Should adolescents have the right to make their own autonomous medical decisions?
The topic that will be researched is medical decision making, more specifically involved with the autonomous rights in adolescents, as well as their capacity to make there own medical decisions. This will include research about the ethics and the morals behind allowing adolescents to make there own medical decisions. I will also explore legal context involved including minor rights, and the legal extent of involvement the patient, the family, and the doctors are allowed. I will also research the emotional and psychological factors involved. More specifically how emotion and information processing is altered due to high stress situations caused by life threatening
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Life threatening illnesses result in altered mental status as it correlates with depression and anxiety. As autonomy and independence has increased, awareness has also increased, causing the topic to to be very controversial. Many physicians and physiatrists have voiced their opinions on what determines the mental capacity to make rational medical decisions without violating ethical and moral standards. Psychologist Dr.Horowitz explains that anxiety and depression impacts reason and information processing. Depression the patient's mental and physical state are all aspects that will prompt the patient to feel hopelessness and pain. Medication will also affect mental state, thus impacting the actual medical choices made. This is presented in a study conducted by Dr. Martin Stein shows that teenagers who are being treated for life-threatening illnesses have high rates of depression that may be amenable to treatment. This can be seen in a medical case of Jorge, a 13-year-old male, who was admitted and treated for the recurrence of acute lymphocytic leukemia. “The oncologist explained that Jorge’s only real chance at survival would require a bone marrow transplant. On returning home, Jorge announced to his parents that he would refuse the transplant and did not want to be placed on the list. His doctor noted that Jorge appeared to be very …show more content…
Understanding their illness, treatment, and situation completely is a huge part of being able to making a decision as substantial as their health. Adolescent capacity for intellectual reasoning is crucial in order to understand both the risks and benefits of a medical treatment. This is difficult for adolescents to achieve because of the lack of reasoning and maturity due to the brain not being fully developed at this stage. Evidence provided by scientist have discovered and identified that a specific region of the brain called the pre-frontal cortex, an area of the brain that controls reasoning, continues to change and develop until matured into adulthood (Harper Collins). The pre-frontal cortex affects understanding, and maturation. Scans of the brain show that adolescent brains function differently than those of adults when asked to solve problems, “Their actions are guided more by the emotional and reactive amygdala and less by the thoughtful, logical frontal cortex” (AACP). A brain that is not completely developed affects the capacity to make medical decision because it causes adolescents to lack judgement, reasoning, and the ability to completely understand the consequences of their
The article “Dude, Where’s My Frontal Cortex?” by Robert Sapolsky talks about the delayed maturation of the frontal cortex in teenagers and how the underdeveloped frontal cortex is the cause of erratic behavior of teenagers. Sapolsky explains to the reader how the frontal cortex does not fully develop until the age of twenty for a person and how that part of the brain is important for extensive reasoning, impulse control, and emotional regulation. He shows the reader how particularly emotional situations affect both a teenager and an adult differently due to either having or not having a matured frontal cortex. This example that he uses allows for the reader to see how a teenager responds to situations with extreme thoughts and behavior which
The article “Inside the Teen Brain’ by Marty Wolner, states that the human brain provides parents with shocking new evidence to possibly explain the sometimes irrational, illogical, and impulsive behavior of teenagers. Teenage years are radically more active and dynamic than they previously thought. So teenagers are left with most of the information reaching their brains being processed in the emotional part (limbic system). Information processed in the limbic system without benefit increases the processing in the prefrontal cortex. It may result in impulsive, egocentric, and maybe even risky behavior choices. The prefrontal cortex of the teenage brain does not excuse inappropriate or irresponsible behavior from the teen. The brain is not yet
When it comes to the teenage brain it’s obvious that they aren’t fully developed. According to Frances Jensen “a mother, author and neurologist” (83), a teenager is missing the frontal and prefrontal lobes of the brain in which adults possess. “The frontal lobes are the seat of what’s sometimes called the brains executive function and is responsible for planning, for self-awareness, and for judgement” (84). Being that a teenager lacks planning, self-awareness and judgement due to a missing brain function, they are subject to not thinking and being aware of circumstances in a difficult situation. For example, Kolbert states that her adolescent sons participate in a “fun pastime known as a ‘case race’” (83). A case race is when “participants form two
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.
Recent research has shown that the human brain continues to develop throughout childhood and adolescence, and may not be fully mature until the mid-20s. The prefrontal cortex of the brain, which regulates “executive” functioning skills, such as decision-making, planning, judgment, expression of emotions, and impulse control, is one of the last to
Neuroscientist performed MRI test on the brain of a child and one of an adult. Their test had shown the key differences of the frontal lobe in the adolescents compared to the adult. The frontal lobe is composed of types of cell matter and contains different neural features compared to the brain of an adult. When the frontal lobe develops it prevents aggression, rage, and the ability to take in long-term consequences and abstract thinking (Human Rights Watch).
The evidence shows that this specified area of the brain is under developed in teenagers, and that their impulses are not always thought out. Teen brains are underdeveloped when it comes to the decision making process is important information and should be taken into consideration when a juvenile is charged with any offense. In addition, with new found evidence of brain development being released doctors and psychologists seem to be in agreement that the findings should be taken seriously. For example, an article posted in the “Observer” in 2013 by Andrew Meriuzzi, Dr Helen Neville an internationally renowned psychologist and neuroscientist implies “Our biggest job will be to convince the public and policymakers to demand evidence and to evaluate evidence.” (Merluzzi 2013) Statements from credible sources may open the eyes to the public, that teenagers need to be evaluated thoroughly before being condemned to cells like rats. It is important to have the physiologists and scientists input so they the world can move forward with proper treatment of our youth. In relations, professionals and specialists are fully aware of a child's state of mind and are trying to alert the public to approach youth thoughtfully. Another strong quote from Dr. Neville comes in her cries for action “For the sake of the economy and the sake of the children, let’s take this evidence-based approach to reducing inequality,”. (Merluzzi 2013)Helen's plead sheds light that a teenager is
It turns out that the development of the brain through a teenagers life, greatly impacts the way they react to situations and the choices they make, whether it be good or bad. For example, when Romeo and Juliet fell in love, they didn’t exactly stop to think if the consequences would be bad or not, most logically explained by the ongoing development of the brain. Romeo and Juliet must have been using the amygdala, the part of the brain that is responsible for guiding instinctive reactions, to substitute as the prefrontal cortex, which would fundamentally describe Romeo and Juliet's behavior and why they decided to get married way to early. The development of the brain gives the brain no choice but to process information through a different part of the brain called the amygdala. The amygdala definitely helps to substitute for the prefrontal cortex, however it can also be responsible for reacting to a situation without thinking of the outcomes, which is why teengers, like Romeo and Juliet, sometimes make negligent and careless alternatives, which end up in bad consequences. The author of an article noting the development of teen brains explains how “[e]ven though the brain [of a teenager] is almost physically mature, the grey matter in the thinking part of the brain (pre-frontal cortex) is still making
The primary issues presented in this case are related to the cultural as well as the religious factors affecting the medical decision making as well as disease management. This involves Rivka Cohen, who is a six-year-old girl diagnosed with cystic fibrosis (CF). Rivka and her family live in a tight knit Hasidic Jewish community where daily life is built on ancient laws and religious devotion. The Cohen family have acknowledged that their daughter requires treatment for her medical condition, but are struggling to find a compromise between their religious and cultural beliefs and the cf treatment team’s recommendations. The Cohen’s medical decision making and disease management is heavy influenced by their cultural and religious beliefs in conjunction with input from their rabbi. At the present time, the CF treatment team has established a treatment plan, but the Cohens are having a difficult time adhering to this plan due to several factor that will be discussed.
The Negative disagrees with a passion the resolved “Adolescents ought to have the right to make autonomous medical choices.” Definitions will play a vital role within this debate as they themselves could be debated. I shall now attempt to provide objective and fair definitions. Adolescents is the “age which follows puberty and precedes the age of majority according to Black 's Law Dictionary. This vague definition gives way to the World Health Organization’s definition that states adolescents as “young people between the ages of 10 and 19 years.” But within the confides of the United States Justice System “you are a minor under the guardianship of your parents” until the age of 18 again according to the Black’s law dictionary. So for the sack of debate we will define adolescents as being any person between the ages of 10-17 beginning at the average age of puberty and ending before the individual becomes a legal adult under full constrains of the law. Ought is defined by Merriam Webster dictionary as to express obligation or natural expectation. To have the right is defined by Black’s Law dictionary as “A term applied to rights, privileges, and immunities enjoyed by all citizens EQUALLY and in common, and which have their foundation in the COMMON LAW. Autonomy is the “personal rule of the self that is free from both controlling interferences by ANY other party and from personal limitations that prevent meaningful choice,” according to University of California San
Teenagers have more filters but still don’t have a fully-formed prefrontal cortex, the brain’s rational thinking arena. Teens are hovering on the brink of adulthood, but without a complete set of judgment tools at their disposal, they will revert to immature responses as soon as things don’t go their way.
The four ethical principles of Beauchamp and Childress’s framework are essential in the medical decision making for adolescent patients. Those bioethics principles include justice, beneficence, non-maleficence, and autonomy (Ishibashi, Lewis, & Baker, 2016). Generally, all patients regardless of their age should be involved in their care along with their families. Moreover, patients are entitled to certain degree of autonomy or assent according to their cognitive levels, which involve self-determination of providing informed consent and accepting or refusing treatment (Ivey & Browen, 2012). For many years, there was a growing literature to support adolescences involvement in clinical decision making of their care. In 2000, the United Nations Convention on the Rights of the Child added articles 12 and 13 states that all children have the right to convey their thoughts and express their opinion openly. Those articles obligate governments to establish reinforcement of autonomy. In light of the ethical and legal obligations pediatric health care providers modified the respect of minor’s autonomy principle. This modification addresses the developmental cognitive capacity in adolescent population to establish the legal responsibility of minor’s decision making. Adolescents intellectual growth and ability to analyze all the benefits, risks and treatment goals must be
I know that there are so many issues that can influence the adolescent’s ability to partake in the decision making process such as age, knowledge, and development. If you compare an adult to an adolescent, the adult brain is already developed and capable of making rational, careful decisions. For example, if an adult were to make a decision on abortion, they would carefully weigh all their options, talk about it with close family, friends, and decide what to do next. Where as an adolescent, their brain is still “premature, ”which can effect their decision on abortion. The prefrontal cortex is located in the adolescent’s brain, and it is the area of the brain that’s not fully developed. This part of the brain controls reasoning, impulses, emotions, forms judgments, and helps people think before they act. Therefore, it plays a huge role for people, especially when having to make such crucial decisions. More often than not, adolescents are less likely to think before they act, and they normally don’t consider the consequences of their decision. Whole –heartedly, I believe that adolescents are not mentally prepared to make a decision on getting an
There are many legal and ethical situations that healthcare providers will be faced with when providing medical treatment to either a child or an elderly adult. While there is often much discussion regarding the elderly and do not resuscitate orders, there are often times when the decisions for health care of a child may be overlooked. Some of the legal issues that may be faced by healthcare professionals are informed consent, confidentiality, reproductive services and child abuse. Patients have the right to decide what is done to their own bodies, but for children under eighteen, their parents decide for them. A major issue faced by healthcare professionals is parental refusal for treatment. Healthcare providers will be faced with many conflicting ethical and legal situations regarding refusal of a minor’s healthcare and treatment. These issues
This paper will write the story of JT, clinical patient of mine. The paper will document her account of our interactions using her eyes and voice. The story will include health assessment data, labs, and a physical assessment. Elements of JT’s journey will also include her culture, level of pain, spiritual and psychosocial stance and ethical issues that arose. The paper will then detail the patient decision making process and strategies in a systemic manner to analyze the situation and help determine what could have been done better. The decision making process will also attempt to identify elements where the patient care could have been improved and determine what went well and what actions or assessments made had no basis in the guidelines or protocol. Additionally, analysis concepts will be integrated with continuous quality improvement (CQI) initiatives. An approach for change process using the Plan-Do-Study-Act (PDSA) model will be described as it applies to this patient scenario and will include clinical guidelines. The paper will then utilize the results from my completed self-assessment tool as well as the self-reflection and self-discovery to analyze the process of clinical decision making.