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Table 1 Ethical processes

From: Children as an afterthought during COVID-19: defining a child-inclusive ethical framework for pandemic policymaking

Process

Our adaptations

Related CRC articles

Actualizing the process

Accountability

Mechanisms to monitor pandemic-related decisions must prioritize and incorporate the rights of children into policy decisions and should assess the ways these rights are being overlooked. These assessments should be explicitly led by decision-makers, private organizations, legislative bodies, and other key stakeholders, ideally through a third-party review that ensures neutrality and fairness.

Article 3: Best Interests of the Child

Article 43–45: These articles explain how governments and international agencies will work to ensure children’s rights are protected.

Children’s Rights Impact Assessments (CRIAs), a systematic process in which policies and decisions are assessed to see whether and how they impact children’s rights, are one useful method for monitoring (amongst others). CRIAs are recommended by the UN Committee on the Rights of the Child. These should also take into account the needs and rights of particular groups outlined under other UN conventions (e.g., United Nations Convention on the Rights of Persons with Disabilities, United Nations Declaration on the Rights of Indigenous Persons).

Inclusiveness

Young people must be considered stakeholders by decision-makers and society in order to be included. Their voices are often shared through the work of adults, but opportunities for direct engagement with young people (in ways that align with their interests) should be developed and implemented in pandemics. Fundamentally, these voices must be solicited and genuinely listened to in these settings, as well, and intersectional elements of identity must be acknowledged and accounted for in engagement strategies.

The CRC should be reviewed and consulted to see where children’s rights are overlooked, how their lives are impacted by being excluded, and where disparities exist across groups of children.

Article 3: Best Interests of the Child

Article 5: Family Guidance as Children Develop

Article 12: Respect for Children’s Views

Article 13: Sharing Thoughts Freely

One way to ensure that young people are included as a relevant group in pandemic policy decisions is to have regional and national children and youth advocates who oversee and examine potential policies. In these settings, young people from a variety of sociocultural and economic positions should also be consulted through paid positions in advocacy offices, discussions with youth advisory councils, and community consultations. These strategies should be informed by children and youth themselves [38,39,40,41,42].

Openness and Transparency

Decisions must be clear and understandable for the entire population. Decisions that are publicly accessible—ones that promote ‘health policy literacy’—require the translation of decision trails into formats that allow understanding on the part of all young people too.

With transparency must come the possibility of criticism or suggestions from young people, as with any population, and a need for public bodies to respond to these perspectives.

Article 3: Best Interests of the Child

Article 17: Access to Information

All public-facing information should be in plain language to improve accessibility amongst young people and their families. In addition, to facilitate critical dialogue and ensure understanding public roundtables, think-tanks, or town halls specifically designated for young people should be created and commonplace. Ideally these would be in public venues like schools or recreation complexes.

Reasonableness

Qualitative research that engages populations of young people, and their families, should be considered  reasonable evidence for policy decisions. Young people, themselves, should also be seen as reasonable and reliable.

Moreover, the scope of information being examined must also be broader. For example: many of the impacts affecting children are future-focused, though immediate impacts are prioritized in pandemic decision-making. Longer-term risks must be included in long-term pandemic plans. While this focus on present concerns is understandable, one by-product is that it may lead policymakers to disregard the ways in which adapting solutions and redistributing resources now to mitigate predictable future harm (for the sake of children’s futures) can have both immediate and long-term benefits for all of society.

Article 3: Best Interests of the Child

Article 12: Respect for Children’s Views

To ensure all evidence is taken into account, public health scientific and bioethics tables must: (a) take a systemic approach when examining pandemic-related evidence that includes various forms of research and sources of knowledge, (b) grant proportional weight to future harms, harms indirectly related to viral transmission or enforced public health measures, and (c) ensure children-specific impacts are included, where evidence is available.

Responsiveness

We need to continue to ensure that we are responsive to the needs of young people too, especially as new information emerges about the ways they are being harmed within COVID-19 that may be outside the ‘transmission’ concerns.

A formal mechanism for parents, caregivers, and young people to provide feedback must be developed in a way that is attentive to the capacities of an organization or state.

Article 3: Best Interests of the Child

Article 4: Making Rights Real

Article 12: Respect for Children’s Views

Article 13: Sharing Thoughts Freely

Article 42: Everyone Must Know Children’s Rights

Implementing a formal complaint mechanism for young people and those in their social circle could be organized by government departments that have mandates for the well-being of children, by provincial Child and/or Youth Advocates (e.g., in New Brunswick [43]) or by implementing a federal Child and Youth Commissioner. This mechanism ought to be efficient and tailored to children and families needs (e.g., open after school hours). Aside from a mechanism for reporting concerns, these bodies should also develop tools that translate the concerns of young people and their caregivers into policy-oriented solutions—again, by working with young people directly, where possible.