Adolescents ought to have the right to make autonomous medical choices.
Before I begin, I think prudence behooves an analysis of the resolution. The resolution states "Adolescents ought to have the right to make autonomous medical choices." This means that PRO in today"s debate must affirmatively persuade you, the judge, that as a matter of general principle, adolescents should be able to make medical decisions for themselves as a matter of right. CON, in contrast, must persuade you that as a matter of general principle, adolescents should not be able to make medical decisions for themselves as a matter of right.
To affirm this resolution as a general principle, I need only argue that adolescents should have the right to make autonomous medical choices in some cases where they are capable. The resolution does not require the affirmation to argue that all adolescents should have a right to make all medical decisions only on their own. Rather, affirming this resolution requires only a denial of the status quo in which adolescents are generally presumed incompetent to make medical decisions on their own behalf.
Insofar as this is an "opinion-topic" the burden of persuasion is equivalent on both sides, meaning that neither side has a greater or lesser persuasive burden than the other. The reason that the burden of persuasion is equivalent is because to do otherwise would be to show deference towards one side at the expense of the other, and therefore to undertake the exercise of judging this debate from a biased perspective. I think this was at one point an LD topic, or it might be an LD topic now. As such, while this debate necessarily entails certain value-based arguments, I"m not going to argue it as if it were an LD round such that I would begin by establishing a value and a criterion. As a roadmap, I"m going to begin by talking about the status quo of adolescents" right to autonomous medical choices, and then I"m going to present some arguments for why this probably isn"t the best way to go.
The Status Quo of Adolescents" Right to Autonomous Medical Choices
The law currently regards adolescents (people between the age of about 13-14 and 17) as generally incompetent to make medical decisions for themselves. What that means is that young people now do not have the right to decide what kind of medical care they receive or even if they receive it. That choice is left up to their parents or guardians, if they have parents or guardians, or to the state if the young people in question do not have parents or guardians. Adults, in contrast (people over the age of 18) get to make decisions for themselves because of the presumption that someone over the age of 18 is decisional capable of making those kinds of choices.
Decisional capacity is a kind of hard concept to define, but to have decisional capacity is basically to have the ability to understand information, consider it carefully and make a decision on that basis. (1) It should come as no surprise that decisional capacity is not the exclusive province of adults. I think that as a general rule, if a kid can master the mysteries of calculus they can probably understand information relevant to their medical care -and an adult may not even be able to pass a high school calculus class.
There is also some irony in the right to make autonomous medical decisions as it relates to adolescents in the sense that while a 16 or a 17 year old girl who gave birth could be legally required to make medical decisions that relates to the care of her child, that same 16 or 17 year old girl could not, in some jurisdictions, receive birth control from her doctor without parental consent. Alternatively, in almost all jurisdictions a fifteen year old boy could be charged as an adult for committing a crime like robbery or murder and punished as an adult on the premise that the boy had the mental acuity to appreciate the gravity of his decision to perform that crime, but the law might at the same time regard him incompetent to consent to or refuse certain medical care as a result of a sexually transmitted disease he could contract while incarcerated. That doesn"t make a whole lot of sense, does it? How can a teenager an adult (insofar as they are decisionally capable) when they commit crimes but a child (such that they are not decisionally capable) when it comes to medical care?
Justice requires that adolescents have the right to make autonomous medical decisions.
If justice requires that individual autonomy be respected, then to the extent that someone is capable of acting autonomously (in this case, being decisionally capable) that right ought to be respected. As a basic rule, if people can understand facts that are presented to them and they can make decisions on the basis of those facts, they should have a right to make choices for themselves about those facts. And the science here supports the notion that adolescents are decisionally capable; adolescents are, as a general rule, capable of understanding facts presented to them and making choices on the basis of those decisions. (1)
A study from the late 1990s compared the decisions of four age groups (9, 14, 18 and 21 years) on outcome measures which were designed to measure the decisional capacity of those groups relative to the others. While the 9 year olds were less competent than the 21 year olds, there was no statistical difference between the decision making capacities of the 14, 18 and 21 year olds. (2) What that means is that the 14 year olds are generally as capable as the 18 and 21 year olds even though there was some statistically insignificant variation between them.
So, that should be our standard for evaluating who gets the right to make autonomous medical decisions, and it"s fairly straightforward that adolescents can do that. That established, if someone is decisionally capable and that person is denied the right to make choices for themselves about matters that pertain to their wellbeing, then their right to autonomy is being violated. There are a lot of teenagers on this site, and they seem like they"re decisionally capable, so it seems proper that they should be afforded the right to make decisions that pertain to their medical care for themselves with or without the involvement of their parents.
1. "Adolescent Autonomy: Clarifying an Ageless Conundrum" Hastings Law Journal 51 Hastings L.G. 1256. Rhonda Gay, J.D., Ph.D. August 2000.
2. "Involving Children and Adolescents in Medical Decision Making: Developmental and Clinical Considerations." Journal of Pediatric Psychology. Vol. 21.4: p. 507. Mary Ann McCabe, Department of Hematology/Oncology, Children"s National Medical Center. 1996.
1: The Status Quo of Adolescents" Right to Autonomous Medical Choices
Pro says “I think that as a general rule, if a kid can master the mysteries of calculus they can probably understand information relevant to their medical care -and an adult may not even be able to pass a high school calculus class.”
This is a poor comparison and certainly not a general rule. Mastering calculus does not require the same capabilities as decision making. This is like saying a 300 pound defensive linemen in football is, “as a general rule” capable of running a marathon. Obvious physical prowess in one field does not imply prowess or capability in another. This is true with the brain as well. While some adolescents may be capable of doing calculus, this is no indication of maturity of the brain in general. As such this comparison does nothing to support pro’s argument. Certainly adults, on balance, are more capable of making medical decisions then the adolescents who rely on adults to survive.
Pro says “that while a 16 or a 17 year old girl who gave birth could be legally required to make medical decisions that relates to the care of her child, that same 16 or 17 year old girl could not, in some jurisdictions, receive birth control from her doctor without parental consent.”
This is an interesting point. The uniqueness of this circumstance is beyond the scope of this debate. As I may argue that adolescents should not have autonomy in regard to medical choices it would be beyond this debate’s subject or purpose to argue that society could stop teens from getting pregnant. Likewise it is beyond this debate to argue who should make medical decisions for the fetus in the body of a 13 year old. However, it is in scope of this debate to discuss whether a 16 year old girl is capable of reasonable electing to take prescription medicine for birth control. I will address this in my counter argument.
Pro says “Alternatively, in almost all jurisdictions a fifteen year old boy could be charged as an adult for committing a crime like robbery or murder and punished as an adult on the premise that the boy had the mental acuity to appreciate the gravity of his decision to perform that crime, but the law might at the same time regard him incompetent to consent to or refuse certain medical care as a result of a sexually transmitted disease he could contract while incarcerated.”
Like the example previous this is an interesting point. Though, again, outside the scope of this debate. I will say that the charging of a fifteen year old boy as an adult is not the norm and on balance does not happen. There are times where exceptions in society have been made. The arguments I will hereafter may quite possibly show that such an exception should not be made. As much as I am tempted to engage this example, I fear doing so will lead me off track. It suffices me to say that a child being tried as an adult is the exception not the norm. On balance, society does not hold adolescents to the same degree of accountability as adults.
As far as the status quo, it is clear that on balance society recognizes that adolescents are not as capable as adults in decision making and as a result are not held accountable to the same degree. Also as a result, they are restricted from participating in society in many ways.
2: Justice requires that adolescents have the right to make autonomous medical decisions.
Pro says “If justice requires that individual autonomy be respected, then to the extent that someone is capable of acting autonomously (in this case, being decisionally capable) that right ought to be respected. “
Perhaps justice requires capable individuals autonomy be respected. As such, it should be respected. What of children?
John Stuart Mill in his work "On Liberty" said this:
"It is, perhaps, hardly necessary to say that this doctrine (of liberty) is meant to apply only to human beings in the maturity of their faculties. We are not speaking of children, or of young persons below the age which the law may fix as that of manhood or womanhood. Those who are still in a state to require being taken care of by others, must be protected against their own actions as well as against external injury… Liberty, as a principle, has no application to any state of things anterior to the time when mankind have become capable of being improved by free and equal discussion."(1)
John Locke said
“The freedom then of man, and liberty of acting according to his own will, is grounded on his having reason, which is able to instruct him in that law he is to govern himself by, and make him know how far he is left to the freedom of his own will. To turn him loose to an unrestrained liberty, before he has reason to guide him, is not the allowing him the privilege of his nature to be free" (2)
Pro says “As a basic rule, if people can understand facts that are presented to them and they can make decisions on the basis of those facts, they should have a right to make choices for themselves about those facts.”
No contention there. Justice calls for such.
Pro says “And the science here supports the notion that adolescents are decisionally capable; adolescents are, as a general rule, capable of understanding facts presented to them and making choices on the basis of those decisions.”
I am entirely unable to verify my opponents source as I do not own the book. However, I will present sources that contradict what pro has shown in my counter argument.
Finally pro appeals emotionally to those who are on this website saying “There are a lot of teenagers on this site, and they seem like they’re decisionally capable, so it seems proper that they should be afforded the right to make decisions that pertain to their medical care for themselves with or without the involvement of their parents.”
A very clever inclusion as for me to refute will likely alienate some voters. Perhaps that is unavoidable in this debate.
As pro presented the status quo, There are many good reasons not to allow adolescents medical autonomy. The main one I would like to present is as follows. Within the human brain is the Prefrontal cortex. "The prefrontal cortex (PFC) is located in the very front of the brain, just behind the forehead. In charge of abstract thinking and thought analysis, it is also responsible for regulating behavior. This includes mediating conflicting thoughts, making choices between right and wrong, and predicting the probable outcomes of actions or events."(3)
"The prefrontal cortex (PFC) is located in the very front of the brain, just behind the forehead. In charge of abstract thinking and thought analysis, it is also responsible for regulating behavior. This includes mediating conflicting thoughts, making choices between right and wrong, and predicting the probable outcomes of actions or events."(3)
"Since the PFC controls intense emotions and impulses, it is sometimes referred to as the seat of good judgement. As such, a properly functioning prefrontal cortex inhibits inappropriate behaviors " including delaying gratification of needs, for things like food or sex " while encouraging wise, acceptable choices. In part, this occurs because it works to allow humans to balance immediate reward with long-term goals."(3)
"Medical studies have shown that the PFC is the last section of the brain to mature. In other words, while all other brain regions are fully developed early in life, its development is not complete until around age 25."(3)
"A damaged PFC can negatively impact a person's ability to assess situations or perform tasks, particularly those of a moral or ethical nature."(3)
"As a number of researchers have put it, "the rental car companies have it right." The brain isn't fully mature at 16, when we are allowed to drive, or at 18, when we are allowed to vote, or at 21, when we are allowed to drink, but closer to 25, when we are allowed to rent a car."(4)
Both of these sources suggest the age of PFC maturity is 25. It is quite clear that adolescents on balance, do not have the mental capability to effectively think abstractly, or rationally, or "to balance immediate reward with long-term goals," due to this scientific truth. This lack of mental capability is generally accepted as a justifiable reason to not allow adolescents to make autonomous medical decisions.
The status quo supports my argument. Society on balance recognizes that adolescents are less capable of making rational decisions. Science supports such an understanding of an underdeveloped brain. As a result autonomy of minors is justly severely limited. Justice demands autonomy of those who are capable. Justice demands that such autonomy is not intended for those not yet able to govern themselves.
Due to what has become obvious in this debate, Adolescents ought NOT to have the right to make autonomous medical choices.
Justice requires that adolescents have the right to make autonomous medical decisions. The reason is because if justice requires that individual autonomy be respected, then to the extent that an individual is capable of acting autonomously they have a right to do so. Adolescents can act autonomously because they are decisionally capable, meaning that they can understand information and make decisions on the basis of information that they learn.
CON made some pretty weak rebuttals... they didn't really work, though. The reasons his rebuttals don't really carry a lot of weight are fairly clear. First, being able to understand something complicated like calculus shows that on a certain level adolescents are capable of abstract and complex reasoning, which shows that at least those adolescents who take and succeed in academic classes that involve complicated reasoning skills are decisionally capable and thus can act autonomously. But, talking calculus is certainly not the "end all" of decisional capacity -it's one example of a kind of "marker" that would let us know that a person can acquire new information, critically consider it and make decisions accordingly.
Second, rather than actually engage any of the examples I listed, CON just said that they were "beyond the scope." The problem is that they're not. It is absurd that a 16 year old can get pregnant and could be legally required to make medical decisions for her child, because in order for that to happen, the law would have to recognize that the same 16 year old is sufficiently capable of making medical decisions in "for others" but not "for herself." In the same respect, the law recognizes adolescents as adults in some cases but not others -so, again, we've got another contradiction in the status quo. If the basis of PRO's claim is that adolescents are not capable of making decisions like adults in some cases, but capable of making decisions like adults in other cases, that's a conflict that has to be addressed. After all, this whole debate comes down to whether adolescents are "sufficiently capable" of decision making for themselves.
Third, CON's claim that adults are "more" capable of making medical than adolescents because adults have a more developed pre-frontal cortex is problematic because it does not mean what he thinks it means. Basically, what CON is saying is that because adults have more developed pre-frontal cortexes, that they and only they should be able to make medical decisions for adolescents. The problem with that argument should be pretty clear: no matter how well developed adults' pre-frontal cortexes are, that doesn't mean that adolescents are not sufficiently mature enough to make those kinds of decisions for themselves. The evidence I have, which CON didn't even bother to address suggests that adolescents *are* sufficiently able to make medical decisions for themselves, and thus able to act autonomously, so justice requires respect for their right to act autonomously.
The point to take away from this is that even if adults are "more" mature than adolescents (obvious), that doesn't mean that medical decisions that affect adolescents should be the exclusive province of adults because adolescents are "mature enough" to have a role in that decision making process to the extent that they are able to act autonomously. Even still, CON is fundamentally mistaken about the differences in decision making processes between adults and adolescents.
"Studies comparing adolescent and adult decision-making processes have found few, if any, differences in cognitive abilities between adults and adolescents aged 14 and over. (3) Psychologist Tara Kuther concludes on her review of the psychology literature that "many adolescents are as able as adults to conceptualize and reason about treatment alternatives, and, therefore, to make healthcare decisions." (4) CON's emphasis on pre-frontal cortex development, thus, is as misplaced as his tendency to infantilize adolescents by denying their medical autonomy.
Fourth, CON attempted to respond to my argument, summarized above, by quoting John Stuart Mill. Mill's point was that the doctrine of liberty does not apply to children. Liberty is "the state of being free within society from oppressive restrictions imposed by authority on one's way of life, behavior, or political views." That is *actually* beyond the scope of this debate, because we're only talking about *autonomy within the context of medical choices* -which is narrower than liberty. Autonomy within the context of medical choices is only the right to decide what, if any, medical care one receives. So, we don't have to give adolescents free reign in society to accept that they can (and probably should) be able to make some decisions for themselves. I don't really know why CON included the Locke quote... because it has nothing whatsoever to do with this debate.
That established, I'm really glad that CON agrees that if people can understand facts that are presented to them and they can make decisions on the basis of those facts, they should have a right to make choices for themselves about those facts. I'm especially glad that he went so far as to concede that justice requires this. The reason is because adolescents, who are people just as much as adults are, are decisionally capable and thus their right to make autonomous medical choices should be respected. That is why at the end of the day, even though the pre-frontal cortex may not be completely developed until age 25, CON has a long way to go to prove that the pre-frontal cortex is "not developed enough" from ages 13-17 to preclude decisional capacity. He hasn't done that, and he can't do that, because the scientific literature directly contradicts such a contention. Insofar as I have shown that the opposite is true, and my opponent has conceded that to the extent that people can act autonomously, justice requires that their right to do so be respected, I've won this debate.
Peace and Love,
Sources, continued... (As an aside, all CON had to do to verify my source was google it.)
(3) Shoshanna Ehrlich, J. "Grounded in the Reality of Their Lives: Listening to Teens Who Make the Abortion Decision Without Involving Their Parents", 18 Berkeley Women"s L.J. 61, 150 (2003); also Shoshanna Ehrlich, Who Decides? The Abortion Rights of Teens (Westport, CT: Praeger Publishers, 2006). (From IPPF. Understanding Young People's Right to Decide: Why is it important to develop capacities for autonomous decision making?)
(4) Kuther, T.L. "Medical Decision-Making and Minors: Issues of Consent and Assent", 38(150) Adolescence 343 (2003) at 350. (From IPPF. Understanding Young People's Right to Decide: Why is it important to develop capacities for autonomous decision making?)
This link explores the nuances of decisional capacity:
This is sort of awkward, because we are now at the second occasion in this debate where my opponent's incapacity to "google" stuff has produced generally unfavorable results on his own end. I think another thing CON doesn't understand is how decision making works... as if medical decisions are somehow "over and above" other kinds of decisions. That seems to be a consistent theme of what he's writing, which is silly. He has done little more than acknowledge that I used a word he didn't know, and has thus far failed to substantively rebut anything I've said.
The problem is that he doesn't understand how logic works... His argument, rephrased in the previous round in some creative ways, is essentially this:
THIS IS IMPORTANT: Teenagers' pre-frontal cortexes are not as developed as adults, therefore only adults can make medical decisions for teens. What he has failed, demonstrably, to do is show how (1) prefrontal cortex development to an adult level is necessary to make medical decisions, (2) that teen prefrontal cortex development -even if less than adults- is not "sufficient" to make medical decisions, and (3) that even if teenager's prefrontal cortexes are not sufficiently developed, and "adult level" prefrontal cortex development is necessary to make "good" medical deacons, that restricting the medical decisions of teenagers only to adults violates adolescents' substantive rights.
THIS IS WHY WHAT I SAID ABOVE IS IMPORTANT: As to the stuff I mentioned above, my opponent doesn't consider any of those things. There is no link between "prefrontal cortex development at the adult level" and "exclusive medical deciders." Even still, insofar as the pre-frontal cortex does not develop until around the mid-20s, his own logic should preclude even legal adults form making their own medical decisions which is (other than violating adult's substantive rights) fundamentally dumb. So while CON can make silly pithy remarks like he did in the previous round, his logic is terribly weak. I said why it was weak above, but he just said that explaining the actual reasons that his argument was weak was an ad hom attack.... such disappoint.
So... I've pointed out a lot of contradictions in the status quo, which he has yet to rebut the substance of. I've pointed out weakness in his case, and he's ignored them. I've made the argument that adolescents ought to be able to make their own medical decisions... and when all else fails my opponent says "adults are more mature than adolescents" therefore only adults should be able to make medical decisions. This is basically the same weak logic as his dumb prefrontal cortex argument. It might be the case that adults are more mature than adolescents, but unless my opponent can show that adolescents are NOT sufficiently mature to make medical decisions for themselves, (accepting "maturity" as the standard for who ought to be able to make medical decisions) then this argument falls too. Again, the fact that adults are more mature than teens does not mean that teens are not mature enough to make those decisions for themselves.
But, I'm not so sure I like the standard of "maturity" being the delineating factor between groups who can make medical decisions and those who can't. The reason is because even if someone else might be in a better position to make certain decisions for someone else (for any number of reasons -one of which might be *LOL* a more developed prefrontal cortex), the reason that we respect people's right to make decisions that relate to themselves is because respect for the dignity of others (read: justice) requires it. In a free and democratic society, it's not good enough to say that all and only those who are in the best position to make decisions get to make those decisions when that decisional power intrudes on another's right to autonomy. And... this is another point that my opponent has just fouled up in totality, inferior as he's completely dropped it other than to put some irrelevant philosophical quotes in that he clearly doesn't understand the meaning of.
Like, he literally does not grasp the difference between "liberty" as a general concept and "limited autonomy within the context of making medical decisions." The former is a whole lot more broad than the latter, even if I were to accept that "liberty" and "autonomy" are the same thing -which they're not, but the semantic argument is another conversation for another day. To say that teenagers should have "some autonomy within a limited context" is not to say that "teenagers should have carte balance liberty to do anything they please."
The other problem with CONs entire case is that he's talking about teens being able to make medical decisions for themselves as if that somehow means that anything the parent thinks is to be thrown out with careless disregard. That is not the case. To say that an adolescent should be able to decide medical things for themselves is not to entirely remove the parent from the medical decision making process. It means, rather, that even though the parent(s) may still have influence in that process, the person who is actually going to be subject to the decision that's made (read: the adolescent) is going to be the one who makes that call. Perhaps CON doesn't get this because his pre-frontal cortex isn't sufficiently developed, so he's not capable of understanding the relevant stakes in place here... like, maybe he lied about being 25. (I kid... I kid... sort of.)
Pro says “This is sort of awkward, because we are now at the second occasion in this debate where my opponent's incapacity to "google" stuff has produced generally unfavorable results on his own end.”
Peace and Love,
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