Resolved: Adolescents ought to have the right to make autonomous 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." n108 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] 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. 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] Moreover, if an adolescent decides to take medication or suchlike which the parent deems uneccessary, it could place a strain on the family’s budget. Conversely, a shared method would seek to find the most cost-efficient solution to the dilemma at hand. CA.1: Health and wellness are inalienable rights. Earlier, in C1, I explained how autonomy is conditional. Likewise, in this scenario, the autonomy of health and wellness is conditional. When one is unable to make the decision that best preserves their health and wellness, the right to do so becomes conditional. Let there be no ambiguity, the intention is not to take away rights. Instead, it is done to benefit the individual and help them in the best way possible. My opponent’s proposed scenario involving the gun is irrelevant. Medical decisions aren’t related to threatened murder. CA.2: People are the most aware of what is best for their body. As I mentioned in C2, this is not the case. Adolescents are not capable of making the best, most informed, and coherent decisions as their mind is not fully developed. His quote by Chris Johnson is unsourced and he has no scientific or research based impact to it. CA.3: There are already precedents set for adolescents. I’m not entirely sure what my opponent is driving at, but the instance he mentioned of the JW boy doesn’t happen often. In most cases, as my reports show, the parents are trying to do what is best for the child. As far as religion is concerned, most children have little objection to treatments such as those and/or they are the same as their parents’. CA.4: You don’t become magically fully mature at 18. This is obvious. However, knowledge, wisdom, and maturity improve over time. Thus, the average 18 yr. old > the average 13 yr. old in regards to those areas. This general notion has been scientifically backed as well. [14] CA.5: There are medical decisions that adolescents can already make. This is also true. However, as I’ve shown, allowing total autonomy for medical decisions (as the resolution advocates) is inherently and empirically detrimental. The decisions they can already make are generally minor. Furthermore, individuals still have a degree of autonomy with the shared model as I proposed. Sources: [1] http://hrweb.mit.edu... [2] http://www.livescience.com... [3] http://www.hinnovic.org... [4] http://digitalcommons.law.byu.edu... [5] Teens with Cancer may Balk at Chemo, Risk Death: Study.” The Leader-Post [Regina, Saskatchewan]. April 1, 2006. Pg. A9 [6] http://eknygos.lsmuni.lt... [7] http://thelawdictionary.org... [8] http://chicagounbound.uchicago.edu... [9] http://scholarship.law.cornell.edu... [10] http://journalofethics.ama-assn.org... [11] http://everydaylife.globalpost.com... [12] http://via.library.depaul.edu... [13] http://jpepsy.oxfordjournals.org... [14] http://www.dailymail.co.uk...