Teens ought to make autonomous medical choices
Debate Rounds (2)
Value: Societal Welfare
Value Criterion: minimizing harm
1. The Categorical Imperative " Such autonomy is not universalizable. We cannot reasonably say that all adolescents, or even all people, should have the right to make autonomous medical decisions. Therefore, we cannot say that, in general, adolescents should have the right to make autonomous medical decisions.
2. Utilitarianism " Adolescents are short sighted and prone to mistakes. Allowing them to make autonomous medical decisions would often result in harmful choices with long term consequences that they will not be able to foresee. Allowing parents to make their decisions for them is the more utilitarian approach
3, They're just not ready: "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."
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.
To clarify, here are some definitions.
Adolescent-a person that is ranging from 14-18 years old
Hartman, 2002 (Rhonda Gay [Professor in the University of Pittsburgh School of Medicine & Affilitated with the Center for Bioethics and Health Law]. "Coming of Age: Devising Legislation for Adolescent Medical Decision-Making." American Journal of Law and Medicine 28 Am. J. L. and Med. 409. Via LexisNexis Academic)
A substantial segment of the American population consists of adolescents. Adolescents, defined as persons between the ages of fourteen and eighteen, have traditionally been regarded as "minors" by law. Minors, as a group, are legally disabled, meaning they are presumed to lack the skills necessary for capable decision-making. Capable decision-making is requisite to the exercise of legal rights. Although the U.S. Supreme Court has extended federal constitutional guarantees to minors, including the liberty right for decision-making in intimate, personal matters, the Supreme Court has observed that vulnerability impairs their decision-making capability. Accordingly, the law regulates decision-making liberties of minors far more extensively than those of adults.
autonomous-acting independently or having the freedom to do so
As Lita Furby once said,
"Justice is usually said to exist when people receive what they are due, and they are due not only fairness but treatment consistent with their natural rights as human beings."
Value Criterion: Justifying Human Rights(autonomy)
Contention 1: Adolescents do have decision making capacity.
Hattab & Kohn (2007)
Weithorn and Campbell (1982), administered to 96 children and adolescents a measure developed to assess competency according to 4 legal standards. Their findings confirmed that access to formal thought was necessary for a subject to be able to consent [to medical treatment]. While minors of 14 years of age had a degree of competence identical to that of adults, children of 9 had lesser understanding of the difficulties of taking into account the various factors involved in the choice they are being asked to make. However, they were found to be capable of expressing, like adults, their preferences concerning treatments, and of participating actively in decisions.
Research reveals that adolescents are capable of making competent choices.
McCabe, 1996 (Mary Ann McCabe [Department of Hematology/Oncology, Children"s National Medical Center]. "Involving Children and Adolescents in Medical Decision Making: Developmental and Clinical Considerations." Journal of Pediatric Psychology. Vol. 21.4: p. 507)
It is clear that neither rights to self-determination, nor the capacities for decision making, appear on the 18th birthday. However, applied research in children's medical decision making is limited. 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; not surprisingly, they used one or two concrete factors in their decisions. 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. We should continue this line of research with ill children in order to explore the impact of physical illness and emotional adjustment upon children's medical decision making.
Subpoint A: As proved above, since adolescents can make decisional making capacities, they can use the Veil of Ignorance.
The Veil of Ignorance, is an idea brought by John Rawls, and is a method of determining the morality behind a certain issue. Since adolescents have a good enough reasoning and decisional making capacity, they will use the Veil of Ignorance to make the right decision.
Contention 2: Adolescents have a constitutional right to bodily integrity.
Though it does not appear that this doctrine has been widely applied in cases outside the reproductive health care context, it nonetheless seems likely that minors possess some sort of right to bodily integrity that may limit the power of the state to restrict their health care choices.91 Finally, when confinement for treatment is at issue, the Supreme Court has held that minors have a protected liberty interest and a procedural due process right not to be arbitrarily deprived of their liberty.
Subpoint B: Parents cannot deny medical care given to adolescents by his/her choice.
Parental rights are often invoked to argue that parents should have a right to dictate their children"s medical decisions, but those arguments often fail. Parents generally cannot deny medically indicated care to their children"even when the parental rights claim is combined with a claim under the Free Exercise Clause. In addition, while parental rights claims are sometimes discussed in the context of state laws allocating decision-making authority over minors" health care, they rarely seem to make any difference to the outcome.
This is my case stated above. As proven, adolescents can make decisions as proven, negating his 2nd and 3rd contention. They are proven to have the same capacity. As seen, adolescents are not short minded. As proven by 2 given sources, adolescents are very strong in decisional making, and should be allowed to make decisions. Secondly, there are given the constitutional right. All people are equal. Nobody has power over another. As said by John Locke, "Men are born and always continue free and equal in respect to their rights."
My value of Justice trumps his value of Societal Welfare because my value gives rights to the denied adolescents that they so rightly deserve with his/her body. Societal Welfare does not benefit the adolescent greatly because it is against the wishes of the adolescents, thus not really protecting the society, because the adolescent is part of the society. My value criterion of autonomy is more valued than minimizing harm is because autonomy is a personal right. It is not a right to be meddled around with. The decisions made not by the adolescent will not minimize the harm because the adolescent will be mad about the choices that where made by other people of his/her own body.
So with these reasons and many more, I strongly, but respectfully urge you to put a ballot in the Pro side of this debate today. Thank you.
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