Back to the Rough Ground! Making (Some) Sense of Secondhand Claims of Child Suffering
Tyler Tate, MD, MA, Oregon Health and Science University, Portland, OR

Theories of child/pediatric suffering are difficult to come by. They are difficult to come by because they are challenging to develop. In this talk I will examine two such challenges. The first challenge is that for both neurotypical and neurodivergent pediatric patients, a theory of pediatric suffering must be informed by developmental psychology in order to account for the neurocognitive stage and evolving subjectivity of young children. The second challenge stems from the fact that a comprehensive theoretical account of pediatric suffering must include the experiences of adults involved in the care of a suffering child. It must do so for two reasons. First, since the ability for neurotypical children to articulate their own suffering unfolds with age, children require partnerships with adults to define their suffering and engage in discussion about it. Second, as noted by Campelia, Kett, and Wightman [1] many secondhand claims of suffering are actually complex projections of the speaker’s own suffering (whether parent, family-member, or in the medical context, clinician), rather than the suffering of the child. Hence, an account of pediatric suffering requires both an analysis of the psychological phenomenon of projection or displacement as well as an examination of the ways that linguistically competent adults experience suffering. I will attempt to begin outlining a comprehensive theory of pediatric suffering by employing a modified version of Amartya Sen and Martha Nussbaum’s capabilities framework that is tailored to the developing child and informed by Paul Farmer's liberation theology, Bowen family systems theory, and Michael Tomsello’s pioneering work in developmental and comparative psychology. In so doing I will also attempt to respond to Professor Brent Kious’s recent criticism [2] of the use of flourishing and care as a frame for understanding the suffering of children and people living with intellectual disability, as well as for deciphering the moral obligations that such suffering generates. 

1. Campelia GD, Kett JC, Wightman A. Relational suffering and the moral authority of love and care. Theor Med Bioeth. 2020;41(4):165-178.
2. Kious BM. Suffering and the dilemmas of pediatric care: a response to Tyler Tate. Theor Med Bioeth. 2023;44(3):249-258