it is important to include this

complexity in one’s analysis. But, when also looking at the functionings
of a person, it is crucial to include a variety of dimensions to get the “full
picture”. Third, there are many different factors influencing how a person
can use the goods at her disposal for her own ends. These so-called “con-
version factors” can be personal (e.g., metabolism, physical condition,
and intelligence), social (e.g., public policies, social norms, discriminat-
ing practices, and gender roles), or environmental (e.g., climate and geo-
graphical location), and they stress the complexity of the relationship
between goods and individual functionings (Robeyns 2005, 99).
Naturally, a capability approach for children has to accommodate what
is special about them and address the challenges mentioned in the previ-
ous section; most importantly, children are developing but not yet fully
autonomous agents and, as such, possess special vulnerabilities. In our
view, the best way to integrate these particularities of children is to con-
sider their well-being and well-becoming as the benchmark of justice.
Before we examine these concepts, we need to take a stance on the issue
of choice and freedom as part of a theory of justice for children.
Most authors working on the capability approach give freedom of
choice a very high value. They argue that, as a state, it cannot be justified
to force people into specific functionings, while respect for persons and
their worldviews demands that they are granted a wide range of choices,
without making the decision on their behalf, about the kind of life they
want to realize (Nussbaum 2011, 26; Sen 1999). There are some dis-
putes within the approach about how far this interpretation of freedom
should reach in the case of adults and whether there are some contexts
in which it is reasonable to prefer functionings over capabilities (Arneson
2000; Wolff and de-Shalit 2007). However, the general importance of
freedom to an adult’s life is hardly ever questioned, and we fully agree
with this diagnosis without being able to substantiate it here. However,
in relation to children, this claim has to be modified. In line with what
we have argued so far, there are good reasons to shift the focus away
from capabilities to functionings. The main reasons for this are children’s
missing competences regarding autonomy, their special vulnerability,
and the prominent role that so many functionings play in the develop-
ment. These reasons limit how much freedom and choice they should be
given, rendering their views as mainly consultative and not authoritative

(Archard and Skivenes 2009; Brighouse 2003). However, this claim
needs some modifications for it to be appropriate to all children, as they
represent an extremely heterogeneous group. First and foremost, chil-
dren’s autonomous competences develop gradually in childhood until
they reach a position where they are able to act autonomously. Over time,
therefore, the aspect of freedom becomes more and more important in
the child’s life, while her choices and decisions increase in terms of their
normative significance. Two insights from the section above connect
directly with this statement. First, from an early age, children participate
in their own development and they have wishes, desires, and preferences
which are important to them and expressed via different channels. They
therefore possess some of the competences necessary for autonomous
choices, so it is crucial to give them opportunities to choose and act on
their own ideas in limited and protected ways. These freedoms, however,
only refer to some areas and specific contexts (what we have called “local
autonomy”), which should not be mistaken for allowing them to shape
their life in a comprehensive way and in the long run. Second, even for
very competent children, it seems reasonable to insist that there should
be more limitations on their actions and decisions compared to adults,
as well an insistence that they realize the most important functionings
constituting their well-being and well-becoming. As children, they are
bound by the rules of a regime of childhood (J. Anderson and Claassen
2012), which comes with some restrictions on freedom but gives them
more room and support in the development of autonomy, although with
fewer responsibilities compared to adults. This point is important to
this book. Some of the challenges we analyse mainly affect older chil-
dren, who often have competencies for autonomy comparable to those
of adults. Nevertheless, we will suggest some measures to counter them,
which some might see as overly paternalistic were they to be directed at
adults, but which are implied by a theory that takes the well-being and
well-becoming of children—sometimes at the expense of limiting some
of their autonomy—seriously.
The lack of autonomy and special vulnerability of children are also
reflected in the goals of justice for children, namely, well-being and well-
becoming. Other capability theorists have put more emphasis on further
normative concepts, such as dignity (Nussbaum 2006) or political equality

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