Treating children and adults: whose body is it anyway?

This essay, about the concept of treatment, is written by a psychiatrist wh o is monitoring extreme treatment situations, namely surgical treatment of epilepsy. It challenges the implicit assumption that persons consulting doc tors necessarily want to be treated. A child may not be privy to, of wish t o be party to, a treatment. The child, or the parent on behalf of the child , may not agree to the course of action that is in its best interest. One p roblem of treatment concerns who owns the body that is to be treated. Ultim ately, the body belongs to the state and is merely tenanted by the child an d managed by a parent on the state's behalf. But the body must, somehow, be owned if its sickness is to be acknowledged. The lack of real autonomy pro vides for the possibility of abuse including abusive therapies. "Abuse" is applicable only to abuse of trust. Autonomy is granted or conceded by paren ts and by the state but is never complete. Autonomy is confirmed by taking informed decisions about what will happen to the body. Treatment is a cost/ benefit deal in which the precise aim to be achieved has to be described an d accepted before treatment begins.