LD Sept Oct 2015 Aff

7/24/2019 LD Sept Oct 2015 Aff

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Af

I affirm the resolution, Resolved: Adolescents ought to have the right to make autonomous medicalchoices.

I ofer the ollowing denitions or the debate:

The World Health Organization denes adolescents thusly:(WHO,Adolescent Development, http:!!!.!ho.intmaternal"child"adolescenttopicsadolescencedeven,#$%&'

WHO identies adolescence as the eriod in hu!an growth andde"elo!ent that occurs ater childhood and beore adulthood# ro! ages

$% to $&'t represents one o) the critical transitions in the li)e span and is characteri*ed + a tremendous pace in gro!th andchange that is second onl to that o) in)anc. -iological processes drive man aspects o) this gro!th and development, !ith theonset o) pu+ert marking the passage )rom childhood to adolescence. he +iological determinants o) adolescence are )airluniversal/ ho!ever, the duration and de0ning characteristics o) this period ma var across time, cultures, and socioeconomicsituations. his period has seen man changes over the past centur namel the earlier onset o) pu+ert, later age o) marriage,ur+ani*ation, glo+al communication, and changing se1ual attitudes and +ehaviors.

According to the A!erican Heritage (ictionary# rights are: (AmericanHeritage Dictionar (online', Rights, http:dictionar.re)erence.com+ro!serights, #$%&'

That which is due to anyone by )ust clai!# legal guarantees# !oralrinciles# etc

*erria!+Webster denes autono!y as: (2erriam3We+ster Dictionar(online', autonom, http:!!!.merriam!e+ster.comdictionarautonom, #$%&'sel+directing reedo! and esecially !oral indeendence

I ,alue *oral Autono!y'

*y -riterion is (educti"e .ogic

First, my criteria of deductive logic is a strong method of reasoning.

Driscoll &Zepeti, 2003(William Driscoll, Joseph P. Zompetti, Discovering

the World Through Debate ! Practical "uide to #ducational Debate for Debaters,

$oaches and Judges, P. %&'%)

In deduction, the reasoned draws a particular conclusion from general

truths. . .Deductive arguments are inherently strong. If the premises are true,


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then the conclusion must be true. In order to dispute the conclusion, one must

disprove the truth of the premises.

*econd, my value of individual moral autonomy is a fundamental value.

Without individual moral autonomy, there is no basis for ma+ing any ethical

udgment.

ill, 20!3, Thomas -ill, in liver *ensen, editor, /ant on 0oral !utonomy,

$ambridge 1niversity Press, p. 2.

"ant argued that autonomy of the will is a necessary presupposition of all

morality. -is idea of autonomy is abstract, foundational, normative and a +ey to

his defense of the rationality of moral commitment.

3ndividual moral autonomy is a universal value and goal.

#ensen, 20!3, in liver *ensen, editor, /ant on 0oral !utonomy, $ambridge

1niversity Press, p. .

$he concept of moral autonomy is one of "ant%s central legacies for

contemporary moral thought. $oday autonomy understood as individual

independence from coercion in ma'ing decisions is variously considered to

be a capacit all normal adults have, agoal one should strive for, and especially

a moral right one can claim from others.

This is the most important value in the debate round.

(hristie !)**, "eorge $hristie, The 0oral 4egitimacy of the 0inimal *tate,

!ri5ona 4a6 7evie6, 8ol. 9, 9:: p. ;


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/irst# disresecting their rights har!s their !oralautono!y'(Alicia Ouellette, Dean 4 5ro) o) 6a! 7 Al+an 6a! 8chool, -od 2odi0cationand Adolescent Decision 2aking: 5roceed !ith 9aution, ournal o) Health 9are 6a!

and 5olic, vol & iss % art ;,http:digitalcommons.la!.umarland.eduAlthough theira+ilit to e1ercise their rights, or to act as )ull autonomous +eings ma +e

developing,the adolescent has rights to bodilyintegrity# sel+deter!ination# and ri"acy'? $;Tobest resect the erson o the adolescent# theserights should be recognized and rotected to a degree

commensurate !ith the a+ilit o) the individual involved to e1ercise them.? $@ Thecosts o disresecting the adolescent as a rightsbearing erson are high'%$ As 5ro)essor enni)er Rosato, a strongproponent o) increased decision3making rights )or adolescents argues,ailureto resect the 1burgeoning autono!y1 oadolescents will likelhar! 1their ersonhood#esecially when the health care decision in"ol"esthe e2ercise o !oral )udg!ent' I adolescents

cannot !a3e these decisions or the!sel"es# they!ay be orced to li"e a lie they ha"e not chosenand certain uture oortunities !ay be oreclosedto the! er!anently'11

4econd# this autono!y is 3ey to the de"elo!ent o*orals(Bim+erl *utcherson, Assistant 5ro)essor o) 6a! 7 Rutgers 8chool o) 6a!C9amden, Whose -od is it An!a An Epdated 2odel o) Healthcare Decision32aking Rights )or Adolescents, 9ornell ournal o) 6a! and 5u+lic 5olic, 8ummer

0%%5'4o!e wouldalsodecry the increased ressure laced onadolescents + this proposal +ecause it ma reFuire them to participate inconversations !ith !hich the are uncom)orta+le or that reFuire comple1 decision3

making. =irst,the roosal in"ol"es young eole in a "arietyo decision+!a3ing rocesses thus gi"ing the!


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oortunities to 1ractice1 their s3ills in less chargeden"iron!ents and !a3ing the! !ore li3ely to !a3einor!ed# reasoned decisions when aced with !orechallenging 6uestions' 4econd# increasing autono!y is a

ste in the rocess o !oral de"elo!ent or youngeole: 7oth cogniti"e+de"elo!ental and social learningtheorists e!hasize that signicance o articiation inroleta3ing in deter!ining the rate o !oral de"elo!ent'8ssentially# !oral+de"elo!ent theorists concetualizeachie"e!ent o !ilestones in cogniti"e de"elo!ent asnecessary but not su9cient or rogress in !oralde"elo!ent' /or e2a!le# ro! a cogniti"ede"elo!ental ersecti"e# )ormal operational thought thecaacity to thin3 abstractly; is necessary or the

attain!ent o rinciled !oral reasoning' Howe"er#attain!ent o such reasoning based on abstract ethicalrinciles also re6uires e2tensi"e e2erience withresol"ing ethical roble!s in social interaction ande2osure to di"erse# GhigherG oints o "iew' #$%Thus# byallowing young eole to gi"e consent to routine care# wecreate better healthcare consu!ers o"er the long+ter!'7y re6uiring that young eole lay an acti"e role indiscussions and decisions about their own healthcare# this

roosal see3s not onl to impact the actions o) parents and healthcareproviders, +ut alsoto create oortunities or ositi"e growthand accetance o sel+regulation in young eole. #$ #While the burden created here !ay be hea"y in so!ecircu!stances# that burden is art o autono!y# and wedo not aid adolescents in learning how to direct their owndestiny i we are araid o gi"ing the! control o"er thatdestiny' 7y lacing the! on e6ual ooting with theirarents# the law teaches young eole lessons aboutintra+a!ily resect and lessens reliance on outdated notions o) parentaldominance.

4uch a !oral dile!!a is resent in an instance othe reusal o treat!ent'

2artin Har"ey, 5h.D., is an Assistant 5ro)essor o) 5hilosoph at 9leveland 8tate


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Eniversit. (Health 2atri1: ournal o) 6a!32edicine 8ummer, 0%%The !oti"ating ethical ideathere+ captured, o) course, is that adults o) IJ$K sound mind areautono!ous beings whose choices# including whether ornot to consent to !edical treat!ent# ought to beresected' The )actual 6uestion# aside )rom having reached the age o)ma' or ?ena#

who has been declareda mature minor @co!etent in this conte1tdeser"es to ha"e her reerences and desires gi"entre!endous weight# +ordering on those o) a legal adult.4he shouldnot be recluded ro! ossessing and e2ercising certainrights nor!ally associated with adulthood'#;mportantl,ho!ever, and unlike someone !ho has reached the age o) ma


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e"idence standard +e)ore +eing aMorded such a change in her legalstatus.#@he onus is thus on herto ro"e co!etency bye"idencing her caacity to ro"ide a thoroughunderstanding o the conse6uences o her roosed

decisionto terminate treatment

along with well articulatedreasons as to why her decision ought to be resected'=ollo!ing n Re 6ong sland e!ish 2edical 9enter, adolescents !ho )ail to measureup to such a demanding standard !ill +e denied a right to re)use medicaltreatment.#he courts have thus primaril adopted an evidentiar approach toadolescent competenc/ IJ$& it constitutes the e1ception, not the norm.=urthermore, even i) an adolescent meets these evidentiar reFuirements, her rightto re)use, unlike that o) a competent adult, is + no means a+solute 3 her decision tore)use treatment ma, +ut need not, +e trumped + principles (#'3(K'.

And such co!etence is co!letely ossible'

(Rhonda a Hart!an# B'(., 5h.D., Decisional Autonom )or 2edical 9are:5hsician 5erceptions and 5ractices, he Eniversit o) 9hicago 6a! 8choolRoundta+le, vol @ iss % art &, :

http:chicagoun+ound.uchicago.eduroundta+levol@iss%&,0%%$'82isting literature related to adolescent decision+!a3ingcaability or !edical care suggests a le"el o decisionalcaacity not resently resu!ed by law' n )act, severalstudies re"eal that adolescents decide on their !edicalcare with an intentionality and thoughtulness not usuallyattributed to the!'&@ 5articularl,co!!entators ha"e ound

1little e"idence that !inors o age $5 and abo"e as agrou are any less co!etent to ro"ide consent than areadults'1 & =or e1ample, 6ois Weithorn and 8usan 9amp+ell, !hen studingdiMerences in decisional a+ilities among children, adolescents, and oung adultsusing standardized !easures o co!etency and clinical"ignettes# reported that1!inors aged $C were ound tode!onstrate a le"el o co!etency e6ui"alent to that oadults.G >$ hese results, according to Weithorn and 9amp+ell, con0rm theG)ormal operational stageG concept proMered in the %&$s + ean 5iaget, !hopostulated that cognitive development and reasoning a+ilit is attained + earl

adolescence. 9ontemporar researchers in cognitive development challenge the5iagetian stage model, >% instead opting )or Gspeci0c task per)ormanceattainment,G !hile e1tolling the 5iagetian tradition as a valua+le contri+ution to an

understanding o) the sel).4trengthening this research are theresults o se"eral studies conducted by (a"id 4cherer# wholi3ewise co!ared children# adolescents# and youngadults to discern diferences in ability to decide


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hyothetical !edical treat!ent and conditions'D< 4chererreorted that 1there is no conclusi"e e"idence to resu!ethat adolescents are incaable o a "oluntary consentco!arable to that o young adults,G +ut )ound diMerences +et!eenadolescents and oung adults in the GFualit and Fuantit o) decision3making

autonom that the ma e1ercise in medical treatment decisionsG due to parentalinPuence and treatment decision gravit. >K 8cherer )ound that oung adults andadolescents see! to aroach !edical decision !a3ing1with a 6uality o intentionality that is not seen in thedecisions !ade by children#E>&suggesting thatrecognizing adolescent autono!ous decision !a3ing or!edical care 1!ay i!ro"e their resonse to treat!entand encourage the de"elo!ent o sel+e9cacy'1 >> 8chererand Q. Dickon Reppucci had previousl studied an adolescent sample to determineho! adolescents respond to and are impacted + parental inPuence in medical

decision making.>; he )ound that# while adolescents areresonsi"e to arental in=uence# adolescents reser"e 1thererogati"e to !a3e treat!ent decisions that ha"econse6uential bearing on their li"es1 >@ and Gdo not appear to +eintimidated + either the gravit or severit o) a treatment decision or + the

)orce)ulness o) coercive parental inPuence attempts. ?> Benneth >insburgand his research tea! also ound a !easure ointentionality and indeendence e2hibited by adolescentsin !edical decision !a3ing' The tea! disco"ered whene2a!ining adolescent choice in health care ro"iders thatadolescents ercei"e honesty and !utual resect asunda!ental re6uisites to a successul atient+hysicianrelationshi# along with straightorward# understandableco!!unication# and that 1their e2ectations o healthcare ro"iders are orthright and clear''' 3now@ing whatdraws and ofends the!'1;$ n a related stud, ins+urg and )ello!researchers )ound that 1adolescents are not assi"e reciients ocare' They acti"ely interret interactions and e"aluateser"ices'1 ;% hese researchers also suggest thatadolescents 1want

to na"igate the syste! indeendently1 and identiedhonesty# resect# e6ual treat!ent o atients#condentiality# and interersonal s3ills as ara!ountcharacteristics o ro"iders# which ositi"ely i!act theirdecision to see3 health care and co!ly with treat!entreco!!endations' ;# While researchers have )ound that consultation !itha trusted adult +ene0ts adolescents, particularl in reducing risk +ehavior,; J


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adolescents emphasi*e that it is caring and connectedness )rom !hich the derive+ene0t, regardless o) )amilial ties.;

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LD Sept Oct 2015 Aff