When cancer treatment becomes no longer curative judgements and decisions need to be made on how to proceed with care. Clinicians balance the principles autonomy, beneficence and nonmaleficence in designing a care plan and patients, as autonomous beings, can make informed decisions based on information presented. But what happens when that patient is a minor (a person under the age of eighteen) who no longer wishes to continue with treatment? At what age does an adolescent demonstrate the cognitive ability and emotional maturity to fully understand the consequences of choosing or refusing medical treatment (Hickey, 2017)? A minor’s right to choose or refuse medical treatment is a growing conflict that has created many ethical dilemmas and …show more content…
A basic principle of bioethics is that individuals have an absolute right to participate in the decision-making process concerning his/her own medical treatment so long as they are deemed competent (Parsapoor, 2013). Adolescents who have the ability to demonstrate an understanding of the proposed therapy along with the short and long-term consequences, benefits, and alternatives have the right to choose or refuse treatment. The mature minor doctrine outlines that adolescents 15 years or older possess the capacity to make informed decisions comparable to that of adult and therefore possess the maturity to make independent decisions regarding their medical care based on studies of adolescent cognitive development (Steinberg, 2013). As a result, if an adolescent is found to be competent they should be allowed consideration to make medical decisions based on their values and life plans (Beauchamp and Childress). Emily as a mature adolescent and developing autonomy has the right and capacity to refuse medical treatment in effort to preserve the remaining life she has left and to live out her time with dignity in a way she sees fit. Parental Authority Adolescents by law are still considered minors, defined by chronological age. Within
This memorandum is written to inform others on the topic of mature minors and medical decisions. This matter has come to the surface of major debate and concern recently. One specific court case, involving Cassandra Callender of Windsor Locks, Connecticut, has sparked much of that concern. Seventeen-year old Cassandra was diagnosed with stage-three Hodgkin's Lymphoma and told by several doctors that she would predictably die within two years without the rounds of chemotherapy they had recommended for her. With the treatment, there was an expected 85% chance of survival (Cassandra Callender). However, Cassandra’s mother kept switching her daughter’s doctors, constantly questioned the diagnosis they were making, and according to the commissioner of her case, had, “...failed to meet the medical needs’, of Cassandra”. Cassandra was taken from her home and placed in her cousin’s because of her mother’s medical neglect. Callender’s mother testified that she knew that her daughter had cancer and that it was something that needed to be taken seriously. She further testified that her daughter should begin the chemotherapy rounds as quick as possible. Medics came to Cassandra’s home, after being returned
Autonomy includes three primary conditions: (1) liberty (independence from controlling influences), (2) agency (capacity for intentional action), and (3) understanding (through informed consent) (Beauchamp & Childress, 2009, p. 100). According to Beauchamp & Childress (2009) to respect autonomous agents, one must acknowledge their right to hold views, to make choices, and to take actions based on their personal values and beliefs (p. 103). Respect for autonomy implies thaturges caregivers to respect theassist a patient in achieving? Heed? the autonomous choices of their patients. From there, patients can act intentionally and with full understanding when evaluating medical treatment modalities. Autonomy also includes a set of rules, one of which requires that providers honor patient decision-making rights by providing the truth, also known as veracity (Beauchamp & Childress, 2009, p. 103). In this case, several facets of the principle of respecting autonomy, specifically veracity, informed
Consent for medical treatment is based on three legal ideals: the patient must be informed to make a decision, the patient cannot be intimidated into making a decision, and the patient must be competent (McCabe). In 1982, a study was held by Weithorn and Campbell showing the competency of four age groups (9,14,18, and 21 years-old) based on questions from the ideals aforementioned. The study concluded that fourteen year-olds’ competence and adult are analogous, while nine year-olds could partake in discussions based off of their treatment (Weithorn). The study conducted by Weithorn and Campbell, not only displays competence, but also the ability to comprehend the possible outcomes, and determine the importance of these possible outcomes relative to their own lives. With studies showing that at the age of fourteen the decisional capacity (prefrontal cortex) of the human brain is equal to that of an eighteen year-old, the legal age of consent must be lowered to fourteen years of age.
As Albert Einstein once said, “The only source of knowledge is experience.” Seeing that I agree with Einstein, I stand in firm negation of today's resolution which states Resolved: Adolescents ought to have the right to make autonomous medical choices. For simplicity in the debate today, I would like to give the following definition from the Black’s Law Dictionary: Adolescence is the age which follows puberty and precedes the age of majority. It commences for males at 14, and for females at 12 year completed. The Oxford Advanced Learner’s dictionary says that the word ought is used to indicate a desirable or expected state. Autonomous, as defined by the Oxford Dictionary of Philosophy, is having the freedom to act independently. The negative will support the value of paternalism, which as defined by the Stanford Encyclopedia of Philosophy, is the interference of a state or an individual with another person, against their will, and defended or motivated by a claim that the person interfered with will be better off or protected from harm. The value of paternalism will be defended with the criterion of knowledge and experience.
The other is that minors shouldn’t be able to refuse medical treatment. People who favor this side say that minors aren’t mature enough to choose their treatment because they can’t think of the lasting effects that refusing treatment can cause. I do agree that there are some minors that make unintelligent choices and don’t think about the permanent effects of their actions. Though some minors do know the abiding effects of their choices and are mature enough to refuse medical treatments that they don’t want. This one of the reasons why I believe that minors should be able to choose their own medical treatment. Or if it goes into a trial the judge should talk to the minor to determine the minor’s level of cognitive
The healthcare team will observe the legal statutes of the state of California when administering care to minor patients. Minor patients are any patients under the age of 18 at the time that services are rendered. In the state of California, minors of any age may consent to medical care related to pregnancy, contraception, abortion, emergency medical service, sexual assault and rape services (this office maintains that minors under 12 can not be expected to give consent to any sexual act* and the attending physician should notify the medical office manager immediately before the minor patient leaves) and skeletal X-ray to diagnose child for abuse or neglect (the physician doesn't need either the minor's or the parent's permission in this instance) without parental permission and the physician can not inform the parents without the minor's consent. Further, minors age 12 years and older may obtain outpatient mental health services, diagnosis and/or treatment for infectious, contagious communicable disease and sexually transmitted disease, HIV/AIDS testing and treatment, rape and alcohol and drug abuse treatment without parental/guardian consent. When
Many people are unsure of the rights granted to minors because of the laws in place, or the lack of laws in place. In fact there are laws, such as the Privacy Act of 1988 that could be a reason people are confused about the rights minors have to confidentiality. This act is directly described in a professional practice article when Bird (2007), stated that an adolescent’s health information can be released to a guardian, but in circumstances where a minor is capable of making their own medical decisions, they should be allowed to do so (p. 655). Bird further explained that “If an adolescent is able to consent to their own medical treatment, then they are
You appear to have taken the same approach to this scenario as I have. We both felt it important for Wendy to be given the status of mature minor (Menikoff, 2001), with the primary reason being her prior experience and her age. I believe this case made it important to look at the actual age of the patient. You mentioned this in your statement of a minor being of proper age and having the right to make medical decisions. It is wrong to say that a minor who is maybe only 10 years old, have the same maturity as a 16 year old. While both are considered minors under the law, there is an apparent difference in maturity and cognitive development between a 10 year old and a 16 year old.
Redefining the word adult, in terms of making medical decisions, is important so that the individual is not forced to do any
Challenges surround whether a child is capable of providing their assent. Since children lack decision making capacity, it is crucial to obtain informed consent of their parents. However, it is challenging determining whether their parents are choosing the best decisions for their child. Additionally, it becomes difficult acknowledging whether the parents truly understand the terms of the experiment. Often times, a parent may resort to an experiment as a hope to gain control over their child’s illness.
The best possible resolution for this case would be to, first, to identify what Andrea would want to do for her end of life care. When her condition was deteriorating but before the cardiac arrest, the parents, social workers, nurses, and the physician should assess Andrea’s pain and suffering, asking her to express what she thinks she would want in the end. Harrison et al. (1997) supports this argument, claiming, “Parents and physicians should not exclude children and adolescents from decision making without persuasive reasons.” “Physicians should ensure that good decisions are made on behalf of their child patients” (as in Boetzkes & Waluchow, 2000, p. 163). It was also argued that, children of primary-school age, like Andrea, can participate in medical decisions, indicating their
A Patient's Rights to Refuse Treatment and How it Relates to Learned Helplessness of Individuals
Currently, the laws concerning decisions are obtuse and contradictory. An adolescent can seek treatment for an STD, but cannot seek treatment for a complication related to said STD. An adolescent can make choices regarding their infant child, but are unable to for themselves. An adolescent could be treated as a legal adult when committing crimes, where they can be prosecuted, tried and sentenced to death, but cannot be treated as an adult when deciding whether they want a new vaccine or not. They are perceived able to drive a car, and sell their livelihood to the workforce, and engage in sexual conduct, but apparently cannot assess the risks of a new vaccine.
The popular belief among our society has always been “Parents know what's best”. While their kids are young, parents know how to make their medical decisions for them. Parents know what's best for their children, they know how to keep them safe and healthy. However, their children soon turn into teenagers who should be trusted to make their own choices regarding their health care. They’re no longer the children they once were; they can comprehend the extension of every decision they make. Services and treatments should not be restricted to them because of their age or need for parental consent. Teenagers should be given confidential health care and should be trusted to make the choices that regard themselves. They should be allowed the privacy from everyone, including their parents make those choices.
Despite the prevalence of body modification in the adolescent population, legal literature has paid scant attention to the topic. In contrast, there is a strong trend in the legal literature advocating for increased decision-making rights among adolescents in the medical context. (13)