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

ColeTrain

Framework:

This debate boils down to how important autonomy is, and if it should be *restricted.* I will demonstrate that because teens are incapable of making the *best* decision for their health, we should pursue a shared model instead. This is argued on the premise that adolescents are not developed *enough* to merit unconditional autonomy (e.g. allowing them to make their own medical decisions).

Contention I: Autonomy is a delicate value.

It’s all well and good that individuals have autonomy, but we must be careful in giving autonomy to individuals in a situation that is rambunctious and potentially harmful. Allow me to first define autonomy. Relatively similar to my opponent’s definition, I believe the following definition provides more clarity: “the right (and condition) of self-government.” [7] It is imperative to realize that autonomy is not only a right, but also a CONDITION. When one displays inability or incapacity to perform the duty of which they are required, it is removed.

For example, when an individual commits a crime, they are arrested and imprisoned. Likewise, their “rights” become conditional, based upon their behavior and ability to perform a duty. In a similar manner, if adolescents are unable to demonstrate maturity and ability to make their own medical decisions, their autonomy to do so must be conditional.

As I will demonstrate, adolescents should not be given the autonomy to make their own medical decisions, and thus the conditional autonomy to do so must take the form of a shared method, between their parents/guardians AND themselves. This is because “capacity to consent to medical care is a presumption for adults and incapacity is the presumption for minors.” [10] The normative method follows this statement, and I argue that it is fundamentally and empirically correct in nature.

Now, before proceeding, let’s clarify what exactly what this autonomy and its medical decision-making ability entails. In all seriousness, it’s quite difficult to define, as law professor Rhonda Gay Hartman explains, “Decisional autonomy is an elusive concept.” [8] However, it can be relatively explicitly defined in this manner, “"(a) the ability to comprehend information relevant to the decision, (b) the ability to deliberate [about choices] in accordance with [personal] values and goals, and (c) the ability to communicate [verbally or nonverbally] with caregivers." This formulation does not allow for a finding of decision-making capacity where a patient demonstrates "an inability to reach or communicate a decision," [9] This also includes the ability to recognize the future ramifications of the decisions. With that defined, we understand that these adolescents must be coherent and mature in their minds to fulfill this definition. Falling short on any of these aspects merits conditional autonomy.

Contention II: Adolescents require guidance in medical decisions.

If an adolescent is unable to make the *best* decision for themselves, and if they are do not have the capacity to choose wisely in regards to medical decisions, then for the benefit of both themselves and the rest of society it is imperative that we not allow them to make their *own* decisions. This premise can be fulfilled as follows:

P1: Teens minds are not fully developed.

P2: Underdevelopment in their minds leads to bad decisions. (fulfilled by P1)

C1: We should not give unconditional autonomy to teens in regards to medical decisions. (fulfilled by P1 and P2)

Quite simply, an adolescent's mind is not fully matured until individuals reach the approximate age of 25. [1] Studies have been conducted and found that teens, even at the age of 18 (as my opponent has advocated) are not fully matured. [2] Allowing teens that are far younger than that age to make medical decisions that can dramatically and permanently affect their lives is a delicate proposition, and one that I will be arguing against.

This lack of brain development alone equates for numerous dangers in regards to medical decisions, some of which are as follows: “impulsivity, inflexibility, emotional volatility, risk taking “short termism.”” [3] These aspects collectively show high risk and potential problems for adolescents, which displays “a peculiar vulnerability of children; their inability to make critical decisions in an informed, mature manner.” [4]

Moreover, the correlation between an immature mind is strongly the cause of distress in adolescents, whether now or later, some of which can be potentially fatal. Cancer is an optimal example of this. “The success of cancer therapy is closely dependent on you taking your medications in a very religious manner," said Koren, a Sick Kids pediatrician and pharmacologist who supervised the study…some adolescents may balk at taking the medications, which can have "terrible" side-effects, he said, especially when pills must be taken day-in and day-out for several years.” [5] Furthermore, this isn’t an irregular occurrence. Pediatric oncologist Dr. Bejamin Gesundheit confirms, “Non-compliance with therapy is widespread among adolescents with cancer.” [6]

Essentially, non-compliance is a big issue that alone merits a shared method of medical decisions. This a huge problem when realizing how important medical decisions are. “Support for confidential care for adolescents has always been a pragmatic notion, directed toward public health outcomes.” [10] As it harms public health by giving potential for harmful medical decisions that could have a trickle-down effect, there is also pragmatic grounds to negate the resolution proposed by my opponent.

Contention III: A shared decision-making model is more pragmatic and beneficial.

On simply pragmatic grounds, a shared model looks WAY better. First of all, it encourages communication between teens and their parents, which is inherently beneficial. [11] Aside from that, however, a discussion can bring up points of which the other party may not have considered.

Beyond that, however, is revealed an even greater dilemma. “Recently... courts have begun to deviate from the common law maxim in order to allow certain chronically ill minors to discontinue necessary medical treatment.” [12] The same review notes, “One may initially interpret this phenomenon as an expansion of the rights of minors, based upon judicial recognition that chronically ill adolescents are (or may be) as mature as adults. However, as this Comment will demonstrate, "maturity" is not a well-defined legal term, and the mature minor doctrine is more an instrument of paternalism than a conduit of liberty for adolescents. The doctrine is nonetheless capable of effecting drastic consequences.”

With medical treatments becoming increasingly sophisticated [13], it is of optimal importance that the decisions are done correctly. To achieve this with the highest of success rates, we must use the traditional shared model between the adolescents and their parents. The best all-around method, “In a shared decision-making model… most health care decisions would require the consent of both patient and parent, rather than just parental consent, with some necessary exceptions for particularly difficult circumstances in which sole decision-making by the young person or parent would be most appropriate. Such a change may improve the actual physical health of young people by encouraging access to care and providing the psychological benefits that come from wielding some measure of power over one's own health care.” [9]

ColeTrain

Personal Dignity

The dignity of human life is indisputably very important, but it's equally important to recognize how negating the resolution preserves human dignity on a utilitarian level, rather than simply an individual basis. Dignity was defined in a relative manner by my opponent, as such: the importance and value of an individual. He asserts this requires individual autonomy. However, as I have demonstrated, personal autonomy is conditional. Just like our other rights are conditional, liberty must be viewed the same.

Essentially, my opponent is valuing life. However, if an individual goes to a harsh extent to supposedly preserve their human dignity, but it harms other individuals' dignity, it is not utilitarian. Conceivably, valuing human dignity to the extent that incompetent adolescents make detrimental medical decisions is a value trumped by both utilitarianism and morality in general. This mandates adolescents have a conception of conditional autonomy in regards to medical decisions to preserve the human dignity of others, protect morality, and ultimately be utilitarian.

Types of Cases

The example my opponent mentions will suffice to give a generic connotation to the resolution, but it’s more of an emotional appeal to sway voters. Intentions good as they may be, it’s still a fallible idea to grant teen’s unconditional autonomy.

Donnelly writes, “A Kantian conception of autonomy, therefore, is not about free choice but about the drive to appropriate or moral action.” [1] Autonomy doesn’t necessarily guarantee *total* free choice, as Kant agreed, and was more about individuals having the right to take the appropriate and moral action. In this case, the appropriate, and moral, action would be utilizing a shared model. This does a lot to prevent impulsive or inappropriate decisions made by adolescents.

Healthy Teens "Aren't" Defined by Peers

My opponent’s view regarding this point is severely skewed. It acts under the false premise that parent’s don’t *really* care for their children. The initial example mentioned basically insinuates that the parent won’t die from no treatment, so they are fine with forcing their child to neglect undergoing said treatment. This is is inherently flawed. As a parent’s duty, the mother would endeavour to do what is *best* for the child.

Moreover, parents have MUCH better ability to make the most appropriate decisions. Parents raise their children, and recognize their strengths, weaknesses, and desires as individuals. It is recognizably true (as my opponent even mentions) that adolescents are trying to express themselves. It is equally obvious that they don’t have a solidified grasp of “who they are” by how religiously they respond to trends, fashion, the polar opposite.

Teens don’t really KNOW who they are, and as such, act impulsively. Pustilnik and Henry note, “Imaging studies show that adolescents have developing, but incomplete, prefrontal cortices, which may indicate immature executive function. The prefrontal cortex ("pfc") is the last region of the brain to develop fully. Researchers agree that the pfc is the seat of "executive control." These are inhibitory functions, like impulse control, long-term planning, and cost-benefit analysis. Neuroscientists hypothesize that a less-developed pfc may correlate with a lesser ability to control impulsivity, weigh future consequences, and engage in rational, cost-benefit analysis - hallmarks of typical behavioral differences between teens and adults. Research suggests not only that adolescents reason less effectively than adults but that they reason differently: Teens appear to evaluate risks relationally ("What do my friends think about this?" "What will my friends think of me if I do/don't do this?") rather than independently ("Is this a good idea?")” [2] This cited evidence and explanation explicitly refutes my opponent's tagline of the argument he's trying to make.

This definitively demonstrates adolescent inability to make competent, rational, and appropriate decisions for their health. It also suggests that parents, whose minds are more developed, would be capable of making competent, rational, and appropriate decisions for not only themselves, but their children as well. Cherry supports this and points out that there is a “substantial array of scientific evidence indicating that children, even so-called mature minors, are generally not in fact mature decision makers. There is a significant body of neurobiological evidence that the adolescent and teenage brain is not yet fully developed in its cognitive and affective capacities.” [4] Teens are simply unprepared to make such crucial decisions.

As parents are required to guide their children, rearing them in a more beneficial manner is the only moral option. Cross-apply more warrants from Cherry: “Parents have usually been identified, within rather broad side constraints, as the source of authority over their children and as the best judges of what constitutes the best interests for the family as a whole as well as the best interests of their minor children in areas of medical decision making. That is, parents themselves have usually been identified as the best judges for balancing costs and benefits, articulating values and inculcating virtues, to determine appropriate judgments for themselves and their children, and the family as a whole.” [4]

This shared model, not solely parental decision making, is much more beneficial as it allows the conversation and discussion, which not only assists family relationships, but also helps move toward a better decision in the long run. “Shared decision making (SDM) is a collaborative process that allows patients and their providers to make healthcare decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences.” [3] This process is not one-sided, it accounts for both opinions when formulating a decision. Parental guidance is not only necessary, but it is much superior to adolescents going through the process alone.

Means to Support

My opponent argues teens will “feel trapped” and decline to report private medical matters. This assertion is untrue given the shared decision-making model for which I advocate. This gives teens the ability to voice their opinion in the matter, but also provides necessary guidance as well. Under this method, adolescents can feel free to share their problems and get the *best* help possible. This also ensures that parents do not make hasty decisions, as they are checked by the adolescent as well. By doing so, they protect not only their own morality and human dignity, but also those of others in utilitarian manner.

Discrimination:

My opponent asserts this is a large problem in our society, specifically regarding teens. I’d argue (strictly in relation to adolescents) that it is NOT a problem. “Ageism” is necessary to protect the entirety of society. This is why there are regulations on a plethora of other things, such as: obtaining a firearm, driving, working jobs, among many others. Without these regulations in place, severe damage could be done. The same applies to medical decisions. Allowing teens to make decisions that have a greater reaching impact than exclusively themselves poses a threat to society.

Conclusion:

My opponent does nothing to show that teens are at the very least even CAPABLE of making appropriate decisions. Moreover, autonomy can’t be valued above morality, as there’s no place for liberty to exist without morals. Immoral autonomy, as Kant noted, is flawed, and entirely different from appropriate or moral autonomy. Since negating the resolution constitutes *better* morality, better protects utilitarian human dignity, and is more pragmatic given the shared model, there is no option but to vote negative.

The resolution is soundly negated.

Sources: http://pasted.co/3db95a47