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BALANCING LIBERATION AND PROTECTION: A MODERATE APPROACH TO ADOLESCENT HEALTH CARE DECISION-MAKING
Abstract
In this paper I examine the debate between 'protectionists' and 'liberationists' concerning the appropriate role of minors in decision-making about their health care, focusing particularly on disagreements between the two sides regarding adolescents. Protectionists advocate a more traditional, paternalistic approach in which minors have relatively little input into the healthcare decision-making process, and decisions are made for them by parents or other adults, guided by a commitment to the patient's best interests. Liberationists, on the other hand, argue in favour of expanded participation by minors in treatment decisions, and decision-making authority for at least some adolescents. My examination of the debate includes discussion of liberationist shifts that have taken place in the medical community as well as in legal policy and practice, and consideration of recent research on adolescent development. In the final section of the paper, I propose a moderate position that addresses both liberationist and protectionist concerns.
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“Differences in decision-making between adolescents and adults have been found in the ability to act or think responsible, the ability to restrain impulsiveness, and the ability to place a given decision in a larger temporal context [16].”
From Why is it hard to make progress in assessing children's decision-making competence? (2015) · cites this paper as [16]
In the citing paper
“Various authors argue that early adolescents (10 to 14) are more susceptible to peer influences than at any other age [16], which may hinder their ability to make thoughtful decisions [15].”
From Why is it hard to make progress in assessing children's decision-making competence? (2015) · cites this paper as [16]
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Cited by
Hein, I. M., de Vries, M. C., Troost, P. W., Meynen, G., van Goudoever, J. B., & Lindauer, R. (2015) · BMC Medical Ethics · doi:10.1186/s12910-015-0067-z · Cited by 222
“Differences between children and adults regarding decision-making competence have been found in the ability to restrain impulsivity and in the ability to place a given decision in a larger temporal context [19].”
BackgroundWhy is it hard to make progress in assessing children's decision-making competence?
Hein, I. M., Troost, P. W., Broersma, A., de Vries, M. C., Daams, J. G., & Lindauer, R. J. L. (2015) · BMC Medical Ethics · doi:10.1186/1472-6939-16-1 · Cited by 191
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“Irrespective of their age, children with chronic or recurring illness can possess deeper understanding of their condition, about the consequences of medical decisions, and about their conceptions of the good [16, 24, 26, 34].”
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“Striking a balance between the ethical principle of benefit and the correlated principle of autonomy, between the need for protection and claims to self-determination, however, finds its natural limit in cases in which the minor’s choices are deemed to be irresponsible and conducive to harm or danger to the physical a…”
BackgroundRodríguez-Domínguez, F. J., Osuna-García, T., Guillén, A., Pérez-Cárceles, M. D., & Osuna, E. (2023) · Children · doi:10.3390/children10121844 · Cited by 9
The Moral Foundations of Child Health and Social Policies: A Critical Interpretive Synthesis
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“As compared to adult counterparts, youth participants tend to accord less attention and import to instrumental justi cations for child and family policies—for instance, child care as a means to adult economic productivity, or education as a means to subsequent economic contribution—and more to policies responsive to t…”
ResultAutonomie als Bezugspunkt einer universalen Medizinethik
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“An ongoing debate concerns whether, and if so, when and how, children/adolescents should take part in decisions concerning their own healthcare (e.g. Piker 2011, Casula 2013).”
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Brabant, B. (2018) · BioéthiqueOnline · doi:10.7202/1044262ar · Cited by 1
Wiesemann, C. (2016) · International library of ethics, law, and the new medicine/The international library of ethics, law, and the new medicine · doi:10.1007/978-3-319-32402-9_6 · Cited by 1
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Badia, J. M., & Esparcia, A. J. (2021) · Anuario de Psicología/The UB Journal of Psychology · doi:10.1344/anpsic2021.51/1.28617
Dephoure, S. (2024) · University of Toronto Medical Journal · doi:10.33137/utmj.v101i1.40751
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Metadata
- Authors
- PIKER, A.
- Affiliations
- Texas A&M University – Corpus Christi (US)
- Corresponding author
- PIKER, ANDY
- Venue
- Bioethics
- Publisher
- Wiley
- Published
- 2011-04-11
- Volume
- 25
- Issue
- 4
- Pages
- 202-208
- ISSN
- 0269-9702 (ISSN-L)
- OpenAlex
- W1945453291
- Cited by
- 29
- References
- 0
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 1 · 2021: 3 · 2019: 3 · 2018: 4 · 2017: 1 · 2016: 4 · 2015: 2 · 2014: 1 · 2013: 2 · 2012: 3
- FWCI
- 0.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 1604 d)
- Locations
- Bioethics (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Funders
- Texas A and M University-Corpus Christi
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Social Sciences › Sociology and Political Science › Children's Rights and Participation
- Keywords
- paternalism, protectionism, liberationism, best interests, adolescent development
- MeSH terms
- Adolescent, Decision Making, Humans, Informed Consent, Pediatrics, United States, Adolescent Health Services, Mental Competency, Personal Autonomy, Paternalism, Minors
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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
