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Adolescents ought to have the right to make autonomous medical choices

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Voting Style: Open with Elo Restrictions Point System: Select Winner
Started: 9/19/2015 Category: Philosophy
Updated: 2 years ago Status: Post Voting Period
Viewed: 3,472 times Debate No: 79805
Debate Rounds (3)
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Should be impossible to accept. I'll take an opponent in a few days. Comment if you're interested.

Resolved: Adolescents ought to have the right to make autonomous medical choices.

Definitions will be within the debate and are up for debate.

This is intended to be an LD debate. If you aren't familiar with how LD debate works, then I'd advise you not accept this. All styles of LD cases are acceptable.

Round Structure will be as such:

Round One: Pro accepts and presents their case.
Round Two: Con case and rebuttals, Pro rebuttals
Round Three: Con rebuttals, pro rebuttals. No new arguments at this point.


I accept the debate.
Just to clarify, Con said in the comments sections that I could ignore all the specifications regarding this being an "LD debate". Treat it as a normal debate with shared burden of proof. I must show that adolescents ought to have a right to make autonomous medical choices, whereas Con must show that adolescents ought *not* to have such a right.

Onto my constructive case!
It will take the form of the following syllogism --

P1: All rational human beings ought to have the right to make autonomous medical choices
P2: Adolescents, in general, are rational human beings
C1: Adolescents ought to have the right to make autonomous medical choices

This syllogism is logically valid, so an affirmation of the two premises will lead to an affirmation of the conclusion.

P1: Right to Bodily Autonomy

All rational human beings have ownership over their bodies. This is intuitively obvious -- since you are the sole user and occupier of your own body, you are the only one who can exert any sort of authority or control over it. Denying self-ownership results in a performative contradiction because simply the act of denying it (via speaking/typing) requires you to exercise your faculty of self-ownership. Thus, it is established that all human beings have a right to bodily autonomy, which, by extension, translates to a right to make autonomous medical decisions (because medical procedures are carried out on the body).

P2: Adolescents are Rational

I think my opponent will concede that adolescents are human beings. The question, then, is whether or not they are rational (i.e. capable of utilizing reason to independently make informed decisions). A large number of medical case-studies on the issue have concluded that adolescents are, indeed, rational, and that there is no significant difference in decision-making capacity between adolescents and adults:

"Existing literature related to adolescent decision-making capability for medical care suggests a level of decisional capacity not presently presumed by law. In fact, several studies reveal that adolescents decide on their medical care with an intentionality and thoughtfulness not usually attributed to them. Particularly, commentators have found 'little evidence that minors of age 15 and above as a group are any less competent to provide consent than are adults'" [1]. "Most studies have involved healthy children who were asked to make decisions about hypothetical medical situations (Lewis, 1980, 1981; Weithorn & Campbell, 1982). The most creative of these studies (Weithorn & Campbell, 1982) compared decisions of four age groups (9, 14, 18, and 21 years) on outcome measures that were specifically designed to reflect the four standards of competency to consent (evidence of choice, reasonable outcome, rational reasons, and inferential understanding). Results suggested that children in the 9-year-old group were less competent than adults in terms of the higher standards of understanding the information provided and rational reasons... However, they did not differ from adults in the standards of evidence of choice or reasonable outcome; that is, they still tended to arrive at logical decisions which were similar to those of adults. In terms of all four standards, the 14-year-old group demonstrated the same level of competency as the two 'adult' groups ; they showed a similar level of understanding and reasoning, and made similar choices" [2].

It is evident that adolescents, in general, should be considered "rational" human beings.

== Conclusion ==

Since both premises have been shown to be true, the conclusion (i.e. the resolution) is affirmed.
I look forward to seeing my opponent's case. It is sure to be less straightforward than my own.


Debate Round No. 1


The affirmative relies on an individualistic view of rights. Their argument is that the adolescent alone is capable of making these decisions. Their view of how rights are distributed and how decisions are made misunderstand the way society works. Complete autonomy is a view from nowhere, a disembodied subject that denies the influence one’s identity and community has. Donnelly '14:

Mary Donnelly, pf of medical law @ University College Cork, "Healthcare Decision-Making and the Law" Cambridge Law, Medicine and Ethics series, November 2014

  • Michael Sandel ...argues that the liberal subject is individualistic, ... ‘standing always at a certain distance from the interests it has’. Thus, the liberal subject is separate (and separable) from her views, beliefs and interests. These are, in a sense, something she can take off or put on. A consequence of this is that ‘[n]o commitment could grip me so deeply that I could not understand myself without it’. Sandel disputes this view of the subject on metaphysical grounds, arguing that ‘community describes not just what [members of society] have as fellow citizens but also what they are, not a relationship they choose (as in a voluntary association) but an attachment they discover, not merely an attribute but a constituent of identity’.

Thus, the standard is respecting communal norms. Prefer this framework because:

A - Frameworks need to account for the socially embodied nature of the subject and it’s impacts on moral agency. Donnelly 2:

  • Traditional conceptions of autonomy accord little significance to the embodied nature of the subject. Yet, all agents are essentially embodied. ... from a feminist perspective , ... ‘[m]enstruation, pregnancy, childbirth, and breastfeeding, for example, are not activities in which participation can be chosen or rejected in the same way that, for example, purchasing a book, deciding to practice the piano, or building a bookshelf are chosen or rejected’ . Failure to recognise the patient as embodied also leads to a failure to appreciate the potentially coercive impact of illness on agency.

B - Only through understanding the society around us can we come to understand notions of autonomy and agency. Donnelly 3:

  • Feminist theorists also identify the role of connection in the creation of the self, drawing especially on the role played by conditions of dependency which are inevitable aspects of childhood in the creation of one’s moral personality. ... ‘our understanding of personality relates to its genesis, and, for us, that is in the conditions of biological life, in which one generation nurtures its successor generation, preparing it to take its place’. ... we are who we are because of where we come from; we are inevitably ‘socially embedded’. Recognising this has consequences for the role of agency within liberal conceptions of autonomy.

My argument is that affirming is a violation of societal norms in terms of medical decision making, and that negating offers the best avenue of upholding them.

First, affirming is a violation of the familial social health norms. Barina and Bishop:

Rachelle and Jeffrey P, Saint Louis University, "Maturing the Minor, Marginalizing the Family: On the Social Construction of the Mature Minor," Journal of Medicine and Philosophy, 38: 300– 314, 2013

  • policy recommendations ... fail to recognize that the meaning of the body is founded in these sorts of familial practices and experiences of the family. Instead, the recommendations focus on consequences to individuals and to the state. This focus on consequences becomes a justification to undermine the normal familial communication of sexual mores, eroding the contextualizing function and foundational ground played by the family.

Only by negating can we support familial norms and support the society. Barina and Bishop 2:

  • Instead of presuming that minors should be emancipated in the context of reproductive health, we are arguing for a strong presumption against the provision of contraception/ abortion/EC without or against parental consent. ... The burden of proof should be on the medicolegal apparatus and individual practitioners to show the maturity of a particular minor and the necessity of providing contraception and EC without and against the consent of that minor’s parents/guardians. ... the sexuality of adolescents will not be cut off from its familial context or the realm where the care of the body finds its origins and its moral significance.

And, prefer parent decision making. Parents, on average, make better decisions for their children than the adolescents. Cherry:

Mark J. Cherry, pf of philosophy @ St. Edward's University, "Parental Authority and Pediatric Bioethical Decision Making" Journal of Medicine and Philosophy, 35:553-572, 2010

  • Parents have usually been identified, within rather broad side constraints, as the source of authority over their children and as the best judges of what constitutes the best interests for the family as a whole as well as the best interests of their minor children in areas of medical decision making. That is, parents themselves have usually been identified as the best judges for balancing costs and benefits, articulating values and inculcating virtues, to determine appropriate judgments for themselves and their children, and the family as a whole. …

Furthermore, parents ought to have the right to raise their children as they see fit to. Will provides a plethora of warrants:

Jonathan F. Will, JD from Pitt, “My god my choice: the mature minor Doctrine and adolescent refusal of Life-saving or sustaining medical Treatment based upon religious beliefs,” 22 J. Contemp. Health L. & Pol'y 233 2005-2006

  • Parents have a fundamental right, protected by the Due Process Clause of the Fourteenth Amendment, to raise their children as they see fit. This right, grounded in both law and ethics, extends to inculcating religious values and making medical decisions … parents possess what a child lacks in maturity, experience, and capacity for judgment required for making life's difficult decisions. … natural bonds of affection lead parents to act in the best interests of their children. Buchanan and Brock offer four reasons in support of the position that parents are the proper surrogate decision-makers for their children: [First b]ecause ... parents ... care deeply about the welfare of their children and know them and their needs better than others do, they will be more concerned as well as better able than anyone else to ensure that the decisions made will serve their children's welfare ... [Second] parents must bear the consequences of treatment choices for their dependent children and so should have at least some control of those choices.... [Third] a right of parents ... [is] to raise their children according to the parents' own standards and values and to ... transmit those standards and values to their children.... [Fourth] the family is a valuable social institution, ... The family must have some significant freedom from oversight, control, and intrusion to achieve intimacy ... the intimate family is itself autonomous, and as such, "promotes the interests and goals of both the children and the parents." ... parents are in the best place to understand familial goals, and therefore, should retain final decision-making authority in continual pursuit of those goals. ... parents generally enjoy the right to make decisions on behalf of their children without state interference. The Supreme Court has stated that "[i]t is cardinal with us that the custody, care and nurture of the child reside first in the parents, whose primary function and freedom include preparation for obligations the state can neither supply nor hinder., …

And now onto the aff case. His entire case revolves around the concept of adolescents being able to make competent decisions.

First, the negative case comes first. It doesn't matter if the adolescents are competent if we should be preserving social norms and allowing the parents to be making the decisions. This means that if he has to be refuting my case to even access his offense.

Second, don't trust competence studies. It's virtually impossible for a study to account for each change in person, change in context, and underlying emotions/stress, which all affect the decision making process. Michaud et al:
Pierre-André Michaud, University of Lausanne, M.D., Robert Wm Blum, M.D., M.P.H., Ph.D., Johns Hopkins, Lazare Benaroyo, M.D., Ph.D., Jean Zermatten, Ph.D.and Valentina Baltag, M.D., M.Sc., Ph.D. “Assessing an Adolescent’s Capacity for Autonomous Decision-Making in Clinical Care?” Journal of Adolescent Health xxx (2015) 1e6
  • The appraisal of adolescents’ capacity is difficult for several reasons: First, the capacity to understand the short- and long-term aspects and consequences of a decision is highly dependent to the situation. … Second, the fact that the pace of cognitive and affective development varies from one adolescent to another makes the delimitation of age cutoffs for decisions regarding health very challenging. ... “competence varies by individual and by decision, … Third, there is increasing evidence from neurodevelopmental research that the capacity to foresee the consequences of a behavior or a decision is, under certain circumstances, hampered by the relatively slow growth and maturation of the prefrontal cortex and by the emotional context. As functional connectivity of the brain increases with age, increasing socioemotional maturity can be expected ,but adolescents react in a variable manner depending on their emotional state, ... If Carlos is asked about his future in the presence of his parents, his reasoning capacity may be hampered by the emotions linked with the conflicts with them. ... if his health care practitioner ... provide a safe and empathetic atmosphere and explore his thinking process calmly, they will promote optimal decisionmaking capacity, a climate of “cold cognition”, which improves competence ...



Thanks, Zaradi.

== Framework ==

Con's case rests upon the misconception that self-ownership is somehow mutually exclusive with being "socially embedded". I agree that humans are social creatures and have to rely on other people to fulfill their emotional & material needs, but that has no bearing on whether or not they have ownership over their own bodies. Con seems to be conflating self-ownership with some strange individualistic state of self-sufficiency which entails complete independence from society, but in reality, self-ownership is strictly limited to physical bodily autonomy -- the right to exclusive control over one's own person.

It is certainly possible to simultaneously recognize both our self-ownership and our social dependency, as they have literally nothing to do with each other... one is a fundamental moral characteristic of human beings, whereas the other is just a behavioral characteristic. Given that, when factors involving social dependency (e.g. "community norms") conflict with our right to bodily autonomy, it is obvious that autonomy should prevail.

A. My ethical justification portrayed self-ownership and the right to bodily autonomy as *absolute*. Con did not address that justification at all, instead just introducing an alternative framework centered around societal norms which had no such degree of absoluteness. Obviously, when faced with two conflicting standards, if only one of them is absolute and the other is not, then we have to grant preference to the absolute standard. Thus, we place greater value on autonomy.

B. But even more damning than its lack of absoluteness is how ill-warranted Con's framework is. Community norms do not necessarily carry any moral significance. Just because we have a psychological tendency to "define our identity" through the lens of society and its norms doesn't mean that those norms can claim any sort of moral authority over us. Autonomy isn't merely an issue of "identity" or "conception" -- it is a fundamental, objectively-existent characteristic of human beings, as I demonstrated last round. Reject Con's framework because it fails to connect its premises to its conclusions.

C. Not only was the existence of a right to bodily autonomy necessary for Con to write his case (re: performative contradiction argument), but the existence of morality itself is contingent upon autonomy. If human beings have no autonomy over themselves, they are reduced to deterministic robots with nothing to distinguish them from the rest of the inanimate & amoral universe -- there is nothing to indicate that they are "morally significant" in relation to reality. Nihilism is not an option for Con (because his own case assumes morality), and therefore neither is denying the right to bodily autonomy.

For those reasons, prefer my framework to Con's.
Rational human beings have a right to bodily autonomy regardless of societal norms.

Regarding parental rights, ignore Con's appeals to the 14th amendment and Supreme Court -- they are non-topical because the resolution isn't US-specific. Con puts forth four other arguments, but none of them actually justify parental rights. Why should we place any moral value on the affection or personal standards of the parents? We are given no reasons. Family might be a "socially valuable structure", but that doesn't imply that it's a "morally valuable structure". There is no reason to accept that parental rights even *exist*, much less that they outweigh the individual right to bodily autonomy.

== Rationality ==

With the paramount ethical value of the right to bodily autonomy established, now I only have to demonstrate that adolescents possess sufficient rationality to be granted such a right. Last round, I showed that the majority of professional medical research on the subject reveals no significant difference between the decision-making capacity of adults and adolescents. Con provides some sources asserting otherwise, but the quality of those sources are dismal. One of them is just a paper on bioethics which says "research shows..." without citing any actual research,. The only other source says that "appraisal of adolescents" capacity is difficult", but that doesn't actually prove what Con was saying (that adolescents *aren't* rational). Obviously, cognitive maturity varies from person to person, but my sources show that in general, adolescents have been demonstrated to be competent decision-makers.

The resolution is negated.
Debate Round No. 2


Pro's lack of responses to the framework damn him in this debate.

Extend Donnelly 1. The affirmative's singular focus on autonomy as an individual principle and characteristic of human beings just misunderstand the way that society works in general. We're all reliant on each other interdependently to have any kind of notion of rights and autonomy. Without this interdependence, there's no such thing as autonomy.

And, extend Donnelly 2. Only understanding the interdependence of society can respect the moral agency of other people.

And, extend Donnelly 3. Only from this interdependent framework can claims of autonomy make any kind of sense. Even if I have the right to conduct myself as I wish to, social dependence comes first as it places demands on us before autonomy factors in.

My opponent makes three responses to the framework that seem to mistake the entire purpose of the framework. The framework I establish isn't just about providing for material needs, but rather that our sense of self and our rights come from the society around us.

His first response is that absolute autonomy comes first because "obviously" the thing that's absolute comes first. This is similar to his third response that without this autonomy there's no morality and I need autonomy to even type this case out in the first place, so I'm going to group the two of them together in this response:

First, the negative framework precludes autonomy. Look to Donnelly 2 talking about how we need to recongize interdependence before claims of moral agency can even be made and to Donnelly 3 that only through interdependence can claims of autonomy be made. Neither of these warrants are responded to.

Second, this is intuitively true as well. He can make the argument that I need autonomy to even type out this round, but in order to type out this round I also need a computer to type this out on, which means I have to rely on my parents or friends to give me this computer. Even if I make the money for it myself, I have to rely on my employers to pay me the necessary money, and to rely on other manufactuers to make the computer for me to purchase. I have to rely on scholars and researchers to publish the research I want to use in round, I have to rely on outside companies to provide me with the internet connection required to even access this website, and I have to rely on other programmers and technicians to keep the site running long enough so that I can actually submit this argument for others to see. Without this social reliance on other people, my claim to autonomy via posting this round becomes impossible.

Both of these reasons means that my framework precludes individual autonomy. We ought to evaluate the round under which side best upholds societal norms as this is the best way to protect and realize our interdependence to others.

But, absolute autonomy doesn't make any sense. If autonomy is absolute then there's no way to weigh between who's right should be protected over anothers in cases of conflict. If I have the absolute autonomous right to conduct myself how I wish to and have absolute self-ownership, then what negative moral claims can we really make if I want to kill Romanii right now? Denying me this action seems to deny that I actually have absolute ability to make my own decisions.

Moreover, if Romanii were to want to kill me while I was trying to kill him, and both of our claims to autonomy are absolute, then how do we weigh between who's claim to autonomy comes first? There's no way to weigh between these rights and resolve conflicts of interest. Both of these are reasons to reject absolute autonomy, which means you reject the affirmative as his case is predicated around it.

His second response to the framework makes me think he literally didn't read any of the evidence I cited in the Donnelly evidence. This literally explains why our social dependence on others has moral significance and is relevant in discussions of autonomy. He makes no response to any of the warrants coming from any of the Donnelly evidence. Cross-apply it to here. They all explicitly talk about why social norms have this moral authority over our being. Just because he doesn't want to see the connections, that doesn't mean I'm not making them.

This means that I'm winning the framework debate. This makes the debate super simple to evaluate. Extend Barina and Bishop that says that by affirming we're violating social health norms. And extend Barina and Bishop 2 that says that the only way to resepct social health norms is by negating. Neither of these arguments are responded to in the last round. This means that because I'm winning the framework debate, I'm winning the debate.

And, because I'm showing you that social interdependence comes before claims of autonomy, if I'm winning the framework debate, then you negate before you even evaluate the affirmative case as it functions a priori to autonomy. This means that you negate, even if he proves his syllogism true.

But, then extend Cherry out. Cherry talks about how socially parents are recognized as the authority over adolescents and the actors fo their best interests. Parents are better judges of value and are better at balancing costs and benefits and making rational decisions for their child, which they keep the best interests of in mind. He never responds to Cherry at all, hold him to this drop especially because I won't be able to defend Cherry after this round. This means that even if he's winning that adolescents can make their own decisions, you still negate because parents are better at it and have the bests interests of the child in mind, meaning that they'll be making better decisions for the child and we're best protecting the adolescent.

Then, extend the four warrants coming from Will as to why parent decision making should be preferred. First, that parents have the best interest of the child in mind while being fully developed and competent. They know their own children better than others and thus will be in the best position to act in the child's best interest. Second, that regardless of decisions being made, the parent's are the one bearing responsibility for the choice and are the one's footing the bill. They deserve to be the ones having the final say if they're the one paying the bill. Third, because the parents are the ones charged with the upbringing and development of the child, it is their right to impact their own standards and values upon the child to help them develop correctly. And fourth, the familial structure is a valuable social institution that requires limited to no oversight from outside sources in order to achieve any kind of intimacy or connection between child and parent. Only this way allows for the best interests of the child and parent to be protected.

The claim that none of these show why we ought to prefer parents making the decision over adolescents is laughably dumb when they all talk about it. As for why this is morally relevant, that just goes back to the framework debate, which I'm already winning.

This means that even if he's winning his case, you still negate because you're preferring parent decision making to adolescent decision making. I'm the only world which allows for parent decision making, which means that you negate here.

But then, extend Michaud et al. Michaud is talking about how existing studies talking about how adolescents are as capable as adults in making decision fall into a lot of pitholes that the affirmative's studies don't really solve back for. Michaud provides three reasons to not trust competency studies:

First, that understanding the short and long term consequences of a decision are dependent on the actual situation at hand, which the affirmative's studies don't specify what decisions are actually being studied (they only say "hypothetical situations", if they studied specific situations at all, which can be anything from getting a sex change to putting on a band-aid).

Second, that the fact that different adolescents develop at different rates from other adolescents makes making definitive age cut-offs (i.e. the 15 and above group and the 14 group) really problematic because not every 14 year old is going to hit that mark and not every 15 year old is going to hit that mark.

Third, that our decision making is affected by the context of which we're making the decision. If I'm deciding about how my future will play out, I might make a different decision alone than I would if I were making the decision in their company because emotionally I'm going to self-consciously consider their interests in my decision as well. Our emotional state is highly relevant to how we actually make decisions (i.e. I'm more likely to make a rational decision if I'm calm and collected than if my dog just got ran over in front of my eyes and I'm really freaked out). Pro's studies make no note of the emotional state of the subjects being tested, nor do they account for any emotional variance.

This is damning because pro makes literally zero response to any of these claims. Insofar as he's not responding to them and he's not answering back for them in his studies, then reject his studies as insufficient to warrant that adolescents are competent decision makers. This has two impacts on the round:

First, if you're rejecting his studies, his studies were the only thing keeping his second premise afloat, which means his entire syllogism falls and you reject the affirmative case.

Second, you prefer parent decision making because I provide the most reliable evidence that addresses underlying claims and concerns. And even if my evidence is bad, I'm the only one trying to provide valid evidence.


I'm winning framework comes before the affirmative case. You can negate there. I'm winning parents come before adolescents. You negate there. And negate off Michaud taking out the affirmative case.


Romanii forfeited this round.
Debate Round No. 3
34 comments have been posted on this debate. Showing 1 through 10 records.
Posted by Romanii 2 years ago
I wanna re-match though. This debate sucked.

Preferably the topic I did with bsh1 forever ago -- "Individuals ought to help those in need"
Posted by Romanii 2 years ago
Next time we debate, I'll decline the challenge.
Posted by Zaradi 2 years ago
First you only post half of your round.....then you don't even post a round....
Posted by truthiskey 2 years ago
varsity or novice u r?
Posted by Romanii 2 years ago
You can tell I was in a rush while writing the last section...
fix'd, in case it is incomprehensible :


Con's only other source says that "appraisal of adolescents' [decision-making] capacity is difficult", but that doesn't mean that it is impossible. Obviously, cognitive maturity varies from person to person, but my sources show that *in general*, adolescents have been demonstrated to be competent decision-makers.

The resolution is affirmed.

Posted by Romanii 2 years ago
15 seconds...
Posted by ShabShoral 2 years ago
Romanii ran an argument from performative contradiction to defend individual rights? How Hoppeian of you.
Posted by Romanii 2 years ago
I can actually understand your case! :O

Posted by Romanii 2 years ago
It's true!!!!
Posted by Zaradi 2 years ago
"It's sure to be less straightforward than my own."

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