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Votes for a better future
  1. Neena Modi
  1. Correspondence to Professor Neena Modi, Section of Neonatal Medicine, Imperial College London, Chelsea and Westminster Hospital campus, London SW10 9NH, UK; n.modi{at}

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Democracy is considered one of the most powerful concepts of the modern era. At its heart is the simple principle ‘one-person one-vote’, a crisp sound bite that summarises the ideal that we are all equal, we all have a voice, the right to have that voice heard and the right to have a say in our future. Yet even in democracies, a substantial proportion of the population—about a quarter in the UK—remain silenced and disenfranchised, with no voice. These are the proportion with the longest future ahead of them, with the most to gain, or lose, from poor electoral decisions—children. So how might we redress this inequality?

Others before me have suggested that parents might receive a proxy vote for each child.1–4 However, raise this in discussion and it will usually be rejected, either immediately as a laughable nonsense, or after a pause, with the justification that this would do no more than give multiple votes to parents. Some go on to add offensively that this would empower irresponsible families with many children. Some justify their disapproval by saying parents should not be advantaged over non-parents. Others say they are in favour of lowering the voting age, but not proxy votes, although are then at a loss when asked for justification. Let us examine the logic of these views.

A common theme in these responses is that a proxy vote for each child would in effect be an extra vote for the parent. Extra votes for parents have indeed been proposed as a counter to gerontocracy in ageing populations4 and some have argued that in countries with falling birth rates, extra votes for parents, by signalling political commitment to generous family policies, would increase fertility.5 Over the last century, Germany, France, Japan, Austria and Hungary have discussed giving parents an extra half vote for each child—so-called ‘Demeny voting’.4 However, in the conceptual framework I propose, the rationale for a proxy vote is not that the parent should have an extra vote or part vote, but rather is entrusted, for a short period of time, with the child’s vote. This is an important difference, and is in keeping with the recognition of children as individuals with rights, the one-person one-vote principle and the inescapable fact that parents are indeed entrusted with responsibility for their children while they are young.

Those who raise the issue of parents whose children are in care, who have differing views or are divorced, should remember that every child has a responsible adult and parents can be required to choose which will exercise the proxy vote. What of the view that a parent would merely use a child vote to advance his or her own ends? Well, the default, and not unreasonable, expectation of society is that parents act in the best interests of their children. The trust that society places in them is only removed when parent actions are extreme and demonstrably harm their children. Society also confers the right on parents to raise their children in their own image and imbue them with their religious, political and personal values and beliefs. So if a parent chooses to cast a child’s vote according to his or her own views this is doing no more than society expects and accepts as their right to do. However, many report that parenthood changes them, making them more considering of the needs and perspectives of others. So perhaps we should also not reject the possibility that when entrusted with a proxy vote, a parent will pause and reflect on what policies would serve their child best.

This century has seen growing recognition that children’s views are important and should be taken into consideration, especially when a decision involves them or their well-being. However, it seems reasonable that this should be to an extent commensurate with their cognitive development, hence the radical suggestion that children as young as 6 should be given a personal vote is unlikely to gain traction.6 Paediatric practice in the UK has long recognised the need to take evolving maturity into account.7 Paediatricians are expected to involve children and young people in discussions about their care, take their views seriously and seek their assent before carrying out an examination or procedure even if they are underage. Conversely, young people, even if legally entitled to consent, are encouraged to involve their parents in important decision-making. However, a parent cannot override the competent decision of a young person. This perspective was enshrined in English law by the Gillick case of 1985. Victoria Gillick was a mother who contested the guidance of the Department of Health that contraception could be prescribed to children aged under 16 years without parental consent if in the doctor’s judgement, the young person was competent to understand the issues. In a landmark decision, the Law Lords rejected her view, and laid down that the authority of parents to make decisions for their children is not absolute, but diminishes as the child’s maturity evolves.8

Consider the issue dispassionately, and it appears that immediate, automatic rejection of the notion of a child proxy vote may be no more than the expression of unconscious, age-old biases. The ultimate defeat of ancient prejudices reflects the evolution of human societies. For example, once upon a time, it was accepted that women and non-white races were intellectually inferior and hence incapable of voting. This view has changed. Societal attitudes towards infants and children have also evolved over the ages. They were first viewed as possessions, with their parents free to do with them as they willed. Infanticide was condoned, girls sold into marriage and children sent out to work as a matter of course. The last century saw the emergence of child rights, initially largely actioned through an emphasis on protection. It was not until relatively recently that it was realised that being overly protective may not be in a child’s best interests. Thus, children were excluded initially from participation in medical research because the prevalent paternalistic view was that they should be protected from its dangers. The British Paediatric Association, the forerunner of the UK Royal College of Paediatrics and Child Health, was one of the first organisations to challenge this view, stating in 1980 ‘research involving children is important, and should be supported and encouraged’, and more boldly ‘research which involves a child and is of no benefit to that child - so called ‘non-therapeutic’ research—is not necessarily either unethical or illegal’.9 The rationale for this stance is sound. Children’s physiological and biological responses differ from adults so they would not necessarily benefit, indeed are placed at risk from treatments that have only been evaluated in older age groups.

Experience from clinical practice offers insight into how the mechanics of a proxy child vote might be implemented, so that children are progressively engaged in the process as they mature and parents are reminded that they have been entrusted with acting in the best interests of another individual. For example, one might envisage the baby in arms taken to the polling booth while the parent puts the ballot paper into the box, a reminder to the parent that the vote is made on behalf of the infant. Later the expectation, possibly even requirement, might be that the child accompany the parent and put the ballot paper into the box. Later still, the underage teenager might put the ballot paper into the box alone while the parent waits outside. This has resonance with the concept of Gillick competence, that a child gradually attains capacity to make decisions. Marks of emerging maturity, autonomy and self-determination are challenge and rebellion, so consider too the discussions between parent and child as he or she insists on voting in a particular way; what a marvellous way to grow a realisation of civic responsibility. And there is likely to be added benefit: a study of Danish voting indicates that parents are more likely to vote when their child joins the electorate.10

The consequences of failing to enfranchise children also merit consideration. Current political and economic thinking is characterised by short-termism with growth triumphing sustainability. Corporate interests dominate governments of every hue around the world. We are still in the age of the quick win and immediate gratification, characteristics that typify immaturity. Consider too the extraordinary spectacle of some politicians around the world, whose actions, intemperate and immature though they are, have nonetheless gained populist approval. The human race would appear to be societally, still at an immature stage of development. Meanwhile, children themselves are showing growing maturity as exemplified, for example, by their calls to combat climate change that have spread globally.11 A recent study has also challenged the adage ‘older is wiser’ showing that those aged over 65 years are about seven times more likely than millennials to spread ‘fake-news’ and suggesting a possible explanation might be inadequate digital literacy for life today.12 The ages at which young people are permitted to have sexual intercourse, able to join the military, drive a car or accept criminal culpability, let alone vote, spring from age-old cultural and societal beliefs around ‘coming of age’ and so vary between and within countries. This irrationality does not serve young people well. Standardising a lowered voting age would be far more in keeping with 21st century thinking.

There is growing recognition worldwide to have a heed to the consequences of today’s actions. What parent does not fear a future for their children that is riven by climate change, lawlessness, environmental pollution, economic instability and extreme political views? Trusting parents with a proxy vote while their children are very young might be another step towards a better future, and societally, represent a mark of growing maturity. Paediatricians have long spoken in support of child rights; surely, a clarion call for their inclusion in the democratic process would sit well within this advocacy?


The author acknowledges helpful discussions on this topic with colleagues around the world.


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  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed in this paper are of the author and not representative of any organisation.

  • Competing interests NM is the Immediate Past-President of the UK Royal College of Paediatrics and Child Health and the President-Elect of the UK Medical Women’s Federation. NM is a member of the Nestle International Scientific Advisory Board; she accepts no personal financial remuneration for this role. In the last 5 years, NM has received research grants from the UK Medical Research Council, National Institute for Health Research, March of Dimes, British Heart Foundation, Westminster Medical School Research Trust, HCA International, Chiesi, Nestle, Prolacta Life Sciences, Shire Pharmaceuticals, Collaboration for Leadership in Applied Health Research and Care for Northwest London, Healthcare Quality Improvement Partnership, Bliss, NHS England and UK Department of Health; conference travel and accommodation from Chiesi, Nestle and Prolacta Life Sciences and speaker honoraria from Chiesi.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Patient consent for publication Not required.

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