ADOLESCENT

DECISION-MAKING:
GIVING WEIGHT TO AGE-SPECIFIC
VALUES*

ROSALIND

E K M A N L A D D " A N D E D W I N N. F O R M A N b

a Department of Philosophy, Wheaton College, Norton, Mass., U.S.A

b Department of Pediatrics, Brown University Program in Medicine, and
Rhode Island Hospital, Providence, R.I., U.S.A.

ABSTRACT. Adults who give proxy consent for medical treatment for adolescents must
decide how much weight to give to adolescents' own preferences. There is evidence that
some adolescents choose treatments different from what adults see as most reasonable. It is
argued that adolescents choose according to age-specific values, i.e. values they hold, as
adolescents, and which fulfil important developmental needs. Because not fulfilling these
needs may do serious psychological damage, it is urged that proxies give weight to these
values, up to the limit where it would endanger or profoundly limit future life.

Key words: Adolescent, decision-making, proxy consent, informed consent, bioethics,

developmental needs, body image.

t.

THE PROBLEM

Adolescence is a time of ambivalence and bitter-sweet experience. Child

or adult? The feeling of being drawn in two directions is a common one:
sometimes to want to act with the spontaneity of the child and not be held
accountable, other times to be anxious to take on the sober responsibilities
of adulthood, to live with the consequences of one's own decisions.
There is ambivalence not only on the part of the adolescent, but also on
the part of parent, physicians, or others who are charged with the responsibility of making medical decisions for those not legally old enough to
give informed consent for themselves. How should proxy consent be
exercised? How much weight should be given to the adolescent's own
preferences?
Having a role in medical decision-making is related to competency.
Although the competency of children to make medical decisions is generally discounted,' it is hard to dismiss in the same way the competency of
adolescents, especially older ones who may be only months away from
their eighteenth birthday. 2 Even for younger children, there is a growing
trend to include them in decision-making, 3' 4 to allow them virtual veto
power over their own participation in research, 5 or to lower the age of legal
competence. 6
Theoretical Medicine 16: 333-345, 1995.
1995 Kluwer Academic Publishers. Printed in the Netherlands.

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ROSALIND EKMAN LADD AND EDWIN N. FORMAN

If one looks to developmental theories of human growth to help answer

questions about competence, it is easy to assume that growth in the cognitive and experiential maturity necessary to make good decisions is incremental: the older the child, given normal circumstances, the closer to being
able to make reasonable choices, or at least the same kinds of choices that
most adults would make. There is good evidence, however, that this is not
the case. Young adolescents, it seems, will sometimes reject a choice that
even much younger children will choose, along with adults, as the most
reasonable.
The sometimes "unreasonable" choice of adolescents is one of the
findings in a much-cited study by Weithorn and Campbell] Four different
age groups, 9, 14, 18, and 21, were presented four choices for medical treatment of a hypothetical illness, and their treatment choices compared. All
of the age groups chose the same alternative that a panel of medical professionals chose as promising the most reasonable outcome, with the exception of a significant portion of the 14-year-olds.
The study presented this question to the test groups:
Suppose you have had grand real seizures of unknown etiology occurring several times in the first week (presented in language understandable to the different age groups).
The treatment options are:
(a) no formal treatment;
(b) phenobarbitol only;
(c) Dilantin only;
(d) sequential trials on each medication if first trial does not control
seizures.
Dilantin sometimes leads to marked swelling of the gums, excessive
growth of body hair, or both.
Which treatment would you choose?
The adolescents who chose the "less reasonable" alternative rejected any
use of Dilantin. Although the difference between the young adolescent
group and the other groups was not overwhelming, it was statistically significant and it is suggestive of the kind of problems physicians and parents
may experience in trying to determine medical treatment choices for and
with adolescents.
Often a person, child or adult, will choose something that seems unreasonable to others. In such cases, we attribute the choice to some idiosyncrasy of that individual. However, when a whole group of same-age persons
chooses differently from all others, it suggests the need to re-examine the
concept of what is reasonable.
Those adults who exercise proxy consent for adolescents already need

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DECISION-MAKING

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to consider two senses of "reasonable": What is reasonable according to

the so-called objective standard vs. what is reasonable according to the subjective standard or substituted judgment. Deciding for someone else
according to an objective standard means deciding as any reasonable person
would decide. This standard is used for infants and small children, for the
profoundly retarded, or for individuals unknown to the proxy, that is, for
those whose personal values are undeveloped or unknown. Deciding for
someone else according to a subjective standard or using substituted
judgment involves deciding as you think that person would decide, if he
or she were able. This is the standard appropriately used for an unconscious
or comatose or newly-incompetent adult who has already formed a stable
character and set of values which are known to the proxy. 8 Deciding to
use one or the other standard might well lead to different choices; yet either
would be recognized as reasonable.
Using either standard in choosing for an adolescent is problematic. To
choose according to a subjective standard implies that adolescents have
fixed character and systems of values, and this is questionable, especially
for younger adolescents. Choosing according to the objective standard,
however, implies that what is reasonable to the competent adult is reasonable to choose for the adolescent, regardless of the adolescent's stated
preferences or different judgments about what is reasonable.
In this paper we will discuss the nature of adolescents' preferences and
values and the implications for medical decision-making. We will explore
the question of what is reasonable for a proxy to choose for an adolescent.
And finally, we will argue that some of adolescents' choices can be
explained in a way that would justify giving weight to their choices, even
when their choices do not seem the most reasonable to the adults taking
responsibility for the decision.

2.

AGE-SPECIFIC

VALUES

When physicians, courts, and others invoke the reasonable person standard,
they speak as though what is reasonable to choose is reasonable p e r se,
not reasonable to so-and-so or reasonable for so-and-so. The hypothetical
reasonable person is always taken to be a competent adult, with all the usual
desires and aversions. However, judgments of what is reasonable are not
value-free. What seems reasonable to anyone, especially in the context of
making life choices, depends on his or her values.
It is generally acknowledged that different people, as individuals, may
have different values. What is not so generally noticed is that in different

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E K M A N L A D D A N D E D W I N N. F O R M A N

age cohorts people share values similar to each other but different from
people in other age cohorts. Those who work in advertising, marketing, and
publishing have learned to gear their messages to the different age groups.
What we read about in Modern Maturity is very different from what we
read about in Seventeen. Interests are different, and values are different,
too.
Developmental psychologists can help chart the way in which groups
of individuals typically change; as philosophers, we can see connections
between changes in interests and preferences and changes in values.
Following Michael Slote, who writes about period-relative goods, those
which are characteristic of certain life periods and have value only relative
to those periods, 9 we shall refer to the values which typically change with
age and psychological development as age-specific values.
We take as a paradigm of age-specific values the concerns of the 14year-olds in Weithorn and Campbell's study: if one understands the overwhelming importance young adolescents give to body image, ~ then one
can understand why to them the risk of ugly, swollen gums and lowered
hairline is greater than the risk of refusing the most effective medication.
The high regard adolescents typically place on body image, acceptance by
peer group, and independence from family,TM 12 suggests that these may be
referred to as age-specific values.
There seem to be five defining characteristics of age-specific values.
(1) They are generally held by people of a certain age group, and although
not universally held, they are common to the vast majority. (2) These values
are characteristic of a particular age group, i.e. they are not simply held
idiosyncratically by some individuals but are recognized by others as part
of what it is to be a member of that age group. (3) They are values that
are not universal across age groups. Although individuals in other age
groups may hold the same values, it is either not common or typical or, if
it is, it is not held with high priority or intensity. (4) Age-specific values
change, they are passing values, e.g. they may be moved from being topranked at one age to a place of lower importance at a later age or they
may be rejected outright, becoming a negative value or weakness. (5)
Acting according to these values, we shall show, fulfils developmental
needs.
Slote develops his discussion of life values by arguing for a "time
preference" theory of value] 3 The goals and values, goods and evils, of
certain periods are considered of greater significance to one's life, overall,
than those of other periods. People do tend to discount childhood and
adolescent values, judging them by "prime of life" values, and Slote thinks
it is not irrational to do so. It is implied by what Slote says that weight

ADOLESCENT DECISION-MAKING

337

need not be given to adolescent values because they can be discounted in

the total picture of one's life. We will argue, however, that it is sometimes
justified and important to give weight to age-specific values.

3. THE ARGUMENT FROM CHANGE

One reason frequently given for discounting typical adolescent values in
the context of proxy consent is that they are sure to change. 14"15 What seems
important to teenagers will seem trivial even to them later on.
There is a similarity between the principle used to discount some of the
values held in childhood and adolescence and the principle often used to
justify paternalism. Someone is justified in preventing others from doing
what they want, it is said, if they would thank you afterwards for it. Persons
who are about to walk over a broken bridge, to use Mill's example, ~6 will
thank us for stopping them; we have only done what they would have done
if they had been informed. So, too, children who now resist violin practice
will, we presume, thank us later for developing their musical talent. The
point is that we can reasonably override children's choices and preferences on the assumption that they are not truly informed, do not really know
what they really want, and will themselves acknowledge that at some later
time.
One could decide a priori to discount adolescent values whenever they
are different from adult values. A better approach is to ask how to decide
of any values a person holds which ones are "real" vatues. When a person's
values change over time, what should the criterion be to determine which
values to give weight to in decision-making?
Permanence is the criterion of a person's real values according to the
argument from change. Only values which do not change over time should
determine decisions. A value is a person's real value only if it is retained
over time or throughout a lifetime. If it will be repudiated or later judged
trivial, then it is not reasonable to allow it to determine decisions.
The argument from change is very Platonic in nature. Like Plato, those
who hold it assume that whatever changes is not: wholly real and therefore
we should not take it seriously, value it, or make life decisions based on
it. Adolescent values change and therefore the reasonable person would not
allow them to determine important decisions.
There are advantages in using the criterion of permanence. First, it is
the agent who determines what is reasonable, If the individual retains the
same values through time, they are seen as worthy of being given weight.
No one else imposes values on anyone else.

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ROSALIND EKMAN LADD AND EDWIN N. FORMAN

Secondly, it makes sense to say that keeping the same values over time
is evidence of real commitment to those values. If the person sticks to a
set of values, this shows real acceptance of them, and this then justifies
giving weight to those values in decision-making.
Thirdly, the permanence of values indicates their place in the person's
total life plan. Not all adolescent values are passing fancies or relative only
to the adolescent situation. Some are sustained and developed and become
part of prime of life values, as well.
Fourthly, the criterion of permanence is practical and workable: It should
be possible for physicians, psychologists, or others to work out ways of
determining the likelihood of a particular adolescent's values becoming
permanent. Just as an experienced person knows what to ask and look for
in order to judge the maturity of a minor, so one could learn to make a
good guess about the permanence of values.
On the other hand, the problems inherent in using the criterion of permanence are many. One could use it as a general argument for treating adolescents in a wholly paternalistic way. In particular, defining a value as
age-specific defines it as non-permanent, and according to the permanence
criterion, it is therefore not worthy of determining decisions.
Total paternalism toward adolescents, however, undermines the respect
due to their emerging adult selves and underestimates the emotional investment adolescents have in their own values. All other things being equal,
any criterion that implies a wholesale paternalism toward adolescents
should be suspect.
A much more serious problem is this: The same principle that justifies
paternalism toward those adolescents who would choose according to agespecific values will lead to extending paternalism to competent adults as
well, for age-specific values are not limited to children and adolescents.
Adults in the prime of life also hold values specific to and characteristic
of their mid-life period. Erikson extends the stages of development into
young adulthood, maturity, and old age, 17 and the work of more recent
psychologists organizes adult life from empirical data into characteristic
periods, is "seasons" of the life cycle,''19 or "passages. ''2 Values change with
the changes in life-stage: Those who are lucky enough to move on into
old age may repudiate their former workaholic orientation or regret their
earlier disregard for good health practices; they adopt new or different
values or begin to move to center stage some values that lay on the
periphery before.
Thus, prime of life values do seem to meet the five defining characteristics of age-specific values. They are held by a majority of people at midlife, they are recognized by others as characterizing that age-group, they

ADOLESCENT DECISION-MAKING

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are not common to or held strongly by other age groups, they are passing
values, and they fulfil needs of the different stages of adult development.
Psychology Today summarizes it well in saying, "Someone who moves to
the sun belt to lead a life of leisure is socially approved if he's 70, but not
if he is 30". zl
If even prime of life values are age-specific, then what we are doing
when we discount adolescent values in their favor or make paternalistic
decisions for adolescents according to the objective, reasonable person
standard is substituting one set of values, namely prime of life values, for
another set of values, the adolescents.'
At the least, one would have to offer an argument to justify choosing
prime of life values over all others. More particularly, it needs to be shown
that what is reasonable for a person in the prime of life is also reasonable
for all other persons, regardless of their age or stage in life. We shall argue,
on the contrary, that it is sometimes, though not always, reasonable to
choose for others age-specific values which are different from what a reasonable person would choose in the prime of life.
What we see about values, when we notice that they are age-specific,
that they change and are not permanent, is that adolescent age-specific
values are not accepted as reasonable values by and for most adults.
However, the question raised in the context of proxy consent is not whether
adolescent values should be accepted by adults for themselves but whether
they should be accepted by adults for adolescents. This is a different
question and one which is not answered simply by the usual invoking of
the objective standard, or what "the reasonable person" would choose.

4.

THE C O N C E P T OF W H A T IS R E A S O N A B L E

So far, we have considered two questions about adolescent age-specific

values. One has to do with whether or not the values expressed by the
adolescent are real values, and we have argued that values may be a
person's real values, even if they are not held over that person's whole lifetime. In other words, we have argued that adolescents' age-specific values
are no less real by virtue of being age-specific.
The second question has to do with reasonableness: Are the adolescent's
age-specific values reasonable? Here the argument seems to come to a
standstill. Obviously, one's age-specific values seem reasonable to oneself;
one does not easily give them up and even reflection or discussion usually
does not change them.
There are two possible ways of defining what is reasonable. The first,

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a subjectivist position, says that whatever seems reasonable is reasonable,

but this is unhelpful in settling disputes. Even if we broaden it to the whole
class - whatever seems reasonable to most adolescents is reasonable to
choose for them - this is not acceptable because the whole institution of
proxy consent is postulated on the decision not to let adolescents make
treatment choices entirely by themselves, individually or collectively.
The second possible way of defining what is reasonable is also unsatisfactory. It says that what is reasonable is what seems so to a reasonable
person, i.e. what is reasonable to choose for an adolescent is what seems
reasonable to a competent adult. But this is, as we have seen, simply
imposing prime of life values on adolescents and begs the questions at issue.
The concept of age-specific values, as we are using it, poses a challenge
to the traditional view that what is reasonable to one person is or should
be reasonable to all.
Agreement about what is a reasonable choice can be reached, if certain
assumptions are made about goals and values. A paradigm of reasoning
according to the traditional view goes like this: "My primary goal in seeking
medical treatment is to be able to live the longest, healthiest, fullest-functioning life possible. I also do not wish to spend more time, pain, or money
than necessary to assure these goals. Therefore I choose the treatment that,
according to professional advice, will be the most effective, quick, and
inexpensive way to achieve quality and length of life."
Once the usually unexpressed assumptions are expressed, it becomes
clear that choices are made on the basis of values and to say that a choice
is reasonable actually means that the choice is reasonable, relative to a particular set of values. Now add to this analysis that adolescents have agespecific values, i.e., have values which are not shared or at least not given
top priority by members of other age groups, and it becomes clear why
judgments of what is reasonable will vary between adolescent and adult.
What we are arguing is that because of age-specific values, we cannot
expect adolescents always to find reasonable what adults find reasonable,
although often, of course, they do. However, rather than explain this in
terms of adolescents' incompetence, which would have to be judged by
prime of life standards, we want to argue that, under certain conditions, to
be specified below, what is reasonable to adolescents is also reasonable
for them. That is, even though a certain choice may be neither reasonable
for or to adults, nevertheless, the adult who serves as proxy should choose
as the adolescent would choose.
One could argue that it is reasonable for the adult to choose for the adolescent according to adolescent values, just as, to adapt Aristotle's example,

ADOLESCENT DECISION-MAKING

341

it is reasonable, i.e., that everyone should recognize it as reasonable, for

the athlete to eat more meat than the average person. What we want to
argue, however, is a more radical view: Sometimes the adult should choose
something for the adolescent even though it does n o t seem to the adult to
be a reasonable choice, even for an adolescent.
There should be limits on this principle, o f course. It should not govern
every choice, but in cases where there will be a chance to re-evaluate the
choice, where there is only a small chance that it will have a very bad effect
or the likely effect is not life-threatening, then the adult proxy should be
willing to tolerate considerable discomfiture in order to honor the adolescent's own values.
Consider this parallel: You are the physician for an adult who, you
discover, holds a false belief and therefore makes a different judgment about
reasonable treatment options than you do. Most people would think it
appropriate to try to correct the false belief, and would expect the patient
to be able to see the mistake and corlect the judgment. By contrast, you
are also the physician for an adult who has a religious or spiritual belief
which you are convinced is of vital importance to his or her psychological
well-being (e.g., immortality). Because of this belief, this person comes to
judgments about what is reasonable different from yours. Quite apart from
the principle that competent adults have the right to choose for themselves,
would you not also see a utilitarian reason for allowing them to choose as
they see fit? Allowing them their beliefs and the choices that follow from
them helps to protect and to enhance their psychological well-being.
Now - is the case of the adolescent choosing according to age-specific
values more like the person choosing because of a false belief or the person
choosing according to a spiritual belief? Those who would see adolescents simply as incompetent would see them as like the first. But it is also
possible to see them as more like the second.
We have argued, then, that what is reasonable in treatment choices
depends on values and that adolescents sometimes have age--specific values
different from their adult proxies. It will be suggested in the next section
that these values are not chosen, but are given by the nature of the developmental needs of the maturing person. Moreover, psychologists suggest,
not allowing these needs to be fulfilled may result in serious compromising
of the mental health of the individual.

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5. ARGUMENT FOR RESPECTING ADOLESCENT
AGE-SPECIFIC VALUES

To argue for the utility of giving weight to adolescent age-specific values,

we take as our starting point Erikson's concept of the tasks of the adolescent. According to commonly-accepted developmental theory, adolescence
is the time during which psychological growth takes the form of emancipation and individuation, a gradual separation from family and the development of sense of identity and self-esteem.22
In a sensitive discussion of the psychological dimensions of illness and
hospitalization in adolescence, Hofman, Becker, and Gabriel point out that
the sense of self-esteem is highly vested in physical appearance and "any
physical threat to developing body-image concepts . . . bears a unique
meaning in adolescence. "23 Early adolescence, they claim, is most concerned with body-image issues, mid-adolescence with body-image and
emancipation issues, and late adolescence with career and life-style goals.
This characterization of early adolescence is consistent with the treatment
choice of the 14-year-olds as reported by Weithorn and Campbell.
It is also suggested by Hofman, Becker, and Gabriel 24 that physical illnesses that pose threats to the accomplishment of the adolescent's psychological tasks arouse great anxiety, and any protracted interruption of the
developmental processes has the potential for precipitating maladaptive
behavior and even maturational arrest. 25 They recommend great sensitivity
to these issues in the managing of hospitalized adolescents and urge that
adolescents be allowed to share in decision-making.26
There is an intimate connection between adolescent developmental tasks
and adolescent age-specific values: the things that are valued are valued
because they fulfil psychological needs and allow the individuals to fulfil
their developmental needs. The prediction of serious adverse psychological effects when adolescents are prevented from carrying out the various
developmental tasks of their age suggests that these needs and values should
be taken seriously by those who must give proxy consent. Physical illness,
in itself, poses a psychological threat to developing adolescents, and not
allowing them a role in decision-making or overriding their strongly-held
preference adds "insult to injury" and raises the possibility of further
damage.
We are now in a position to re-evaluate the choice of the 14-year-olds
in Weithorn and Campbell's study who chose medical treatment which
would avoid the threat to body image. Given the adolescents' psychological task of developing self-esteem and sense of self, often accomplished
by attaining approval of peers and developing relationships with those of

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the opposite sex, it is reasonable for the young adolescent to choose alternatives that do not threaten the fulfillment of these needs. Rather than being
an inappropriate or trivial value, it fulfils a basic need of the developing
adolescent.
Nonetheless, in urging that weight be given to adolescent values in proxy
decision-making, we cannot escape the fact that there will be times when
the proxy should not concur with the choice of the adolescent. It is our
view that the role of the proxy should be broad: Discuss, educate, reason
with, challenge, and to the greatest extent possible, share decision-making
with the adolescent, and override the adolescent's choices only in the most
extreme cases.
The limits of permissible choices for adolescents may be drawn by not
allowing choices, based on adolescent values, which would make a future
life impossible or severely curtailed. 27 Making choices that will narrow
the possibilities in the future is a necessary part of adolescence; one cannot
wait to decide which talents to develop or to prepare for demanding careers.
But some medical choices might threaten life itself, to the degree that no
future at all can be envisioned or threaten quality of life to a profound
degree. When these choices are based on age-specific values, then they
should not be honored. Refusal of treatment, when based on the same kind
of reasons an adult might give, would not come under this limitation.
Hofman, Becker, and Gabriel suggest setting a wider range for paternalistic decision-making. Although they always recommend seeking the
adolescent's informed consent, they do not do so in the case of amputation. They write: "No teen-ager is really able to consent freely to his own
mutilation." The patient's narcissistic involvement in physical normalcy
and attractiveness virtually prohibits its voluntary acceptance. 28
It has not been the experience of the authors nor that of their child psychiatrist and child psychologist colleagues who are experienced in working
with adolescents facing amputation that adolescents cannot choose that
for themselves, when necessary. It may need some time and it is always
done with reluctance, but it is done. It is also true that adolescents and other
patients are never asked to make such decisions without some interpersonal
interaction, information and discussion colored by the physician's and
family's values, and this undoubtedly influences the decision, as well.
Except for the extreme case o f decisions which would cut off or seriously curtail all possible future for the adolescent, decisions should be overridden only when a similar decision by an adult in similar circumstances
would be overridden, i.e., when it can be shown that the adolescent is
incompetent, not by virtue of age, but on the same criteria as would be used
to judge competency in adults.

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O n e o t h e r c a v e a t is n e e d e d here. It is s o m e t i m e s a r g u e d that d e c i s i o n s
for c h i l d r e n m a y b e b a s e d n o t o n l y on the c h i l d ' s b e s t i n t e r e s t b u t also in
p a r t on the i n t e r e s t s o f p a r e n t s or others. 29 A l t h o u g h w e w o u l d h o l d that
this s h o u l d not g e n e r a l l y a p p l y to a d o l e s c e n t s and d e c i s i o n s should be m a d e
s o l e l y on the g r o u n d s o f the a d o l e s c e n t ' s o w n b e s t interests, w e d o r e c o g n i z e that s o m e t i m e s the costs to o t h e r s o f r e s p e c t i n g a d o l e s c e n t c h o i c e s
w i l l be so g r e a t that t h e y m u s t be c o n s i d e r e d .

6. CONCLUSION
W e h a v e e x p l o r e d the nature o f the v a l u e s that a d o l e s c e n t s h o l d that s o m e t i m e s l e a d t h e m to m a k i n g m e d i c a l d e c i s i o n s d i f f e r e n t f r o m w h a t an adult
p r o x y w o u l d c h o o s e for them. A d o l e s c e n t s ' a g e - s p e c i f i c v a l u e s , it has b e e n
a r g u e d , arise f r o m the d e v e l o p m e n t a l t a s k s o f the age, w h i c h n e e d to be
c o m p l e t e d in o r d e r to a l l o w a p p r o p r i a t e p s y c h o l o g i c a l m a t u r a t i o n . F o r
utilitarian r e a s o n s , then, those w h o are r e s p o n s i b l e for g i v i n g p r o x y consent
for a d o l e s c e n t s s h o u l d g i v e w e i g h t to a d o l e s c e n t s ' a g e - s p e c i f i c values, e v e n
i f the c h o i c e d o e s n o t satisfy the " r e a s o n a b l e p e r s o n " s t a n d a r d and adol e s c e n t s do n o t h a v e the f i x e d c h a r a c t e r r e q u i r e d to satisfy the s u b s t i t u t e d
j u d g m e n t standard.

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Research. Ethical, Medical, and Legal Issues in Treatment Decisions. Washington, DC:
U.S. Government Printing Office, 1983: 132-136.
9. Slote M. Goods and Virtues. New York: Oxford University Press, 1983.
10. Schonfeld WA. The body and body image in adolescents. In: Caplan A, Lebovici S,
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11. Lewis M. Clinical Aspects of Child Development. Philadelphia: Lea & Febinger, 1971:
chapt. 16.
12. Hofman A, Becker RD, Gabriel HP. The Hospitalized Adolescent. New York: Free Press,
1976: chapt. 1.
13. Slote: 22ff.
14. Gaylin: 3.
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16. Mill JS. On Liberty. Rapport E, ed. Indianapolis: Hackett, 1978.
17. Erikson E. Identity: Youth and Crisis. New York: Norton, 1968.
18. Valliant G. Adaptation to Life. Boston: Little, Brown, 1977.
19. Levinson DJ. The Seasons of a Man's Life. New York: Knopf, 1978.
20. Sheehy G. Passages: Predictable Crisis of Adult Life. New York: Dutton, 1976.
21. Anonymous. Life flow. Psychology Today, 1987.
22. Hofman: chapt. 1
23. Ibid: 12.
24. /bid: chapt. 1 and 2.
25. Ibid: 21
26. Ibid: 16, 32.
27. The reasoning here is based on the kind of arguments offered in Feinberg J. The child's
right to an open future. In: Aiken W, LaFollette H, eds. Whose Child? Children's Rights,
Parental Authority, and State Power. Totowa, NJ: Rowman and Litttefield, 1980:
124-153.
28. Hofman: 174.
29. See, for example, Brock.