Should Adolescents Make Their Own Life-and-Death Decisions?

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Should adolescents, still considered children under the law, be allowed to make their own healthcare decisions regardless of whether or not they follow parents’ or guardians’ wishes? If the adolescent has the cognitive and developmental skills comparable to that of an adult, but not the life-experience, how much control should adolescents have over their own medical care?
Pediatrician Charles Peters and ethicist Robert F. Weir adopt the position that most adolescents have the capability and maturity to make their own life-and-death decisions. They sight circumstances surrounding terminal/life threatening illnesses as providing the skills necessary in healthcare decision-making, thus uniquely qualifying the adolescent patient facing these issues to make the decision. Unfortunately, legal issues regarding adolescents and end-of-life decisions have not been resolved. While special classifications such as mature and emancipated minors have been created, most minors don’t have the legal right to make their own end-of-life medical decisions. Lainie Friedman Ross argues that this is in their best interests. She believes that most adolescents have not acquired sufficient autonomy to make this type of decision without the consent of their parent or guardian.
Peters and Weir base significant parts of their argument for adolescent decision-making around the circumstances the adolescent is faced with during the course of medical treatment. Regarding life-and-death decision-making, he believes that most adolescents with a terminal/life-threatening illness have sufficient knowledge about their disease and life experience coping with the disease to competently make an autonomous decision. As a result, Peters and Weir feel adolescents should have more legal options. Currently, adolescents have only three options:

  1. Parents and physicians can carry out the expressed wishes of the adolescent;
  2. Parents invoke an advance directive (only in a small number of states) on behalf of the adolescent;
  3. The adolescent acts according to the parents’/physicians’ wishes.

Lainie Friedman Ross, on the other hand, argues that adolescents have very limited world experience. While adolescents may have the capability and maturity to make the decisions, she believes that it is best that the decisions are made within the context of the family. She views adolescents as lacking complete autonomy and, as such is the case, dependent on parents’ continued guidance to develop life-time autonomy. Health care rights for adolescence, in her view, open the door to equal rights for children, which would place them in an extremely vulnerable position.
Key terms include: emancipated minor, advance directive, moral persuasion, and competency. An emancipated minor is an individual under 18 years of age who has been granted legal adulthood due to extenuating circumstances (marriage, parenthood, military service, etc.). An advance directive is a legal document requiring the wishes of the adolescent to be carried out. It is currently an option in only a small number of states. Moral persuasion involves an individual successfully imposing their point-of-view on another individual through appeal to their sense of decency. Competency is having the ability to intelligently make a decision once all options have been carefully analyzed.

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