Are Adolescents Competent Enough to Make End of Life Decisions?

Section 1:

 In modern medical ethics, patient autonomy is considered to be a major principle in making decisions about an individual’s health, and those who receive healthcare should have the right to practice their autonomy consciously and freely.  A major debate in ethics that is part of patient autonomy consists of adolescents being able to make their own life-and-death decisions or not. Questions such as “What types of decisions should adolescents be able to make?” and “Are they competent and capable to make end of life decisions?” come into account when deciding if an adolescent can have a say in their decision.  Although one might assume that the decision is easier than said, there are many factors that influence this decision.  Though it is not a right or wrong debate, it does consist of an ethical dilemma that we all have to partake in, especially the parents, the physician, and most importantly the patient.

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 Adolescence is the period in a person’s life where they are going through dramatic changes in physical appearance, but also self-esteem, independence, social skills, and many more.  In short, people who are adolescent are typically teenagers who are going through puberty and discovering themselves while making critical life choices that will impact them in the future.  According to the World Health Organization’s definition of an adolescent, an adolescent is an individual who is in the period between the ages of 10 and 19 years old.  When it comes to decision making, adolescence creates controversy between what is legal and what might be ethical.  In most cases, patients who are 18 and older are considered to be legally competent and knowledgeable enough to make a medical decision on their own.  Therefore, parents are often in charge of most medical decisions for adolescents.  However, what if there is a case where the adolescent is considered mature? Many would argue that mature minors should be recognized by law as having the ability to make informed decisions about their own health care, on their own. In life, it is possible to have a minor who is mentally and physically more mature than one who is 18 and older, so with that, it throws out the age issue out of the equation.  Every person is different in how they develop and mature, which would make them competent to make an important decision at the end of life.  Since adolescents have the resources to be informed about their medical condition and they are willing to question and discuss their treatment, they are given the knowledge and information in order to be able to make that decision on their own. On the other hand, when given certain information, adolescents may not consider the situation seriously, or make impulse decisions and this is the issue that is created in the first place.  Often adolescents are mentally unstable when dealing with heavy information like the end of life. This can affect the decision-making capability of the patient, so they should not be allowed to have autonomy in this situation. On the other hand, if they are smarter than most people perceive them to be, then they should be allowed to.  The ethical dilemma is essentially an issue that just goes around in a circle, incorporating the three stakeholders in the situation, and a conclusion can never truly be justified.  By exploring deeper into the ethical dilemma in adolescent autonomy, a conclusion can be said on if adolescents are capable and competent enough to make their own medical decision or not.

Section 2:

 For an adolescent to be able to make medical decisions on their own, they need to possess the appropriate traits of an adult, being responsible, educated, and independent. From a medical perspective, anyone should be able to decide based off these basic traits, rather than a mere number that states their age.  Adolescents who are competent enough should be allowed to make their own medical decisions because of the following:

The Doctor’s Perspective

Although adolescents are not legally allowed to make medical decisions for themselves, in most cases, adolescents should be involved in medical decisions at the end of life for themselves if the physician feels they are developmentally and physically competent and informed about their medical condition. A counter to this argument would be that a parent has the final say in the decision making, but many would argue that the doctor’s judgement is just as good as the parents, if not, better. Since adolescents have the resources to be informed about their medical condition and they are willing to question and discuss their treatment, they should be competent to make a medical decision at the end of life. If the doctor personally believes the minor is as strong as an adult to be able to make medical decisions on their own, then it should be honored.

It Is Their Right

It is simple, adolescents have the right to make their own medical decisions, just like anyone else.  An individual has a right to their life and their body, not the state’s nor their parents. Being a human is part of having freedom in your own decision making, regardless of the consequences.  Whether they want to live for 17 years or 100 years, it should not be anyone else’s choice, but the person involved in the decision making. There is nothing that is written on paper that states how long a person is supposed to live and why. No one can determine that but the person themselves. Essentially, it is a conflict between the quality of life vs the quantity of life. 

Maturity

Making complex medical decisions, and making them well, means dealing with information about your illness, about therapies, about risk and benefits and side effects.  The assumption that those under the age of 18 are not mature enough to give consent, and parents are in a better position to decide what is in their child’s best interest is not necessarily true.  Many teens are intellectually and emotionally capable of giving informed consent.  Adolescents are on the brink between childhood and adulthood and have an extended capacity for critical thinking. There is no age that determines how mature and competent a minor is besides their own ability to show that they are mature enough to make end-of-life-decisions.

Responsibility

Adolescents are also capable of making other decisions outside of the medical fields that are high stakes and can affect themselves and those around them. Some of these high impact decisions include joining the military at age 17 and choosing to leave school at age 16. Responsibility is necessary for both decisions, so if an adolescent is capable to make these other high stakes decisions, then why are not they able to make end of life decisions about their own health care. Many minors show levels of competency that far exceed some adults, yet we still allow adults to make terrible decisions on their own knowing the consequences that will follow. 

Section 3: 

 With every debate, there is always going to be a counter argument, and in this case, adolescents should not be able to make medical decisions on their own due to the following reasons:

Incompetency

With the argument that minors should be able to have a voice in medical decision making based off their competency, it can be said with the counter argument that the ones who are not competent enough should not be able to make decisions on their own. Children can be a multiple of things and of those things can consist of being immature, reckless, uneducated, scared, etc. Regardless if they feel they have a right in choosing what is best for them, if these kids show signs of incompetency, they should not be able to make medical decisions on their own. Even if they are smart, they may lack in areas such as having anger issues and making impulsive decisions based off their emotions and not logic.

Principles

Allowing minors to make their own medical decisions may conflict with one’s morals and values because they may know in their heart that they are not making the right decision. Essentially, one would argue that no one else’s opinion matters other than the person at risk making the decision, but being an adult comes the responsibility of guiding the younger generations to make wise choices in life. With age, adults may have attained more knowledge and experience in situations like this, and for them to allow adolescents to make medical decisions on their own, knowing that they are making a bad decision, will cause conflict with their ethics.

The Family

With minors being under the age of 18, assuming that they are still living under their parents/guardians roof, the family members are expected to take care of their minors till they are ready to be on their own.  For a minor to have the option of making a medical decision on their own, they have to be fully aware that they will be affecting their family members as well.  This can be a problem because family members are expected to care for them after any medical procedure, and if the family disagrees with the choice that the minor made, it will cause conflict.  It is not fair that family members have to deal with the burden of a poor choice the minors make, and due to this, family members should be have a voice in the decision making, even if it counters the minors choice.

The Law

State legislations do not allow a minor (under the age of 18), under most circumstances, to make medical decisions for themselves because minors are deemed incompetent decision makers based on their age and development.  This category includes adolescent’s, thereby limiting their autonomy in end of life decision making or any medical decision making at all. This law is mainly in place to keep minors, including adolescents from making bad decisions. In other words, in most cases, the law prevents minors from making medical decisions on their own, regardless of how competent they may seem.

Section 4:

In order to understand ethical decision making, it is important for people to realize that not everyone makes decisions in the same way, using the same information, employing the same decision rules. In relation to this topic, ethical theories and principles are used to represent the viewpoints from which individuals seek guidance as they make decisions. Understanding ethical theories and principles will help better understand how people justify their decisions. These ethical theories and principles include respect for autonomy, justice, deontology, and beneficence.

Respect for Autonomy

This principle states that decision making should focus on allowing people to be autonomous—to be able to make decisions that apply to their lives. Thus, people should have control over their lives as much as possible because they are the only people who completely understand their chosen type of life style.  Each individual deserves respect because only he/she has had those exact life experiences and understands his emotions, motivations, and physical capabilities in such an intimate manner. This also applies to minors because regardless of their age, they are still a human being. Adults are fully aware of the consequences that come with the decisions that they make on a regular basis, so if minors are aware of their consequences in medical treatment, and they still want to go through with the process, adults should respect it and allow it.

Justice

Justice is a complex ethical principle and it entails fairness, equality, and impartiality; in other words, it is the obligation to be fair to all people. Essentially, individuals have the right to be treated equally, regardless of age, gender, ethnic group, etc. In this case, age is a big issue when dealing with minors and allowing them to make their own medical decisions or not. No matter the circumstance, discrimination is discrimination. If a minor proves to be competent enough to make educated medical decisions, just like an adult would, there is no reason why we should not allow minors to have that opportunity to do so. This causes major conflict within the health industry because doctors and parents have to justify why they feel their patient/child should not have a say in the situation, and they also have to ask themselves if they are being fair to the adolescent or not. It has gone to the depths of minors taking legal action in situations like this because they feel they are not being treated fairly and is willing to combat it.

Deontology

Deontology considers the way things are done rather than focusing just on the consequences. Deontology considers the rightness or wrongness of an action. For instance, a doctor may believe that one should never allow a minor to make a medical decision on their own, and to that extent he/she will never allow them to do so, regardless of the outcome. Parents and doctors may find it extremely “wrong” to allow adolescents to make end of life decisions, even if they are competent enough. Due to this, minors may feel as though they are being treated unfairly, may take legal action, or simply may find hatred towards the doctor and/or parents. Regardless of this fact, doctors will follow his or her obligations to not allow minors to do so because they believe what they are doing is ethically correct.

Beneficence

The principle of beneficence guides the decision maker to do what is right and good. The priority to “do good” makes an ethical perspective and possible solution to an ethical dilemma acceptable. This demands that health care providers develop and maintain skills and knowledge, continually update training, consider individual circumstances of all patients, and strive for net benefit. In the context of the professional-client relationship, the professional is obligated to, always and without exception, favor the well-being and interest of the client. If a minor is competent enough to feel they can make an educated decision on their own, and the doctor acknowledges this, the best thing he/she can do is provide the necessary information and guidance to the adolescent.   On the other hand, they may deny the same situation because some doctors may advocate for high standards and strive for the greater good, which to them, would be by not allowing minors to make medical decisions on their own. If they feel as though this does nothing for the greater good and is just to make the minor happy, then they will not allow it.

References

• David, J. G., Lo, M. S., & Langer, D. A. (2018). Adolescent and parent perspectives on medical decision-making for chronic illness. Families, Systems, & Health, 36(2), 248–251. https://doi-org.ezproxy.net.ucf.edu/10.1037/fsh0000297
• Petronella Grootens-Wiegers, Irma M. Hein, Jos M. van den Broek, & Martine C. de Vries. (2017). Medical decision-making in children and adolescents: developmental and neuroscientific aspects. BMC Pediatrics, Vol 17, Iss 1, Pp 1-10 (2017), (1), 1. https://doi.org/10.1186/s12887-017-0869-x
• Rebecca Babcock. (2016). Medical Decision-Making for Minors: Using Care Ethics to Empower Adolescents and Amend the Current Power Imbalances, (1), 4. https://doi.org/10.1353/asb.2016.0001
• Adolescent Autonomy and End of Life Decision Making. (2017, May 25). Retrieved from http://blogs.kentplace.org/bioethicsproject/2016/02/08/adolescent-autonomy-and-end-of-life-decision-making/
• Irina Olimpia SUSANU, Nicoleta CRISTACHE, Diana Elena ZAHARIA STEFANESCU, Tiberius STANCIU, & Tiberiu Ilidor PLESA. (2017). Analysis of Influence of Ethical Principles on the Performance of Health Care System. Risk in Contemporary Economy, Vol 1, Pp 397-414 (2017), 397. https://doi-org.ezproxy.net.ucf.edu/10.18662/lumproc.rce2017.1.35
• Smith, S. W. (2012). End-of-life decisions in medical care. [electronic resource] : principles and policies for regulating the dying process. Cambridge, UK ; New York : Cambridge University Press, 2012. Retrieved from https://login.ezproxy.net.ucf.edu/login?auth=shibb&url=https://search-ebscohost-com.ezproxy.net.ucf.edu/login.aspx?direct=true&db=cat00846a&AN=ucfl.032063977&site=eds-live&scope=site