West Coast Publishing
LD 2014-15 Adolescent Medical Decisions
Page 1
West Coast Publishing
LD 2014-15
Adolescent Medical Decisions
Edited by Jim Hanson
Research assistance by
Kathryn Starkey
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Adolescents ought to have the right to
make autonomous medical decisions
Table of Contents
Adolescents ought to have the right to make autonomous medical decisions...............................................2
Topic Overview ............................................................................................................................................3
Definitions and Discussion ...........................................................................................................................7
Affirmative .................................................................................................................................................10
Affirmative Extension Evidence .................................................................................................................13
Healthcare Organizations Recognize Adolescent Rights ...........................................................................14
Adolescents Find Difficult in Obtaining their Right to Autonomy..............................................................15
Competence is Socially Constructed ..........................................................................................................16
Fear of Parental Reprimand Clouds Adolescent Judgment (1/2) ..............................................................17
Fear of Parental Reprimand Clouds Adolescent Judgment (2/2) ..............................................................18
Parental Notification Bad for Teens (1/2) .................................................................................................19
Parental Notification Bad for Teens (2/2) ..................................................................................................20
Without Autonomy, Adolescents’ Reproductive Health is at Stake(1/2) ..................................................21
Without Autonomy, Adolescents’ Reproductive Health is at Stake (2/2) .................................................22
Parental Decision-Making Bad ...................................................................................................................23
Teens Legally Recognized as Competent ...................................................................................................24
Negative .....................................................................................................................................................25
Negative Extension Evidence .....................................................................................................................29
Not All Adolescents Make Informed Decisions ..........................................................................................30
Adolescents Avoid Health Decisions ..........................................................................................................32
Adolescents are Immature and too Emotional (1/3) .................................................................................33
Adolescents are Immature and too Emotional (2/3) .................................................................................34
Adolescents are Immature and too Emotional (3/3) .................................................................................36
The Law Deems Adolescents Immature.....................................................................................................37
The Supreme Court Rules that Adolescents are Immature .......................................................................38
Parental Guidance is Good.........................................................................................................................40
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Topic Overview
The conversation regarding adolescents and their medical choices is becoming more and more
prevalent in today’s society. The debate ranges from parents and concerned guardians whom feel that
adolescents or teens have not had the experience, the chance to grow in order to make informed medical
decisions. Adults oftentimes feel that adolescents do not comprehend the implications of their decisions,
which speaks to their young disposition in society. On the other hand, adolescents feel as if it is their right
to make their own medical decisions, as their autonomy depends on it. These individuals argue that they
possess the intellect and ability to understand the pros and cons of any medical decision, which denotes
their right to be given the chance to do so. Cultural differences, societal growth, and differing viewpoints
denote an interesting debate concerning the right for adolescents to make autonomous medical
decisions.
The affirmative in this debate is focused on the notion that a right to make a medical decision is
crucial for autonomy. Focusing on autonomy as a state of being, something all must acquire is crucial to
win the value of the debate. Your value will be autonomy, which the negative truly cannot achieve unless
they can prove that parents are more important than the adolescents themselves. At the top of Maslow’s
Hierarchy of Needs rests self-actualization. This is the most self-improving need an individual may have.
Self-actualizing allows an individual to become attuned to one’s own self-discovery, to self-reflect, to
explore, to pursue knowledge, and recognize one’s full potential. Autonomy is the internal link to making
these self-exploratory actions and concepts a reality for any adolescent. If autonomy is denied to
someone, it denotes an instance of dehumanization. Adolescents are seen as less than human, not worthy
or competent enough to make decisions for themselves. When dehumanization is not alleviated, it
becomes permanent. Adolescents witness stigmatization. Once they are stigmatized as incompetent,
under developed, or incapable of making decisions, they will forever be seen as morally inferior. The
persecution of a stigmatized group becomes more psychologically acceptable. It also increases the chance
of violence. For many adolescents, this is witnessed through continued verbal, emotional, and physical
abuse from parents or guardians, which could continue to seep into other facets of their life if the
stigmatization of adolescents is not curbed.
Another interesting facet of this debate is the notion of what is an adolescent. Western
constructions of this term lead to the more concrete definitions you will find below, where an adolescent
is a particular age range for an individual. In many cultures, however, the term adolescent can mean an
entirely different concept. Across the world, an individual can be seen as an adult worthy of making
autonomous decisions at ages far younger than what is recognized in Western culture. These adolescents
are trusted with essentially a rite of passage to make their own decisions, as they are seen as mature and
competent to do so. For the affirmative in this debate, you need to be focusing on the notion that in other
cultures, it is acceptable for individuals in the “adolescent” age range to make their own decisions and
that this freedom of autonomy ought to be accepted in western culture. Even medical organizations have
noted that adolescents have the capacity to make their own decisions. Piaget and other theorists and
psychologists have argued that most adolescents have matured to the point that they have developed
cognition worthy of cost-benefit analysis and therefore, capable decision-making capabilities. Use this to
your advantage. Even if some teens are rather immature, generally, teens have the mental capacity to
make well informed decisions. Those decisions can become more informed when they do not have to
acquire parental guidance in the process.
One of the more important arguments for the affirmative is the notion that adolescents will fail to
seek medical help if parental consent is necessary. You have a plethora of evidence in this packet that
shows situations in which teens avoid medical care in the event they must consult their parent or
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guardian. In some situations, teens or adolescents live in violent households, where a healthcare concern
like a pregnancy could bring emotional, verbal, or physical abuse to the teen in question. Teens will have
to face trauma because the letter of the law deems them incompetent in making their own decisions.
These sorts of scenarios ought to be prevented. Other times, teens will avoid seeking parental guidance or
assistance with reproductive health concerns. Teens will engage in unsafe sexual behaviors and actions
rather than ask their parents to help them with contraceptive acquisition for fear of judgment or
reprimand. It is possible to avoid these risky behaviors if adolescents could be able to bypass their
parents’ consent and obtain medical care themselves.
Oftentimes, parents are rather uninformed about the medical decisions their children face. Many
times, children can experience bad living conditions under their parents’ roof. This could include
insufficient medical care, education, nutrition, and the like. When an adolescent has the propensity to
learn about their medical choices in a classroom, they could possibly be more informed about their own
medical choices than their parents. Generationally, there are differences between a parent and their
child, which can include topics like decisions and feelings towards healthcare. One generation can believe
that vaccines are bad, while the younger generation can believe, and witness the scientific benefit, that
vaccines are inherently good. There will be uninformed parents who could possess negligent parenting
skills that should not be the sole arbiter of their child’s healthcare treatment.
Additionally, granting adolescents the right to autonomy in their medical decisions bolsters the
medical industry. Since the debate surrounding adolescent autonomy in this field has been growing, it has
triggered a response from the field to be able to better serve this community in an atmosphere that is
absent of parental guidance. When there is a new facet of the industry, there must be research and
specialization for that new population. Recently, new journals are being created to discuss the crosssection of adolescent care and autonomy. The field is growing. It also means that healthcare providers
must learn to discuss their healthcare directives in new ways. The vocabulary of an adolescent can differ
greatly from another individual in another generation. Jargon can be left by the wayside in doctor-patient
conversations if the patient does not know its meaning. Healthcare providers will not only learn new ways
to discuss the treatment, diagnosis etc. of adolescents, there is also a growing facet of the field of
psychology to discuss and study this cross-section of autonomy and healthcare of adolescents. These
psychologists work with healthcare providers to better understand the ways in which adolescents
understand and process information, as well as work with the legal system to demonstrate the ways in
which adolescents are truly competent and worthy of making their own medical decisions.
On the negative side of the debate, your main focus will be on the competency and maturity of
adolescents. Essentially, you will be focusing on the notions that parental guidance is good, is effective in
the eyes of the legal system, and ensures adolescents do not make terrible medical decisions. The value
for the negative focuses on legal decision making. Currently, in the eyes of the law, adolescents are
neither autonomous nor competent enough to make their own medical decisions. This is the core of your
argument. Society has essentially established a litmus test for who can or cannot make these sorts of
decisions, and that guideline is a rather good one for the immaturity level seen among most adolescents.
The criterion for the negative is parental guidance. Parents and guardians have more years under their
belt, which benefits their children in decision making. One’s parent has many shared experiences, more
advanced knowledge, and other useful tools to help adolescents make informed decisions about their
health. Without parents, adolescents would be lost in the medical industry.
Cognitively and physically, adolescents are not mature to make their own decisions. Many scientists
believe that the brain of an adolescent is not up to par as compared to adult brains. There have not been
enough years for it to fully develop, which denotes a risk to the cognitive decision-making abilities of
adolescents. There are many times when a teen uses emotion and impulse to make their decisions. They
become afraid of the situation, especially when they hear consequences for whatever decision they make.
At times, teens will make a rash decision without truly understanding the procedure, types of medication,
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possible side effects, etc. Emotion takes over their disposition. They are young, and their decision making
strategies and process definitely demonstrate this. With age comes responsibility and experience. The
ages at which adolescents are currently able to make their own decisions and be their own guardian
should not be altered. Teens have simply not had enough life experience in order to ensure they make
correct decisions in their life. Yes, everyone makes bad decisions, but without the mental capacity or
lifespan to have had experience and knowledge to make well-informed decisions, adolescents probably
should not be willed the autonomy to make these sorts of decisions.
Additionally, adolescents mature at different ages. Changing the age at which an “adolescent” can
consent to medical treatment could offer adolescents with different maturity levels, some with the
cognitive ability to make an informed decision and others without. When the USFG was writing laws
about the legal voting age and the legal drinking age, studies and expertise when into making the
necessary decision to set legal standards for age requirements. With the term, adolescence, a varying list
of ages apply, which deems it harder to note that “adolescents should have autonomy in their medical
decisions.” Some adolescents mature faster than others, which could make them worthy of such
autonomy, but for those who are not mature enough to make a potential life altering decisions. Biology
does not lie. Some adolescents’ brains will be more fully developed than others, lending only some teens
cognitively capable to make medical decisions. Because the brightline is not clear, this age group should
not be granted this autonomy.
Despite opposition from angsty teenagers who rebel against their parents’ advice, parental guidance
is truly inherently good for an adolescent’s well-being. As mentioned, not only do many parents have
experience and knowledge to help guide an adolescent’s healthcare, they also provide assistance through
use of insurance and finances. Many adolescents lack the capital necessary for healthcare, even if they
were granted the autonomy to make the decisions themselves. Parents are necessary to ensure access to
healthcare is a possibility, through things like insurance family plans and financial capital to help pay for
the healthcare that is needed. Parents are integral to ensure adolescents can both make informed
decisions but to also pay for the resultant healthcare needs.
There will be instances in which adolescents make the wrong decision for themselves. This is when
you, as the negative, can discuss some of the horrific medical defects that could arise as a result of a
wrongly-made medical decision. One of those instances is the decision to be vaccinated. To an adolescent,
vaccines and receiving shots can be painful. If they decided to not take those vaccines, they could be
susceptible to diseases later in life, for which they would not have the proper immunizations for their
bodies to fight off the disease. This could mean either suffering or death for an individual, all because they
were granted autonomy in being able to make decisions about their vaccines. One specific example is the
chicken pox vaccine. After not catching it while they were little, adolescents are at the age where they can
take a vaccine to prevent chicken pox from ever occurring. Stubborn reaction to the vaccine could mean
an adolescent refuses the shot, and they catch chicken pox later in life. When you are older, the chicken
pox can have adverse effects on one’s health, which can even lead to death. This is only one example of
many instances in which an adolescent can make the wrong decision. Other times, a physician could
prescribe a medication for which the adolescent does not truly understand the side-effects. In some
circumstances, these side effects can be life altering, all because the adolescent did not recognize the
severity of the possible side-effects of a medication. Granting this age group autonomy is not in their best
interest.
The notion of making the wrong decision also speaks to daily healthcare necessities that become
overlooked when adolescents are in control of their healthcare autonomy. When teens have diabetes,
they may be less inclined to check their blood sugar or inject themselves with insulin due to the pain of
pricking your finger or other body part daily. Teens are not fully developed enough to understand the long
term effects of a disease like diabetes, deeming them incapable of making these sorts of medical
decisions for themselves.
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Definitions and Discussion
Adolescent
Psychology Today, “Adolescence describes the teenage years between 13 and 19 and can be
considered the transitional stage from childhood to adulthood. However, the physical and psychological
changes that occur in adolescence can start earlier, during the preteen or "tween" years (ages 9 through
12). Adolescence can be a time of both disorientation and discovery. The transitional period can bring up
issues of independence and self-identity; many adolescents and their peers face tough choices regarding
schoolwork, sexuality, drugs, alcohol, and their social life. Peer groups, romantic interests and external
appearance tend to naturally increase in importance for some time during a teen's journey toward
adulthood.”
Merriam-Webster, “One that is in the state of adolescence: the state or process of growing up; the
period of life from puberty to maturity terminating legally at the age of majority; a stage of development
(as of a language or culture) prior to maturity.”
World Health Organization, “WHO identifies adolescence as the period in human growth and
development that occurs after childhood and before adulthood, from ages 10 to19. It represents one of
the critical transitions in the life span and is characterized by a tremendous pace in growth and change
that is second only to that of infancy. Biological processes drive many aspects of this growth and
development, with the onset of puberty marking the passage from childhood to adolescence. The
biological determinants of adolescence are fairly universal; however, the duration and defining
characteristics of this period may vary across time, cultures, and socioeconomic situations. This period has
seen many changes over the past century namely the earlier onset of puberty, later age of marriage,
urbanization, global communication, and changing sexual attitudes and behaviors.”
Discussion: The definitions for adolescent range from very specific interpretations with ages and school
discussions to a state of being. The varying definitions here allow for either a legal approach with a clear
brightline for who is and is not an adolescent worthy or not worthy of autonomy in medical decisions.
Others discuss adolescence as a state of being, which could add a cultural facet to the debate, as various
cultures have their own interpretation on who is considered competent and worthy of autonomy in
important matters like health decisions.
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Right
The Universal Declaration on Human Rights, “All human
beings are born free and equal in
dignity and rights. They are endowed with reason and conscience and should act towards one another in a
spirit of brotherhood”
Merriam-Webster, “morally or socially correct or acceptable, agreeing with the facts or truth”
The Business Dictionary “(1) Justified, recognized, and protected (violation of which is unlawful)
claim on, or interest in, specific tangible or intangible property. (2) Freedom, immunity, power, or
privilege, due to one by agreement, birth, claim, guaranty, or by the application of legal, moral, or natural
principles.
Discussion: The definitions for “right” become more difficult. A “right” can be a legal guarantee or it could
be what is socially acceptable or morally justified. Utilizing the Universal Declaration on Human Rights is
useful for the affirmative to denote why autonomy is universally accepted across the international
community. A moral justification as a “right” can take into account other value-laden facets of the debate,
such as what are morals or what is just.
Autonomous
Stanford Encyclopedia of Philosophy, “Individual autonomy is an idea that is generally understood
to refer to the capacity to be one's own person, to live one's life according to reasons and motives that
are taken as one's own and not the product of manipulative or distorting external forces. It is a central
value in the Kantian tradition of moral philosophy but it is also given fundamental status in John Stuart
Mill's version of utilitarian liberalism”
The Free Dictionary, “possessing a large degree of self-government; of or relating to an autonomous
community; independent of others; acting or able to act in accordance with rules and principles of one's
own choosing; directed to duty rather than to some other end.”
National Commission for the Protection of Human Subjects of Biomedical and
Behavioral Research, “An individual capable of deliberation about personal goals and of acting under
the direction of such deliberation.”
Discussion: Autonomy is one of the more important facets of the debate, as the entire debate stems upon
whether this group of people should be able to make a decision on their own accord or not. The first and
more philosophical definition gives leeway in application in your case. Being able to be one’s own
personally, generally, is a way to gain access to self-actualization. Other definitions discuss goals, or
working within the “rules,” which would work well for the negative in deeming that laws are good as
written adolescents should not be making these decisions on their own.
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Medical Decisions
Houston Journal of Health Law and Policy, “Medical decision making for children and adolescents
reflects the broad and well-recognized issues that arise in any legal context involving children. Those
issues include: What should be the scope of parental authority over their children? What autonomy (if
any) should children have to make their own decisions? To what extent should the state (through its
legislators or judges) be permitted to interfere with parental decision making?”
Informed Medical Decision Making Foundation, “We believe the only way to ensure that high
quality health care decisions are being made is for a fully informed patient to participate in a shared
decision making process with their clinician. Shared decision making (SDM) is a collaborative process that
allows patients and their providers to make health care decisions together, taking into account the best
scientific evidence available, as well as the patient’s values and preferences.”
Journal of Health Care Law and Policy, “To understand the state of medical decision making with
respect to minors, it is helpful to first understand the status of medical decision making by adults. First,
state law, whether by statute or common law, generally requires informed consent from a competent
adult before a medical procedure may be performed.”
Discussion: The term medical decision is less of a term of art than the other definitions, and truly only is
discussed in terms of an ailment or condition and the course of action taken with ones’ healthcare
provider. The first definition is interesting in that it outlines some of the important questions surrounding
this debate and autonomy over medical decisions. For the negative, the third definition is rather useful as
it focuses on legality, current statutes, and common law, which can also be applied to cultural arguments
throughout the debate.
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Affirmative
Resolved: Adolescents ought to have the right to make autonomous medical decisions.
I define:
Adolescent:
Psychology Today, “Adolescence describes the teenage years between 13 and 19 and can be
considered the transitional stage from childhood to adulthood. However, the physical and psychological
changes that occur in adolescence can start earlier, during the preteen or "tween" years (ages 9 through
12). Adolescence can be a time of both disorientation and discovery. The transitional period can bring up
issues of independence and self-identity; many adolescents and their peers face tough choices regarding
schoolwork, sexuality, drugs, alcohol, and their social life. Peer groups, romantic interests and external
appearance tend to naturally increase in importance for some time during a teen's journey toward
adulthood.”
Right:
The Universal Declaration on Human Rights, “All human
beings are born free and equal in
dignity and rights. They are endowed with reason and conscience and should act towards one another in a
spirit of brotherhood”
Autonomous:
Stanford Encyclopedia of Philosophy, “Individual autonomy is an idea that is generally understood
to refer to the capacity to be one's own person, to live one's life according to reasons and motives that
are taken as one's own and not the product of manipulative or distorting external forces. It is a central
value in the Kantian tradition of moral philosophy but it is also given fundamental status in John Stuart
Mill's version of utilitarian liberalism”
Medical Decision:
Informed Medical Decision Making Foundation, “We believe the only way to ensure that high
quality health care decisions are being made is for a fully informed patient to participate in a shared
decision making process with their clinician. Shared decision making (SDM) is a collaborative process that
allows patients and their providers to make health care decisions together, taking into account the best
scientific evidence available, as well as the patient’s values and preferences.”
Value: Autonomy
Kathryn Hickey, BA, RN, 2007, Minors’ Rights in Medical Decision Making, p. 101
Informed consent presumes respect for patient autonomy and the provision of full and accurate
information to a patient to enhance decision making. These mandates apply to both the acceptance and
the refusal of treatment. Informed consent must include the following: an understandable explanation of
the condition, the recommended treatment, the risks and benefits of the proposed treatment, and any
alternatives; an assessment of the person’s understanding of the information provided; an assessment of
the competence of the minor or surrogate to make medical decisions; and assurance that the patient or
surrogate has the ability to choose freely between alternatives without coercion. Minors can and should
participate in medical decision making commensurate with their developmental level and ability.
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Criterion: Making one’s own medical decisions
Kimberly M. Mutcherson, Associate Professor at Rutgers School of Law-Camden, Spring 2006, Minor
Discrepancies: Forging a Common Understanding of Adolescent Competence in Healthcare DecisionMaking and Criminal Responsibility, p. 929-930
Defining competence is a difficult task in part because the concept does not lend itself to simple
definitions. It has been described as "the ability to 'perform a task,' entailing the capacity to understand
information, deliberate, and decide."
Contention 1: Adolescents can make informed decisions, which is good for their
autonomy.
Teens have had the chance to witness hard life events, which have allowed them the mental capacity to
make informed decisions.
Assuming teens cannot make informed decisions destroys their humanity and the
efforts to make them informed citizens.
Baruch Fischhoff, Department of Social and Decision Sciences at Carnegie Mellon University, January
2008, Assessing Adolescent Decision-Making Competence, p. 25-26
Interventions also reveal little, unless performed to professional standards. That means keeping those
critical facts from being buried in irrelevant information, including critical facts that recipients already
know. That means taking advantage of research into how people process such information and
conducting rigorous pretests. Unless information interventions are tested fairly, their recipients may be
blamed unfairly—for ignoring messages that deserved to be ignored, because their content was
irrelevant, cluttered, incomprehensible, etc. Unfairly criticizing teens’ competence can unfairly
undermine their social standing. For example, a pundit recently chose to spin adolescent research as
proving ‘‘We’re perceivers first, not deciders’’ (Brooks, 2007). Any sweeping generalization diminishes
the humanity of the individuals being depicted so formulaically. This particular generalization
undermines any attempt to inform teens (e.g., sex education, over-the-counter labels on Plan B, driver
education). Its acceptance would decrease the risk of holding teens responsible for decisions that they
lack the competence to make, while increasing the risk of denying them choices that they could handle,
were they properly informed. If one succumbed to the temptation to make sweeping generalizations,
but based them on detailed examination of specific decisions, one might conclude that teens do
surprisingly well, given the difficulty of the decisions facing them (e.g., intimacy, friendship, drugs,
careers, identity, money, appearance). These decisions often pose hard tradeoffs, have unpredictable
effects, require mastery of unfamiliar facts, and lack trustworthy infor- mation sources. The number of
poor decisions that teens make reflects not just their abil- ities, but also the number and nature of their
challenges. Excellent third basemen still make a lot of errors, at the ‘‘hot corner,’’ relative to other field
positions. Behavioral decision research’s normative, descriptive, and prescriptive research provide an
integrated structure for accomplishing tasks addressed by anyone concerned about teens: identifying
the critical issues in teens’ choices, assessing their current understanding, and helping them do better.
It takes advantage of research into cognitive decision-making processes, while clarifying their interface
with affective and social processes. It encourages the nuanced assessment of competence that teens
deserve.
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Adolescents are capable of effective cost-benefit analysis.
Priscilla Alderson, Westminster Children's Hospital in London, 1992, In the Genes or In the Stars?
Children's Competence to Consent, p. 121
Children's cognitive development is not as inexorably slow as Piaget believed, nor does their thinking fit
the abstracted list quoted earlier. Risk and benefit concern actual or potential experiences, and are
understood through the imagination, a potent skill in children, but one not mentioned in the list.
Children's well developed sense of morality and justice is shown, for instance, in their response to Blue
Peterappeals and their interest in ecology. Many children adopt lasting moral values, and little is known
about how rare or common are precocious examples, such as Dante's life-long passion which began
when he was nine. Apart from underestimating children's abilities, Piagetian psychology and the bioethics
based on it take the individual as the unit of analysis; competence is then seen as a mechanical skill or
quality, isolated from the social context. Yet competence is understood by seeing the child's inner, partly
genetic abilities in relation to external influences, as considered in the next section.
Contention 2: Parental infringement on autonomy is dangerous for adolescents.
Adolescents are less likely to obtain care if parental consent is necessary
Paul Arshagouni, Associate Professor of Law & Director of the Health Law Program at Michigan State
University, 2006, "But I'm an Adult Now … Sort of" Adolescent Consent in Health Care Decision-Making
and the Adolescent Brain, p. 328
Adults have the option to treat and rectify the consequences of risky behaviors in which they may have
been willing participants. Such options are not as easily available to adolescents who engage in such
risky behaviors. Research has shown that the same media campaigns to encourage responsible
behavior and medical treatment among adults do not often work as effectively for adolescents. We
need a more uniform and effective health care policy toward adolescent consent to medical treatment.
The health risk behaviors of adolescents, which create adverse effects in later life, demonstrate the
need to provide medical information and access to health care for them. The numerous studies that we
have seen all indicate that teens are less likely to seek health care if they are required to obtain
parental consent before they are allowed access to medical treatment or care.
Parents often times breach their obligations toward their children during medical
decisions, invading their privacy.
American Academy of Pediatrics Committee on Bioethics, February 1995, "Informed
Consent, Parental Permission, and assent in pediatric practice." Pediatrics, Volume 95, pp. 314317, http://www.cirp.org/library/ethics/AAP/ (accessed 7/28/14)
Usually, parental permission articulates what most agree represents the ``best interests of the child.''
However, the Academy acknowledges that this standard of decision-making does not always prove easy
to define. In a pluralistic society, one can find many religious, social, cultural, and philosophic positions
on what constitutes acceptable child rearing and child welfare. The law generally provides parents with
wide discretionary authority in raising their children. Nonetheless, the need for child abuse and neglect
laws and procedures makes it clear that parents sometimes breach their obligations toward their
children. Providers of care and services to children have to carefully justify the invasion of privacy and
psychologic disruption that come with taking legal steps to override parental prerogatives.
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Affirmative Extension Evidence
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Page 14
Healthcare Organizations Recognize Adolescent
Rights
Historically, the American Academy of Physicians and other organizations recognize the
right to confidentiality in healthcare.
Elizabeth M. Alderman, Department of Pediatrics at the Albert Einstein College of Medicine, Jessica
Rieder, Department of Pediatrics at the Albert Einstein College of Medicine, and Michael I. Cohen,
Department of Pediatrics at the Albert Einstein College of Medicine, 2003, The History of Adolescent
Medicine, p. 144-145
Since the earliest days of English law, adolescent parents were considered to be emancipated, free to
consent to their own care and the care of their children. In addition, by the end of the 1960s, all 50 states
had public health law provisions allowing adolescents to receive care for the evaluation or treatment of
STIs without parental knowledge or consent . This heralded the movement to establish free clinics in large
urban centers to treat STIs as well as an initiative to develop hospital-based clinics for the same purpose.
Within a decade, such provisions were extended to the treatment of alcohol and substance abuse. In
1989 several national medical organizations, including the American Academy of Pediatrics, the
American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists,
issued a joint statement advancing the right to “Confidentiality in Adolescent Health Care”. That
statement, although recognizing that in many circumstances the involvement of parents in adolescent
medical decision making was to be encouraged as valuable, concluded that health professionals had an
ethical obligation to provide the best possible care and counseling to their adolescent patients and that
“Ultimately, the health risks to the adolescent are so impelling that legal barriers and deference to
parental involve- ment should not stand in the way of needed care."
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Page 15
Adolescents Find Difficult in Obtaining their Right
to Autonomy
Adolescents internationally find it difficult to attain autonomy in their healthcare
decisions.
Elizabeth M. Alderman, Department of Pediatrics at the Albert Einstein College of Medicine, Jessica
Rieder, Department of Pediatrics at the Albert Einstein College of Medicine, and Michael I. Cohen,
Department of Pediatrics at the Albert Einstein College of Medicine, 2003, The History of Adolescent
Medicine, p. 146
The challenges of further developing the field of adolescent medicine at an international level are many.
Numerous countries have restricted health budgets and so have few economic resources to fund
adolescent-specific services. Currently, these nations do have maternal-child health aid programs, and
the hope is that some of these programs will extend their services to engage the adolescent patient.
Second, many nations have cultural and religious norms that do not recognize adolescence as a distinct
group with unique health- care needs. This is often a serious barrier to establishing special services for
the adolescent, who is perceived, in such settings, as either an older child or a young adult. Finally,
there are significant areas of the world where the established medical systems do not recognize
adolescent medicine as a discipline distinct from pediatrics, internal medicine, obstetrics and gynecology,
or family practice.
Disallowing an adolescent's ability to make decisions about end of life care in
extenuating circumstances disallows them autonomy that is necessary in such a
sensitive circumstance.
Melinda T. Derish, Berkeley Law, and Kathleen Vanden Heuvel, Berkeley Law, 2000, Mature Minors
Should Have the Right to Refuse Life-Sustaining Medical Treatment, p. 117
State's interest in protecting human life Legal commentators have argued that in giving minors the
autonomy to refuse medical treatment the State disregards its own interest in the preservation of life
and its parens patriae duty to protect minors. These commentators, how- ever, fail to address the
essential difference between LSMT and life saving treatment. This is not a mere semantic difference. It is
the difference between potentially painful treatment that nonetheless has a reasonable chance of
saving a life, and treatment which, at best, forestalls the moment of death, and at worst inflicts the sort
of misery described in our prologue. Without an honest discussion of this crucial difference, it is
pointless to discuss whether the State's interest in protecting the minor's life trumps the mature
minor's right to medical autonomy. A mature minor's refusal of LSMT cannot accurately be considered a
fatal error from which she must be protected. Rather, it must be recognized and supported as her
personal choice about how much suffering she wants to endure at the end of her life.' To deny a mature
minor autonomy to make LSMT decisions amounts to giving someone else the power to decide how she
will die.
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Page 16
Competence is Socially Constructed
Social context dictates that competence should be called into question when
considering personal attributes.
Priscilla Alderson, Westminster Children's Hospital in London, 1992, In the Genes or In the Stars?
Children's Competence to Consent, p. 120
Competence is usually called into question during conflict between the child and adults, when stress,
anxiety or anger can easily complicate assessments of the child's ability. Defining competence in terms
of personal attributes risks ignoring the social context, and may imply that ability unfolds at its own
internal rate, hardly affected by external factors. This approach is strongly influenced by Piaget's
theories that children develop through cognitive stages and cannot grasp certain concepts until they
reach the correct stage. One of many examples of Piaget's influence on bioethics is the following
quotation from bioethicists in 1989 quoting psychologists from 1978 who share Piaget's theories initiated
in the 1920s. 'Role-taking skills are also thought to be necessary to enable a child to consider as
potentially valid both a position presented to him or her by the physician and his own or her own,
different position, so that the alternatives can be weighed against each other. These skills are undergoing
substantial development in the eight to eleven age period, and are often quite well developed by twelve
to fourteen'.
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Fear of Parental Reprimand Clouds Adolescent
Judgment (1/2)
Adolescents fear reprimand for their medical problems and forego care as a result,
which denotes the need for privacy with medical treatment.
Paul Arshagouni, Associate Professor of Law & Director of the Health Law Program at Michigan State
University, 2006, "But I'm an Adult Now … Sort of" Adolescent Consent in Health Care Decision-Making
and the Adolescent Brain, p. 323
Of those who reported that they did not seek needed health care, 11.5% said that the reason they did
not seek care was that they did not want their parents to know. Another 11.7% indicated that there
was no adult available to take them to a health care provider. Fifteen-and-a-half percent were afraid of
what the physician would say or do. The concern of teenagers regarding privacy and not wanting their
parents to know brings up significant questions about the need for adolescent consent and privacy in
medical treatment. Adults expect privacy in medical treatment as a universal right. Adolescents, who
must obtain parental consent before even the most innocuous health care visit, are not afforded this
same right. We could ask what health care services competent adults might forego if their employers,
spouses, or family members were notified of their medical procedures and consultations. When should
adolescents, navigating the path to full autonomy, also have the same rights of confidentiality?
Fear of parental reprimand clouds decision making; adolescents need autonomy in
reproductive health decisions.
J. Shoshanna Ehrlich, associate professor of legal studies at the College of Public and Community Service,
University of Massachusetts Boston, Spring 2003, Choosing Abortion: Teens Who Make the Decision
Without Parental Involvement, p. 15
All of the minors had multiple reasons for why they did not tell their parents about their pregnancy and
abortion plans. Clustered thematically, the most important reasons included: an anticipated severe,
adverse parental reaction or anger; anticipated harm to the relationship; concern for a parent's wellbeing; anticipated pa- rental pressure to have the baby; and a problematic family relationship.
Significantly, all of the minors distinguished between their parents when discussing reasons for
nondisclosure. Clearly identifying each parent as a distinct person and each relation- ship as having its
own dynamic, they grounded their decision in this awareness. Also, worth noting is the fact that these
minors consistently reported that they had had almost no communication with their parents about sex.
Many of the parents had not even spoken with their daughters about the facts of life, and, with one
exception, none had spoken with their daughter in a serious way about birth control or her own sexuality.
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Fear of Parental Reprimand Clouds Adolescent
Judgment (2/2)
Alleviating fear of parental judgment could encourage adolescents to seek medical care
for ailments that would otherwise be ignored.
Paul Arshagouni, Associate Professor of Law & Director of the Health Law Program at Michigan State
University, 2006, "But I'm an Adult Now … Sort of" Adolescent Consent in Health Care Decision-Making
and the Adolescent Brain, p. 324
When adolescents believe they can seek medical advice without the fear of their parents' knowledge,
they may actually seek advice and treatment for their condition. As with most diseases, early detection
and prevention help to prevent major complications in the future. This is a health care policy that has
been strongly advocated for years. If we wish to foster such responsible behavior in our youth, in order
that they may continue toward sound health practices, then we need to nurture such attitudes at an
early age. Another 2002 study published in JAMA reported a survey of Planned Parenthood clinics
throughout Wisconsin, which polled 950 females under the age of eighteen. It found that 59% (nearly six
in ten) of respondents would stop using health care services, including delaying testing or treatment for
HIV or STDs, if parental consent were required.
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Parental Notification Bad for Teens (1/2)
Parental consent for medical choices denies adolescents informed choice.
Priscilla Alderson, Westminster Children's Hospital in London, 1992, In the Genes or In the Stars?
Children's Competence to Consent, p. 123
The quite recent Western custom of excluding all children from the work-force and putting them into
school offers them benefits and disadvantages. For street-wise Victorian children, 'whatever the
compensation, the school put these children into the servitude of a repressive innocence and
ignorance'. We have inherited a Victorian tendency to confuse ignorance with innocence although, as
Blake's pre-Victorian reflections on childhood illustrate, the two qualities are very different. This
confusion leads many adults to want to protect children from harsh realities, such as knowledge of their
serious illness. Yet children are frequently aware of the truth and may have joined a collusion of silence
to try to protect their parents. Avoiding discussion can be convenient for adults but less so for children
if it denies them informed choice.
Prioritizing parental rights is harmful to adolescents' well-being.
Cynthia Dailard, Guttmacher Institute, and Chinué Turner Richardson, Guttmacher Institute,
November 2005, Teenagers’ Access to Confidential Reproductive Health Services, p. 8
Proponents of laws and policies designed to require parents to be involved in their adolescent’s
decisions to seek reproductive health care argue that in addition to restoring “parental rights,” such
requirements will further parent-child communication while dissuading minors from engaging in sexual
activity; however, research spanning almost three decades fails to confirm these claims. There is no
research that supports the notion that mandatory parental involvement requirements for either
contraceptive services or abortion improve parent-child communication or facilitate conversations about
sex, birth control or related matters. To the contrary, the research suggests that these policies are
potentially harmful to teenagers’ health and well-being, and highlights the importance of
confidentiality to teenagers’ willingness to seek care.
Forcing parental consent in some abortion cases risks abuse and violence for the
adolescent.
Cynthia Dailard, Guttmacher Institute, and Chinué Turner Richardson, Guttmacher Institute,
November 2005, Teenagers’ Access to Confidential Reproductive Health Services, p. 9
In addition, forcing teenagers to inform their parents that they are pregnant or seeking an abortion may
place some at risk of physical violence or abuse. The 1992 FPP study found that approximately one-third
of teenagers who did not tell their parents about their decision to seek an abortion had experienced
violence in their family, or feared that violence would occur or that they would be forced to leave
home. Among minors whose parents found out about their pregnancy from other sources, 6% reported
physical violence, being forced to leave home or damage to their parents’ health.
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Parental Notification Bad for Teens (2/2)
Parental authority disallows adolescents to make end-of-life decisions.
Melinda T. Derish, Berkeley Law, and Kathleen Vanden Heuvel, Berkeley Law, 2000, Mature Minors
Should Have the Right to Refuse Life-Sustaining Medical Treatment, p. 112
The result of this strong protection of parental authority is that although minors are protected from
invasion of their bodily integrity by the same doctrine of informed consent as adults, they have no legal
way to exercise this protection independently. Even if a minor were to be fully informed of her
condition and were to understand the consequences and give her refusal of, or consent to medical
treatment such as LSMT, that refusal or consent would not be valid as a matter of law. Although
parental autonomy to make medical decisions for their children is not unlimited, neither of the two most
commonly invoked exceptions to the presumption of a minor's legal incompetence and to the
requirement of parental consent involve an examination of a minor's own capacity to make medical
decisions. In an emergency, a physician may proceed with treatment without the parents' consent,
because their consent is implied." In the "medical neglect" exception, the State intervenes under its
power as parens patriae and its strong interest in preserving life when a minor's parents refuse life saving
medical treatment
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Page 21
Without Autonomy, Adolescents’ Reproductive
Health is at Stake(1/2)
Because adolescents do not have autonomy in their medical decisions, many have not
received necessary contraceptives as a result of the physician's ability to deny care
without parental consent.
Farr A. Curlin, M.D. University of Chicago Department of Medicine, Ryan E. Lawrence, M.D. Pritzker
School of Medicine University of Chicago, Marshall H. Chin, M.D., University of Chicago Department of
Medicine, and John D. Lantos, M.D., University of Chicago Department of Pediatrics, February 8,
2007, Religion, Conscience, and Controversial Clinical Practices, p. 4
Physicians who objected to abortion for failed contraception and prescription of birth control for
adolescents without parental consent were more likely than those who did not oppose these practices
to report that doctors may describe their objections to patients (P<0.001 for both comparisons); the
association for the objection to terminal sedation was not significant (P = 0.11) (Table 4). Physicians who
objected to the three controversial medical practices were less likely to report that doctors must
present all options and refer patients to other providers (P<0.001 for all comparisons). The associations
for religious characteristics and objections to controversial clinical practices persisted after controlling for
age, sex, ethnic group, region, and specialty.
Parental notification has no impact on reducing adolescent participation in risky
behaviors, and notification can increase these behaviors.
Paul Arshagouni, Associate Professor of Law & Director of the Health Law Program at Michigan State
University, 2006, "But I'm an Adult Now … Sort of" Adolescent Consent in Health Care Decision-Making
and the Adolescent Brain, p. 325
The 2005 YRBSS results also revealed that 46.8% or roughly 7.8 million high school students have had
sexual intercourse. Of those who were sexually active, only 62.8% reported using a condom in their last
sexual encounter. The low rate of condom use is surprising considering that no state laws require
parental notification in order for a minor to purchase nonprescription contraceptives. State laws do not
generally prohibit physicians from writing prescriptive contraception for a minor. A few states also give
an age, usually sixteen, at which a minor can request contraceptives, but do not punish the doctor for
treating patients who are even younger than this specified age. However, many states permit a physician
to breach confidentiality and inform the parent when writing a contraceptive prescription for a minor.
Such breaches of a youth's privacy would undoubtedly deter an adolescent from seeking a
contraceptive prescription from a physician.
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Page 22
Without Autonomy, Adolescents’ Reproductive
Health is at Stake (2/2)
Parental consent in reproductive health harms adolescents.
Cynthia Dailard, Guttmacher Institute, and Chinué Turner Richardson, Guttmacher Institute,
November 2005, Teenagers’ Access to Confidential Reproductive Health Services, p. 9
In addition, research suggests that laws that require teenagers to involve their parents in their decisions
to obtain birth control are likely to have harmful consequences. According to the 2005 JAMA study, only
1% of minor adolescents visiting family planning clinics indicated that their reaction to mandated
parental involvement would be to stop having sex, while as many as two in 10 said they would practice
unsafe sex (by forgoing contraception entirely or relying on withdrawal). Significantly, seven in 10 of
those whose parents did not know they were at the clinic said they would not use the clinic for
prescription contraception. Furthermore, there is evidence that parental consent requirements for birth
control alone would deter teenagers from seeking care for other important reproductive health services
at family planning clinics, such as testing and treatment for STDs. A 2004 study published in the Archives
of Pediatric Medicine estimated that recent changes to Texas law requiring parental con- sent for statefunded prescription contraceptives and increased reporting of statutory rape would significantly increase
the number of teenage pregnancies and untreated STDs, costing the state and federal governments
approximately $44 million per year.
Parental consent harms adolescent choice and available options when concerning
abortion, increasing their risk for adverse health concerns.
Cynthia Dailard, Guttmacher Institute, and Chinué Turner Richardson, Guttmacher Institute,
November 2005, Teenagers’ Access to Confidential Reproductive Health Services, p. 9
As with contraception, research shows that more than six in 10 teenagers in states without a parental
consent requirement say one or both parents knew about the abortion, according to a study published
in 1992 in Family Planning Perspectives (FPP). A similar study published in 1987 in AJPH found that the
proportion of teens who inform their parents is approximately the same in states with and without
such requirements. Moreover, there is no evidence to suggest that laws mandating parental
involvement in a teenager’s decision to obtain an abortion improve family communication or
relationships In contrast, research suggests that parental consent requirements can have potentially
serious adverse consequences associated with delayed access to timely medical care among those
teenagers who do not wish to involve their parents in their abortion decisions. Teenagers typically
detect their pregnancies later than do adults, and legal obstacles that create further impediments to
timely care are likely to result in later abortions, which are significantly more dangerous to a woman’s
health and more expensive to obtain.
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Parental Decision-Making Bad
Parents do not always make the right decision for their child.
Melinda T. Derish, Berkeley Law, and Kathleen Vanden Heuvel, Berkeley Law, 2000, Mature Minors
Should Have the Right to Refuse Life-Sustaining Medical Treatment, p. 117
It is tempting to assume that as long as physicians give parents adequate information that parents will
always make the best decisions about their children's medical care. There are several reasons, however,
why parents may not necessarily make the best choices. For instance, as Lisa Hawkins has pointed out,
"parents' judgment concerning life-sustaining treatment may be clouded by religious views not shared
by the minor ... by their own needs (or those of other family members).. . and (most directly) by their
own grief and sense of powerlessness."' As Rosato has said, "[t]e strength of the minor's right to selfdetermination is truly tested" in the situation where the minor refuses treatment, but the parents
consent." If a mature minor does not wish to undergo LSMT then it is her own judgment about how she
wants to die that ultimately must be hon- ored by the physician.
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Teens Legally Recognized as Competent
Teens have been legally recognized to make coherent decisions by the US Supreme
Court.
Kimberly M. Mutcherson, Associate Professor at Rutgers School of Law-Camden, Spring 2006, Minor
Discrepancies: Forging a Common Understanding of Adolescent Competence in Healthcare DecisionMaking and Criminal Responsibility, p. 939
In Bellotti v. Baird, in which the Court adjudicated the Constitutionality of a parental consent for
abortion statute, the Justices faced a named plaintiff rep- resenting the "class of unmarried minors in
Massachusetts who have adequate capacity to give a valid and informed consent [to abortion], and
who do not wish to involve their parents." That the courts allowed this young woman to proceed as a
representative of young people with sufficient maturity and skills to make abortion decisions indicates
some appreciation for the fact that there are minors who are capable of informed and mature decisionmaking.
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Negative
Resolved: Adolescents ought to have the right to make autonomous medical decisions.
I define:
Adolescent:
Merriam-Webster, “One that is in the state of adolescence: the state or process of growing up; the
period of life from puberty to maturity terminating legally at the age of majority; a stage of development
(as of a language or culture) prior to maturity.”
Right:
The Business Dictionary “(1) Justified, recognized, and protected (violation of which is unlawful)
claim on, or interest in, specific tangible or intangible property. (2) Freedom, immunity, power, or
privilege, due to one by agreement, birth, claim, guaranty, or by the application of legal, moral, or natural
principles.
Autonomous:
National Commission for the Protection of Human Subjects of Biomedical and
Behavioral Research, “An individual capable of deliberation about personal goals and of acting under
the direction of such deliberation.”
Medical Decision:
Journal of Health Care Law and Policy, “To understand the state of medical decision making with
respect to minors, it is helpful to first understand the status of medical decision making by adults. First,
state law, whether by statute or common law, generally requires informed consent from a competent
adult before a medical procedure may be performed.”
Value: Legal governance and health
Rhonda Gay Hartman, American Journal of Law and Medicine, January 1, 2002, Coming of Age: Devising
Legislation for Adolescent Medical Decision-Making, p. 2
The underlying tenet of law governing adolescents-that they lack the skills required for capable
decision-making-seems well-settled. It is an artifact from an industrial society that spawned legislation
authorizing governmental regulation of adolescents for education and labor in order to protect and
promote their health and well-being. Known as parens patriae, this philosophy for legislation governing
minors has been invoked by courts as a basis for upholding statutes that require parental involvement
in reproductive decision-making and that permit involuntary commitment of adolescents to mental
health institutions by parental consent coupled with psychiatric evaluation.
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Criterion: Parental guidance in adolescent decision making.
Douglas S. Diekema, M.D. University of Washington School of Medicine Adjunct Faculty in Bioethics and
Humanities, 2014, "Parental Decision Making," Ethics in Medicine,
https://depts.washington.edu/bioethx/topics/parent.html (accessed 8/4/2014)
Parents have the responsibility and authority to make medical decisions on behalf of their children. This
includes the right to refuse or discontinue treatments, even those that may be life-sustaining. However,
parental decision-making should be guided by the best interests of the child. Decisions that are clearly
not in a child's best interest can and should be challenged.
Contention 1: Parental guidance in medical decision making is good for adolescents’
well-being according to the law.
In the eyes of the Supreme Court, parents make good decisions for the betterment of
their child.
Martin Guggenheim, Professor of Clinical Law and Director of Clinical and Advocacy Programs at New
York University School of Law, January 1, 2002, Minor Rights: The Adolescent Abortion Cases, p. 640
In Parham, however, the child was considered a "voluntary patient" because the child's commitment was
based on the parent's consent."° Placing one's child in a psychiatric hospital over the child's objection is
an extraordinary exercise of parental power, effecting a "massive curtailment of liberty." Moreover, the
exercise of this power directly implicated a constitutional right of children which the Supreme Court
already had held children possess- the right to avoid loss of physical liberty. Nonetheless, the Supreme
Court upheld parental power in Parham, reasoning that because parents usually make good child
rearing choices, their right to raise their children should not be interfered with lightly.53 The Court also
reasoned that because the parental decision was subject to review by the attending physician, doctors
were able to protect children from wrongful institutionalization
Parental guidance is good for an adolescent's well-being when making decisions about
abortion
Rhonda Gay Hartman, American Journal of Law and Medicine, January 1, 2002, Coming of Age:
Devising Legislation for Adolescent Medical Decision-Making, p. 13
Adolescents require guidance for fostering responsible decision-making. Studies with adolescents and
physicians have suggested that adult involvement in adolescent decision-making is valued and
beneficial. However, a crucial point for policy consideration is the scope of adult guidance and whether
the adolescent or the state should decide who provides the guidance. Statutes requiring parent
notification or consent for an adolescent's abortion, which the U.S. Supreme Court has upheld under
the federal Constitution, are a paradigmatic example. While adult involvement could provide an
adolescent with emotional sustenance and support in making this difficult decision, a policy point that
should be considered is whether the state should dictate through notification and consent requirements
that a parent provide the guidance, or whether the adolescent is capable to choose for herself the adult
with whom she would be most comfortable in seeking guidance.
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Contention 2: Adolescents lack the maturity level, according to legal standards,
necessary to make informed medical decisions.
Biology dictates that teens have not only lacked the time necessary for their brains to develop but also to
allow them to be fully mature to understand and comprehend the medical decision they are about to
make.
Adolescents lack the knowledge and the maturity level to determine and understand
the long term implications of a medical decision.
Paul Arshagouni, Associate Professor of Law & Director of the Health Law Program at Michigan State
University, 2006, "But I'm an Adult Now … Sort of" Adolescent Consent in Health Care Decision-Making
and the Adolescent Brain, p. 322
Adults often understand the potential long-term consequences resulting from the lack of necessary
medical treatment based on their own knowledge and experience. However, teenagers generally do
not possess such knowledge and may lack the ability to make long-term projections about their health.
As such, adequate foresight may not be as prevalent. In fact, the single biggest reason that adolescents
give for avoiding necessary health care treatment was the belief that the problem would go away.
According to Carol Ford, an overwhelming 63.3% stated this as their primary reason for avoiding
treatment. This belief well eclipsed the next closest reason, fear of what the physician would say or do, by
almost 50%. Several factors contributed to the likelihood of adolescents' deciding to forego health care.
The overall average rate of self-reported forgone health care was 18.7%.
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Roper vs. Simmons proves that adolescents cannot make decisions worthy of such
consequences like the death penalty, deeming them unable to make coherent decisions
concerning their health.
Maureen Carroll, Articles Editor UCLA Law Review, J.D., 2009, Transgender Youth, Adolescent Decision
Making, and Roper V. Simmons, 729-731
In Roper v. Simmons,20 the U.S. Supreme Court held that the juvenile death penalty violated the Eighth
Amendment’s ban on cruel and unusual punishment. Surveying the laws of the fifty states, the Court
found that a national consensus had developed in opposition to imposing the death penalty for crimes
committed by offenders younger than eighteen years old. The Court reaffirmed its prior holding that
“[c]apital punishment must be limited to those offenders . . . whose extreme culpability makes them
‘the most deserving of execution.’” The Court then determined that few if any juveniles could be
classified among the most culpable offenders, and that nothing short of a categorical rule would protect
insufficiently culpable youth against inappropriate imposition of the death penalty. The Court found
“confirmation” for its decision in international law, noting that the United States was “the only country in
the world that continue[d] to give official sanction to the juvenile death penalty.” The Court’s assessment
of juvenile culpability rested on its view of adolescent maturity. The Court identified three general
characteristics of adolescence that weighed against classifying juveniles among the most culpable
offenders. First, adolescents more often exhibit “a lack of maturity and an underdeveloped sense of
responsibility” than adults, which results in “impetuous and ill-considered actions and decisions.”
Second, youth are “more vulnerable or susceptible to negative influences and outside pressures,
including peer pressure,” in part because of their limited “control . . . over their own environment.”
Third, “the character of a juvenile is not as well formed as that of an adult.” The Court rejected the
argument that these adolescent characteristics could be evaluated as mitigating factors on a case-by-case
basis, determining that nothing short of a categorical rule would adequately protect less-culpable youth
from the unjust imposition of capital punishment. The Court reasoned that “[a]n unacceptable likelihood
exists that the brutality or cold-blooded nature of any particular crime would overpower mitigating
arguments based on youth as a matter and lack of true depravity should require a sentence less severe
than death.”
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Negative Extension Evidence
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Not All Adolescents Make Informed Decisions
Adolescents are raised differently, which alters their maturity level; allowing all
adolescents to make medical decisions would be irresponsible.
Priscilla Alderson, Westminster Children's Hospital in London, 1992, In the Genes or In the Stars?
Children's Competence to Consent, p. 122
Younger children depend on their parents to interpret and explain medical details. A psychologist we
interviewed thought that a three-year-old understood the purpose and nature of his liver biopsy as well
as some adults would, because his mother, a nurse, explained it so carefully. A boy with muscular
dystrophy learns much about his future from his older brother and friends who have the same disease.
Each family's way of discussing or secreting information, and sharing or fighting over decisions, will also
affect their response to medical decisions. Parents affect the child's maturity when they reward or
punish growing independence. Ann Solberg's research with hundreds of Norwegian twelve-year-olds
shows that children whose parents expect them to be responsible respond well, and are entrusted with
more and more adult responsibilities. Yet children whose parents perceive them as immature remain so,
their resistance being perceived as foolish or rebellious.
Science cannot prove that adolescents are not mature.
Laurence Steinberg, Temple University, Elizabeth Cauffman, University of California, Irvine Jennifer
Woolard, Georgetown University, Sandra Graham, University of California Los Angeles, and Marie
Banich, University of Colorado, October 2009, Are Adolescents Less Mature Than Adults? Minors’
Access to Abortion, the Juvenile Death Penalty, and the Alleged APA “Flip-Flop,” p. 592
Developmental psychologists with expertise in adolescence are frequently called on to provide
guidance about the appropriate treatment of young people under the law and about the proper
placement of legal age boundaries be- tween those who should be treated as adults and those who
should not. The results of the present study suggest that it is not prudent to make sweeping statements
about the relative maturity of adolescents and adults, because the answer to the question of whether
adolescents are as mature as adults depends on the aspects of maturity under consideration. By age 16,
adolescents’ general cognitive abilities are essentially indistinguishable from those of adults, but
adolescents’ psychosocial functioning, even at the age of 18, is significantly less mature than that of
individuals in their mid-20s. In this regard, it is neither inconsistent nor disingenuous for scientists to
argue that studies of psycho- logical development indicate that the boundary between adolescence and
adulthood should be drawn at a particular chronological age for one policy purpose and at a different
one for another.
Minors are incapable of giving informed consent.
Jonathan F. Will, M.A. University of Pittsburgh, 2001, My God My Choice: The Mature Minor Doctrine
and Adolescent Refusal of Life-Saving or Sustaining Medical Treatment Based Upon Religious Beliefs, p. 78
In the medical setting there is a clear divide between the medical decision-making capabilities of adults
and minors. At the very core of this divide is the presumption that adults are competent to make these
decisions while minors are not. Minors are “assumed to lack sufficient cognitive and conative maturity
to craft autonomous health care choices, therefore being deemed legally incapable of giving genuine
informed consent to medical treatment.” The United States Supreme Court has held that “most
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children, even in adolescence, simply are not able to make sound judgments concerning many
decisions, including their need for medical care or treatment.
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Adolescents Avoid Health Decisions
Adolescents avoid healthcare when engaging in risky behaviors, deeming them unable
to make coherent medical decisions.
Paul Arshagouni, Associate Professor of Law & Director of the Health Law Program at Michigan State
University, 2006, "But I'm an Adult Now … Sort of" Adolescent Consent in Health Care Decision-Making
and the Adolescent Brain, p. 322
Interestingly, of the adolescents surveyed, those who practiced risky behaviors (such as smoking,
drinking, and sexual activity) had forgone health care services at a rate higher than the average.
Adolescents who were frequent smokers made up 21.6% of all respondents and had a 26% rate of
forgoing health care. Frequent alcohol users constituting 5.7% of respondents had forgone health care
rates of over 30%. Adolescent who were sexually active made up 38.3% of respondents and had
medical care avoidance rates of 25.1%. Statistically speaking, those who displayed two or more of these
health risk behaviors were more prone to health complications, and were even more likely to forego
health care. The study also measured the rates of forgone health care in youths who had symptoms of
physical or mental health problems. Adolescents who reported that they had frequent physical symptoms
constituted 12.7% of respondents and had rates of 32.4% in forgone health care. Frequent criers made
up 1.8% of adolescent respondents and had health care avoidance rates of 38.5%. Adolescents with
symptoms of dysuria (painful or frequent urination) occurred in 1.4% of respondents and had health care
avoidance rates of 38.2%. Notably, the burning sensation upon urination may be caused by a sexually
transmitted disease or bacterial urinary tract infection that affects the bladder. Both causes can lead to
greater health complications with delayed treatment. The concerning results of this research data
indicate that adolescents with high health risk activities and/or health care problems and who have an
even greater need for medical treatment show the highest rates of forgone health care.
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Adolescents are Immature and too Emotional (1/3)
Teens use emotion rather than logic to make decisions, Harvard studies proves.
Paul Arshagouni, Associate Professor of Law & Director of the Health Law Program at Michigan State
University, 2006, "But I'm an Adult Now … Sort of" Adolescent Consent in Health Care Decision-Making
and the Adolescent Brain, p. 350
A study on adolescent brains by the team of Deborah Yurgelun-Todd at Harvard's McLean Hospital has
also revealed the role of the amygdale, contained within the medial temporal lobe of the brain, in
emotional processing in teens. The research team utilized functional MRI (fMRI) to uncover differences in
teenage versus adult identification of emotions. The subjects were shown images of facial expressions
and asked to identify the emotion displayed, during which their brain activities were scanned. The adult
subjects were able to identify correctly the emotion of fear nearly every time, but only half the teens
correctly identified the emotion. Instead, the teens typically responded by saying they saw shock,
confusion, or sadness. The surprising results of the study showed that the teens that performed poorly
on this task had activated the amygdala, a brain region responsible for fear and other "gut" reactions,
rather than the frontal lobe. Conversely, adults used their frontal lobe, the reasoning part of the brain, in
order to correctly identify the facial feature. This study showed teenagers relied more on the emotional
regions of their brain. Reactions, versus rational thought, are derived from the amygdala, which resides
deep in the brain. Yurgelun-Todd and other neuroscientists believe that an immature brain leads to
impulsivity, or what some researchers label as risk-taking behavior. The implications of this are
enormous for teens where such behavior is ubiquitous. This reliance on an emotional versus a rational
response can often lead to misjudgments and mistakes in decision-making. These impulsive decisions
characterize the irrational behavior of teens. The teenage brain responds differently to its external
environment than do adult brains. The difference in the responses between teens and adults to the same
visual cues shows the lack of inhibition to an internal emotional response within teenagers.
Emotions and cognitions cause teens to exaggerate judgments, which could affect their
decision making processes.
Baruch Fischhoff, Department of Social and Decision Sciences, Carnegie Mellon University, 2008,
Assessing Adolescent Decision-Making Competence, p. 23
Cognitions can also affect emotions. For example, teens who see a 20% chance of dying in the next year
(or think 50–50) might feel frustrated enough to act out or to disassociate themselves from long-term
future outcomes (as in row 2, Table 2). The article reporting these exaggerated mortality judgments
concludes by speculating that teens take ‘‘risks, in part, because they underestimate what is at stake, as
a result of overestimating the risk of dying. That is, they take risks not just because of an exaggerated
feeling that they are not going to die, but also because of an exaggerated feeling that they are not going
to live’’ (Fischhoff et al., 2000, p. 200). More generally, any cognitive process that undermines effective
decision making may increase the roles of social and emotional factors. For example, Table 3 shows
teens considering reduced sets of options. An overly narrow focus could keep teens from identifying good
choices or from finding any acceptable choices. As a result, they may drift toward decision points—
perhaps into situations where social and emotional concerns overwhelm cognitive ones. The cognitive
rehearsal intervention used by Downs et al. (2004) sought to help young women make decisions prior to
experiencing the passion and coercion of intimate encounters.
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Adolescents are Immature and too Emotional (2/3)
Teenagers are too unpredictable.
Michelle Oberman, Santa Clara University School of Law, January 1, 1996, Minor Rights and Wrongs,
p. 127
Inconsistency may well be the hallmark of the teenage years. Frequently, teenagers are serious and
adult-like, yet just as often, they are callow and unpredictable. Generally, they are all of these things, in
no particular order. They studiously observe the adults in their lives, adopting certain values and
behaviors, while wholly rejecting others. Their moods shift without warning, leaving entire households
with the sensation that they are living on a roller-coaster. As a result, it is not entirely surprising that the
legal system has had difficulty deciding how to respond to them. The laws devised to govern teenagers
are layered, reflecting society's alternating perceptions of teenagers as adult-like and child-like, and our
accompanying impulses to respect as well as to protect this population. Read together, these laws defy
any consistent description of adolescent capacity.
Policies for adolescents and adults need to be different; adolescents are too immature
due to their cognitive development.
Elizabeth S. Scott, University Professor and Robert C. Taylor Research Professor at University of Virginia
School of Law, January 1, 2001, The Legal Consequence of Adolescence, p. 549
Several interrelated dimensions of immaturity are important in shaping legal policies that treat children
differently from adults. First, children are dependent on others-initially, for survival and, as they grow,
for the care that will enable them to mature to adulthood. This dependency means that others provide
for their basic needs-for food, shelter, health care, affection, and education-so that they may become
healthy, productive members of society. Children also lack the capacity to make sound decisions.
Because of their immature cognitive development, children are unable to employ reasoning and
understanding sufficiently to make choices on the basis of a rational decision-making process!
Children's decision-making also reflects immature judgment, which may lead them to make choices that
are harmful to their interests and the interests of others
Peer pressure influences adolescent decisions, deeming them incapable of making their
own informed medical decisions.
Elizabeth S. Scott, Professor at the University of Virginia School of Law, and Thomas Grisso, Professor of
Psychiatry (Clinical Psychology), University of Massachusetts Medical Center, Fall 1997, The Evolution of
Adolescence: A Developmental Perspective on Juvenile Justice Reform, p. 162
It is widely assumed that peer influence plays an important role in adolescent crime, and evidence
supports the claim that teens are more subject to this influence than are adults. Peer influence seems
to operate through two means: social comparison and conformity. Through social comparison,
adolescents measure their own behavior by comparing it to others. Social conformity to peers, which
peaks at about age fourteen, influences adolescents to adapt their behavior and attitudes to that of their
peers. Peer influence could affect adolescent decision- making in several ways. In some contexts,
adolescents might make choices in response to direct peer pressure. More indirectly, adolescent desire
for peer approval could affect the choices made, without any direct coercion. Finally, as Moffitt
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suggests, peers may provide models for behavior that adolescents believe will assist them to
accomplish their own ends.
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Adolescents are Immature and too Emotional (3/3)
Adolescents' perception of risk demonstrate reasons why they should not make
medical decisions.
Elizabeth S. Scott, Professor at the University of Virginia School of Law, and Thomas Grisso, Professor of
Psychiatry (Clinical Psychology), University of Massachusetts Medical Center, Fall 1997, The Evolution of
Adolescence: A Developmental Perspective on Juvenile Justice Reform, p. 163
Research evidence also indicates that adolescents differ from adults in their attitude toward and
perception of risk. It is well established that adolescents and young adults generally take more risks
with health and safety than do older adults by engaging more frequently in behavior such as
unprotected sex, drunk driving and criminal conduct. This inclination may result because adolescents
are less aware of risks than are adults, because they calculate the probability of risks differently, or because they value them differently. In some contexts, adolescent risk preferences may be linked to other
developmental factors. For example, adolescents may be more averse than adults to risking social
ostracism.
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The Law Deems Adolescents Immature
Minors are legally presumed incompetent, which means legally, parents are responsible
for making decisions for their children.
Melinda T. Derish, Berkeley Law, and Kathleen Vanden Heuvel, Berkeley Law, 2000, Mature Minors
Should Have the Right to Refuse Life-Sustaining Medical Treatment, p. 112
The adult's right to execute an advance directive is derived from the legal presumption that adults are
competent to make their own decisions about activities that affect themselves, including decisions to
consent to or refuse LSMT. Those who would force an adult patient to receive unwanted medical
treatment have the burden of proving that a patient is incompetent rather than the patient having to
prove that he is competent. Minors, however, are in precisely the opposite position. At common law
they are presumed legally incompetent to give their own consent to medical treatment. Although the
common law presumes that minors have the same right to bodily integrity as adults, only their parents
are allowed to exercise this right. Parental authority to make medical decisions for their children is also
based upon a general, legal presumption that parents will act in the best interests of their children and
upon the Constitutional right of privacy in family matters.
Age does not equate to competence in decision making about abortion, studies prove.
J. Shoshanna Ehrlich, associate professor of legal studies at the College of Public and Community Service,
University of Massachusetts Boston, Spring 2003, Choosing Abortion: Teens Who Make the Decision
Without Parental Involvement, p. 20
Looking at two abortion specific studies, Lewis, in comparing the decision- making process of pregnant
women and minors, found that although there were differences in the factors that the teens and adult
women considered, age did not determine decisional competence. Ambuel and Rappaport who
interviewed a mixed sample of adult women and minors at the time of their pregnancy test, reached a
similar conclusion. They used the following three criteria to evaluate each participant's cognitive process:
"(a) consideration of immediate and future risks and benefits, (b) quality and clarity of reasoning, and (c)
factors considered in making a decision," and they concluded that "(t)he minors were comparable to the
adults on all.., measure of competence. ''
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The Supreme Court Rules that Adolescents are
Immature
The Supreme Court notes that a child's lack of maturity deems their parents worthy of
guardianship authority in decision making.
Elizabeth S. Scott, University Professor and Robert C. Taylor Research Professor at University of Virginia
School of Law, January 1, 2001, The Legal Consequence of Adolescence, p. 551
This account of childhood leads quite naturally to the conclusion that children must be subject to adult
authority, and that the deeply ingrained political values of autonomy, responsibility, and liberty simply
do not apply to them." Under American law, primary responsibility for the welfare of children and
authority over their lives is given to their parents. Justice Burger captured the conventional rationale
for this assignment in Parhan v. J.R., a United States Supreme Court opinion dealing with parent's
authority to admit their children to state psychiatric hospitals. The law's concept of the family rests on a
presumption that parents possess what a child lacks in maturity, experience, and capacity for judgment
required for making life's difficult decisions. More important, historically it has recognized that natural
bonds of affection lead parents to act in the best interests of their children. "Parents are charged with
their children's basic care and with the duty to protect them from harm. They also are authorized to
make decisions on their behalf about matters ranging from nutrition, medical treatment, and residence
to (in theory) the choice of friends and reading material. Parental responsibility and authority go hand
in hand. In some sense it is fair to view parental "rights" as legal compensation for the burden of
responsibility that the law imposes on parents.
Justice Kennedy notes that adolescents have an underdeveloped sense of responsibility
and are therefore immature in the eyes of law.
Laurence Steinberg, Temple University, Elizabeth Cauffman, University of California, Irvine Jennifer
Woolard, Georgetown University, Sandra Graham, University of California Los Angeles, and Marie
Banich, University of Colorado, October 2009, Are Adolescents Less Mature Than Adults? Minors’
Access to Abortion, the Juvenile Death Penalty, and the Alleged APA “Flip-Flop,” p. 583
Developmental science was front and center in the Court’s ruling, which drew extensively on an amicus
curiae brief submitted by the American Psychological Association (APA, 2004) and was informed by a
recent summary of relevant research on psychological development during adolescence that was
published in this journal (Steinberg & Scott, 2003). Writing for the majority, Justice Anthony Kennedy
drew attention to three specific aspects of adolescents’ immaturity that diminished their criminal
culpability: their underdeveloped sense of responsibility (and difficulty controlling their impulses), their
heightened vulnerability to peer pressure, and the unformed nature of their characters. As Justice
Kennedy wrote, First, as any parent knows and as the scientific and sociological studies respondent and
his amici cite tend to confirm, “[a] lack of maturity and an underdeveloped sense of responsibility are
found in youth more often than in adults and are more understandable among the young. These
qualities often result in impetuous and ill-considered actions and decisions.” . . . The second area of
difference is that juveniles are more vulnerable or susceptible to negative influences and outside
pressures, including peer pressure. . . . The third broad difference is that the character of a juvenile is
not as well formed as that of an adult. The personality traits of juveniles are more transitory, less fixed. . .
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. These differences render suspect any conclusion that a juvenile falls among the worst offenders. (Roper
v. Simmons, 2005, pp. 15–16)
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Parental Guidance is Good
Adolescents need assistance in making medical decisions.
Michelle Oberman, Santa Clara University School of Law, January 1, 1996, Minor Rights and Wrongs,
p. 133
A second alternative is to reassert the common law principle denying adolescents autonomy until they
reach the age of majority." Rather than attempting to discern an adolescent's competence to consent to
certain forms of treatment, parents or guardians would be granted presumptive authority over their
child's health care. Under this standard, providers would be required to obtain parental con- sent
before treating a minor. If consent is denied and the provider believes that the treatment is in the
minor's best interests, the provider must request a court-order to provide treatment. Such a rule would
be as efficient as any other age- based standard, in that it would not require competency
determinations. It has the further advantage of acknowledging the interdependent nature of
individuals within families, and the way in which medical decisions may affect not only the adolescent
patient, but also the entire family unit. The basic premise of this proposal is that most adolescents need
assistance in making important medical decisions, and such assistance should come from people who
care deeply for the adolescent, rather than from strangers.
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