Early Intervention: Justice for babies?

When deliberating on the many claimed benefits for early intervention services a number of ethical questions arise:

  • – Why should the government invest in early intervention programmes?
  • – Why is early intervention ‘right’?
  • – Why is early intervention ‘good’?

These inquiries seek to uncover the arguments behind the current UK government’s commitment to early intervention. To answer these ever prominent questions, I have spent the last couple of months analyzing a set of policy documents which each make a case for ‘why’ early intervention. The main ethical argument for early intervention within UK policy can be interpreted in the following way:

Early Intervention is good because it addresses injustice, and contributes to building a fairer and more equal society.

At heart, it seems the government’s commitment to early intervention is a commitment to justice. But we can ask yet further ethical questions:

  • – What is justice?
  • – What does justice require?
  • – How is such justice achieved?
  • – And whose responsibility is it to bring about such justice?

Justice is… Equality of Opportunity

Much of early intervention policy focuses on ‘life chances’ – this phrase refers to an individual’s degree of opportunity, the ‘chance’ they have to achieve a good life. Within the policy documents, it is often implied that everyone should have the same chance to achieve a successful, happy and healthy future; in this sense, justice requires equality of opportunity.

In the context of early intervention, this is taken to mean that every child needs a good start in life; findings from developmental science show that the first two years are crucial for determining a child’s future outcomes (Shonkoff 2003; Johnson et al 2016; Heim & Binder 2012).  This is where early intervention comes in – if babies from disadvantaged backgrounds can be identified at the earliest possible opportunity, they and their parents can be provided with the appropriate support to neutralize the initial condition of disadvantage.

Justice: Whose responsibility?

But how can the State ensure equality of opportunity when so many factors that influence opportunity are outside of its control? Inequalities between people’s life chances could be the result of a range of factors: environment, socioeconomic status, ‘natural’ talents and skills, personality, health, individual goals, and motivations.  Most, if not all, of these factors, cannot be fully controlled by a liberal State. But if not the State, then where does the responsibility to ensure equal opportunity for the next generation fall?

Early intervention policy highlights scientific discoveries, particular in the fields of Neuroscience, Epigenetics and Attachment theory, that show how the factors that impact a child’s life chances are mediated in important ways by parental care. Even those traits that would be traditionally attributed to the ‘natural lottery’ – intelligence, personality, physical stature – are no longer solely seen as the arbitrary gift of Mother Nature. Rather, a mother’s nurture, care and teaching influence brain development and epigenetic mechanisms during the early years of life, and so can facilitate the development of a wide range of traits in a child. Early intervention policy positions these positive traits as the key to improved life chances for babies, concluding that ‘parents are the architects of a fairer society’.

Some ethical concerns

As discussed briefly above, science can be used to inform a certain argument around justice, which in turn leads to policy recommendations, and to the responsibilisation of groups of people. This raises a number of ethical concerns:

  1. There are multiple theories of justice and it is not clear that equality of opportunity is what justice demands. Further, justice may need to be balanced against other ethical ideals, such as autonomy or freedom.
  1. The scientific evidence is inconclusive and the link between parenting and child outcomes is complex (Peacock et al 2013). This creates problems in drawing oversimplified assumptions on the power of parents in shaping their child’s life chances in relation to health, well-being, and character.
  1. Early intervention policy places a great responsibility upon parents to bring about justice, even though, somewhat ironically, they may be the victims of injustice themselves. Some parents will be disadvantaged through a range of factors outside of their control, and as a result, may have no choice in passing this disadvantage on to their children. Greater and more holistic State support is required if these families are to break the cycle of disadvantage in which they are trapped.

In conclusion, early intervention may be a response to social injustice, but we should be wary of policy that makes the jump from scientific ‘evidence’ to what ‘justice’ demands without first providing a substantive account of justice as an ethical concept. We must think carefully about what the evidence really shows, and ask what are the consequences for real-world actors.

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Suggested Reading

Gentleman, A. 2011. ‘Making the case for early intervention’. The Guardian [online].

Lamont, Julian and Favor, Christi, ‘Distributive Justice‘, The Stanford Encyclopedia of Philosophy (Summer 2016 Edition), Edward N. Zalta (ed.).

The Centre for Social Justice 2016 ‘A Submission from the Centre for Social Justice: Delivering a Life Chances Strategy’. London, England: CSJ.

 

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About the Author

Rose Mortimer

Rose Mortimer is a BeGOOD project DPhil student at Oxford, based in the Nuffield Department of Population Health.

View Rose’s BeGOOD project profile

View Rose’s University of Oxford profile

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This blog post is based on the opinions of the author and does not necessarily represent the views of the University of Oxford or the Oxford Department of Psychiatry.

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