Charitable participation

Wendler defends the “charitable participation” standard (Wendler, 2005; Wendler & Glantz, 2007; Wendler, 2010) according to which risks are considered minimal when they do not “exceed the risks of charitable activities deemed acceptable...in daily life” (Wendler, 2005, p.40). That is, children should be enrolled in research that does not aim to offer them the prospect of direct benefit only when the research poses no more risk than society would deem permissible for a child to face while she participates in

charitable activities. For example, minimal risks should be understood as those faced by children participating in Global Youth Service Day, during which children across the world carry out local community improvement projects including crop planting, visiting the sick, digging wells, and collecting donations (Wendler & Glantz, 2007).

Wendler makes his case by drawing parallels between research and charitable activities and then appealing to our intuitions about the permissibility (or desirability) of volunteering children to participate in charitable activities. He argues that both charitable activities and nonbeneficial pediatric research are designed to help unrelated and

unidentified others (Wendler & Glantz, 2007). And neither activity is able to predict with certainty that it will benefit others; the benefits of a clinical trial, like those of a charitable fund raiser, may not materialize. But both are valuable endeavours that offer a reasonable prospect of helping others (Wendler & Glantz, 2007).

Next, Wendler argues that participation in charitable activities is socially endorsed. He writes:

Parents may reasonably instruct their children to mow the lawns of infirm neighbors, and they may allow their children to participate in car washes and go door to door collecting money for charitable organizations, even though these activities pose some risks to their children. Further, society not only implicitly accepts such charitable activities but in many cases actively endorses them. Schools and local governments often support them, and respected organizations like the Red Cross and Habitat for Humanity encourage children to participate in

them. Presumably, if society considered it outright exploitation in every case to expose children to risks for the benefit of others, the public would not, through the government, give them a special tax status. (Wendler, 2005, p.40)

That is, society endorses parent’s decisions to volunteer their children’s help in charitable activities that pose some risks to children but also offer the possibility of helping

unidentified and unrelated others. This suggests that it may also be permissible for children to participate in clinical research involving similar degrees of risk without direct medical benefit but with the ability to benefit others.

The charitable activity interpretation lines up well with the common moral intuition that parents should encourage children to learn the value of charity and of helping others. In addition, charitable organizations often have strict rules about what kinds of charitable activities children of different ages may undertake, which offer clear guidance about what kinds of risks may be permissible in research (Wendler & Glantz, 2007). For example, Habitat for Humanity reaches out to children as young as 5 years old to help contribute towards their goal of providing every person with a safe, decent, and affordable place to live. But children’s participation is carefully constrained to age-appropriate activities. Children between 5-8 years old are encouraged to help build piggy banks for fundraisers, construct welcome baskets for homeowners, and help with landscaping (Habitat for Humanity). But to be permitted on construction sites, one must be over 16 years old (Habitat for Humanity). Thus, some charitable organizations offer clear guidance about what kinds of risks are appropriate for children of different ages.

However, Wendler’s charitable participation standard fails to meet other necessary criteria of a successful interpretation. Wendler’s standard does not clearly limit risks to a defensible degree. Wendler successfully points out that charitable activities help to teach children socially and morally valuable traits. He also points out that the risks of

participating in charitable activities are risks and burdens to which society is willing to expose individuals for the benefit of others (Wendler, 2005, p.40). These claims are compelling. But it is not clear that charitable activities are the only kinds of valuable activities in which society is willing to expose children to risk for the sake of others.

Wendler does not offer a strict definition of what he means by charitable

entirely clear. But his examples, including American Red Cross, Habitat for Humanity, UNICEF, and Global Youth Service Day (Wendler & Glantz, 2007) refer mostly to the works of charitable organizations. He also raises the example of helping out infirm neighbours (Wendler, 2005). There is little question that these are valuable activities. But there are other valuable activities in which it may be permissible to undertake, or to expose children to risks for the sake of others, that do not clearly fit within Wendler’s charitable activities standard. Consider, for example, valuable social goals such as reducing poverty, promoting public health, promoting democracy, reducing pollution, reducing traffic accidents, and promoting racial tolerance, to name a few. It is desirable for people to be involved in, and in some instances, to involve their children in activities that involve risk but help contribute to these valuable goals. But constraining the degree of risk to which it is permissible to expose children in research to the degree of risk involved in charitable activities does not capture the permissibility of involving children in these other kinds of valuable activities. In other words, Wendler’s interpretation is overly narrow. He identifies a set of clear cases in which one exposes oneself or one’s child to risks in order to benefit another, often a complete stranger, but it is not clear why we should limit permissible risks to the risks involved in charitable activities. These are only one example of the kinds of valuable activities society promotes.

Further, Wendler’s charitable activity standard fails to meet the requirement of generality. That is, it does not apply to children of all ages. As Wendler recognizes, interpreting minimal risk according to charitable activities does not seem to support research on infants or very young children. Socially endorsed charitable organizations, like Habitat for Humanity, do not endorse the inclusion of children under five years old in charitable activities (Wendler & Glantz, 2007). If minimal risk is to be compared to the degree of risk socially permissible in charitable activities, then infants and young children cannot face any risks without the prospect of corresponding benefits. This is not simply a disadvantage of the argument (Wendler & Glantz 2007, p.580) but a serious problem; a convincing interpretation of minimal risk must explain the permissibility of research risks for children of all ages. Insofar as the charitable activity interpretation bars infants and young children from facing any degree of risk, it is not a persuasive definition of minimal risk. Applying it would prohibit the progress of research that investigates the medical

treatment of infants and young children. Thus, Wendler’s charitable participation interpretation should be rejected.