Peer 1

Catherine Peer

Mr. Davis

ENG 101

12/18/23

Ray Dalio, an American billionaire, once said, “The quality of your life ultimately

depends on the quality of your decisions.” This seems pretty straight forward to the average

person: if they make good decisions they will see positive outcomes. But for someone who does

not have the ability to make their own decisions this is not the case. For someone under the age

of 18, a decision that their parents make can change the entire course of their life, even if the

decision goes against the child's wishes. This is why it is crucial for parents to have an open

discussion with their child about the medical decisions for the child.

In the United States, after 18 trips around the sun, people have collectively come together

to decide that someone is capable and deserving of being able to make their own life choices.

Many people would say that “being an adult implies being able to make mature decisions,

participate in civic matters, have self-control, and be responsible,” (Christensen). Although the

baseline number of 18 seems like a genuine age at which one should be able to make their own

decisions, it also leaves room for discretion. It is unarguable that some people under the age of

18 possess the ability to make rational, good decisions and would be able to make responsible

choices that would have a positive impact on their lives without any problems. Now in the same

argument, there are absolutely people over the age of 18 that cannot make good decisions for

themselves. Even though they are of an age where rational decision making should come easy to

them, they still cannot seem to make responsible choices concerning their life. This goes to prove

that there is no concrete age where a person takes on the responsibility to make good life
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decisions. The ability to make rational decisions is less about an age, and more about the person

themself.

So when is a good time for minors to start making their own medical decisions? This is a

loaded question that has no right or wrong answer. The answer is based on morals, ethics and

individual experiences. As children grow into adults, “it is generally asserted that… there is an

increasing capacity for abstract reasoning, counterfactual reasoning, reasoning from premises

that are not true, systematic reasoning, and a growing capacity for probabilistic reasoning,”

(Fischhoff). Although this supports that as children grow and mature they develop the skills to

make good decisions, it also shows that there is no concrete age at which children should be

responsible for their own decisions. No two people are the exact same and no two people’s brains

will develop at the same rate. So the answer for this question is not as easy as black and white.

The main focus on finding out when one is ready to make their own decisions is their maturity.

But for someone under the age of 18, a minor per se, they could be left with no way to

make their own medical decisions, not based on their maturity or their decision-making abilities,

but solely because they are underage. The inability to make decisions pertaining to their medical

health could cause minors a great deal of stress. It can create frustration, especially if the person

who is making their medical decisions, such as a parent or guardian, is going against their

wishes. These young adults are usually mature and completely capable of making their own

decisions. They could feel that their freedom is being threatened because they cannot make the

choices that they want concerning their own bodies. Even if the person making the decision is in

the child’s best interest, the decision itself could make the child unhappy or make them feel like

they do not have freedom. It is unfair to force someone to go against their free will, simply

because they are underage. In the United States people emphasize freedom and liberty. Everyday
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in school, children recite the pledge of allegiance which ends with the words “indivisible, with

Liberty and Justice for all” (“The Pledge of Allegiance”'). Schools print these words into

children's minds from kindergarten on, but fail to inform them that they are not part of ‘all’ until

they turn 18. It is unfair to base someone’s freedom on their age alone and is something that

needs to be addressed in the United States.

An important aspect of patient care in the medical field is autonomy. The inability for a

minor to make their own decisions can limit their autonomy and their freedoms. When facing the

debate of who should be making a minor’s medical decisions their is a huge ethical dilemma

because, “a central tenet to much ethical argument within medical law is patient autonomy…

competing concerns for greater welfare and individual freedom, complicated by an overarching

commitment to value-pluralism, make this a tricky area of policy-development… there are

distinct understandings of, and justifications for, different conceptions of autonomy” (Coggon

and Miola). Obviously a minor that does not have their own best interest in mind or the mental

capacity to understand the situation should not be responsible for making their own medical

decisions. In the event that a minor is incapable of making their own decisions, it is reasonable

that a parent would be the one to decide on the best medical choices for the child. However,

when a child is capable of making medical decisions, physicians cannot honor both the

autonomy of the patient, the minor, and the wishes of the parents if they do not coincide. It can

put medical professionals in murky waters, because there is no possible way to appease both

sides if they have completely different views.

When looking at this dilemma in the terms of right and wrong there is often a large gray

area that can only be filled by the physician's own moral standing. This leaves them with a

difficult decision, whether to honor the patient’s or the parent’s wishes. When looking at these
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dilemmas from an ethical standpoint alone, it could be difficult to decide whether to honor the

patient's autonomy or the rights of the parents to make decisions that affect their child’s life. In

one study “when prognosis is poor, pediatricians prefer shared decision-making over unilateral

decision-making. However, when there is no family consensus and the prognosis is poor, minor

autonomy is an important principle” (Talati et al.). The ethical dilemmas that a provider may

face when both parties do not agree on the best route for treatment. On one hand, the provider

must respect the wishes of the parents but on the other hand, it is not fair to take away a patient’s

right to self determination, no matter what their age is. When faced with a situation where a

patient’s wishes and their parents' wishes do not align, it is important that a physician uses their

best discretion to see what is in the patient’s best interest and uphold patient autonomy to the best

of their abilities.

These disagreements can also cause physicians legal trouble in some situations, even if

they do the right thing morally. When faced from a legal standpoint, “there is a substantial

consensus among ethicists that harm is the central moral concept when judging the appropriate

threshold for state intervention in parents’ medical decision-making” (McDougall and Notini).

Physicians do have a say in whether or not to honor a minor's wishes, when they go against the

parent’s wishes, but only if harm is presented by the parent’s wishes. Whether that harm is

blatantly obvious or more subtle, a physician is responsible to do no harm, based on the

Hippocratic Oath. Therefore, when a parent’s wishes have the possibility to cause harm, a

physician may choose to go against them or get the law involved.

Legally, a minor is the complete responsibility of their parents, unless there is an

exceptional situation (such as an alternate guardianship, abandonment, emancipation, etc). This

means that they are responsible for the minor's actions, good and bad. They are also responsible
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for supporting the minor with the basic necessities to live. Some people would argue that this is

enough to prove that parents should be the ones responsible for making medical decisions for

minors. They may reason that if an adult has to support a minor, then they should be making the

medical decisions for the minor. However this is a false cause, since the decision-making

capability of the minor is not affected by the fact that they are supported by their parents. Minors

should not have their liberties taken from them just because of their age and it is unfair to expect

them to comply with ideas that are not in their best interest.

To put this into a better perspective, legality is a large contributing factor to whether a

minor gets to make their own medical decisions. This is present in abortion cases. The ability of

minors to make their own medical decisions or not is especially apparent when focusing on

abortions. Abortions have been a hot topic for decades. In the United States the abortion debate

is a never-ending battle between pro-life and pro-choice groups. However the main point around

this debate is the ability for someone to have the freedom to do what they please with their own

body. When minor’s face this dilemma it can be even more complicated than just the abortion

debate alone.

So what happens when a young girl gets pregnant and her parents will not allow her to

get an abortion? The effects of her inability to make her own medical decisions will have a

lasting impact on her, even when she is no longer a minor. This is not an uncommon dilemma.

Without the consent of her parents, a young girl would have to carry the child against her will or

resort to unsafe options to terminate the pregnancy. Many states step in on these situations based

on their own individual abortion laws. For example, “on March 28, 1991, the Michigan

legislature enacted a statute entitled The Parental Rights Restoration Act … to probate court

judges the extraordinary task of deciding whether a minor girl may have an abortion without the
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consent of a parent” (Scarnecchia and Field). This gives some minor patients the right to make

the decision to have an abortion even without the consent of the parents. Laws like these help

make sure that no young girl is forced to carry out a pregnancy that they don’t want to. This

situation is best for the minor and the state is keeping the patient’s autonomy in mind because in

the grand scheme, the patient’s rights are being upheld.

However not all states focus on upholding patient autonomy. On the contrary to the

Michigan legislatures, Minnesota legislatures decided on a law that “requires physicians to notify

both parents of a minor's intention to have an abortion, unless the procedure is necessary to save

the young woman's life, both parents have given their written consent to the procedure or the

minor reports to the authorities that she has been sexually or physically abused by a parent”

(Greenberger). In this scenario, a minor’s rights would mean very little compared to the parent’s

decisions. With the requirement that parents are notified and must give consent to a minor having

an abortion, there is more room for conflict and the possibility that the patient’s autonomy is

being constricted. The situation here is much bigger than pro-life or pro-choice. The idea of

forcing a young girl to carry a child against her will is a problem that cannot be left unaddressed.

Common ground must be found where states prioritize the rights of the patient over their age.

Another situation that concerns a minor’s ability to make their own medical decisions are

those battling a terminal illness. When a child goes through a terminal illness, it is heartbreaking

for both the child and their family. No mom or dad wants to watch their child struggle. So when

a child is ready to stop treatment and focus on comfort it can be difficult for a parent to ‘give up’

and let their child pass away. Some parents may be overwhelmed with this and refuse to allow

the child to stop treatment, even if the child is suffering. In these cases, the child has little say in

whether or not they want to continue treatment and may have to if that is what their parents wish
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to do. When these cases go to court, “minors’ decisional capacity becomes relevant only after

legislatures or courts determine that the default of parental discretion does not…protect

implicated constitutional rights in a particular health care context and that those goals can best be

achieved or rights best protected by authorizing capable minors to choose for themselves''

(Weithorn). This means that many times minors only get to make their own health decisions by

themselves if the parents do not have the child’s best interest in mind. So if a physician views the

parents decision as ‘good enough’ the minor will have no say in their own medical decisions. In

a sense of a long painful life or a short peaceful death, the parents must look past their grief to

decide what is best for the child. No child should have to suffer through a terminal illness or be

forced to continue treatment, to save the feelings of their parents. It is morally wrong and unfair

for the child.

The idea of the best interest of the child can be understood in different ways as well,

which puts even more pressure on the physician to make the best decisions for their patient. The

goal of a physician is to help people improve their patient’s lives. But does this mean extending

their life as long as possible or giving them the best quality of life? They would not want to do

something out of their scope of practice or anything that would put their career in jeopardy.

However they also can not let their feelings or personal judgment alter their ideas of what is best

for the patient. In the scenario where a patient, who is a minor, and their parents do not agree on

the route of treatment, a physician must ultimately use their own discretion and their knowledge

of medicine to decide if either party is being unreasonable or if the patient’s best interest is the

motive for both decisions.

When parents make medical decisions that blatantly go against their child’s wishes many

people come up with the same question: why can’t they compromise on the best route for care?
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Many problems could be resolved if both the parents and the child went into the discussion with

an open mind. Studies show that, • “improving parent-adolescent communication… may affect

child factors… that influence an adolescent's intentions… and subsequent behaviors… the

quality of the parent-adolescent relationship may influence how an adolescent responds to a

parent's belief… if the parent and adolescent have a distant relationship, the child may be more

likely to dismiss the parent's view; if the relationship is close, the parent's opinion may influence

the adolescent's intentions and behaviors'' (Eastman). According to the study, when parents make

the effort to build relationships with their children, they will be more respectful of the parents'

ideas and will be more likely to make a compromise that fits both of their wishes. This would be

the best scenario where everyone has some say in the decisions being made.

In conclusion, as a nation, it is important that the rights of citizens are respected and that

the liberties stated in the Constitution are upheld for everyone, regardless of their age. For the

states, this means that laws are in the best interest of the people and no one can be forced into a

situation that harms their freedom. In the terms of the medical field, it is crucial for physicians to

focus on patient autonomy and make sure that the care they provide is in the best interest of their

patient. Physicians cannot get caught up in their own moral standings and must focus on the

patient’s care. When looking at parent-child relationships, it is important that there is a mutual

respect for one another’s ideas and decisions. It is important that parents respect their child’s

wishes, but it is also important that the child takes into consideration their parent’s opinions as

well. When faced with tough decisions the ideal situation would be a compromise between the

parents and the child to decide what medical decision is best for the child. However when a

compromise cannot be made, the patient’s autonomy must be honored, as long as the patient is

capable of making their own decisions. A person’s control of their own body should not be taken
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from them on account of age and no one should be forced to go against their own medical

wishes.
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Works Cited

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States Now, 5 Nov. 2023,

www.unitedstatesnow.org/at-what-age-is-someone-considered-a-legal-adult-in-the-us.htm

Coggon, John, and José Miola. “AUTONOMY, LIBERTY, and MEDICAL

DECISION-MAKING.” The Cambridge Law Journal, vol. 70, no. 03, Nov. 2011, pp.

523–547. Google Scholar, www.ncbi.nlm.nih.gov/pmc/articles/PMC3535760/,

https://doi.org/10.1017/s0008197311000845. Accessed 11 Dec. 2023.

Eastman, Karen L. "Talking Parents, Healthy Teens: A Worksite-Based Program.." Preventing

Chronic Disease, 2006, pp. 1-10. ProQuest; SIRS Issues Researcher,

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National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK224102/

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https://explore.proquest.com/sirsissuesresearcher/document/2267212645?accountid=5809

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Accessed 18 Dec. 2023.

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