Problem
Parents are usually identified, within broad side constraints, as in authority over their children, and as the best judges for balancing costs and benefits, inculcating moral virtues, and articulating proper lifestyle choices for themselves and their children. There has generally existed the normative presumption that, absent emergency or other exigent circumstances, medical treatment of minor children should occur only with the consent of parents.
As Doriane Lambelet Coleman and Philip Rosoff summarize, United States law "... generally emphasizes and reemphasizes parents' decision-making rights and the 'fundamental' role these occupy in our constitutional order." Recently, however, political activists have sought to move away from such traditional understandings of parental authority, to shift law and public policy in ways that undermine the presumption that parents ought to make such decisions regarding their own minor children. Advocates have sought to reconceptualize minor children as morally in authority over themselves and as the best judges of their own best interests, so as to motivate a concomitant shift in law and public policy.
Some commentators claim that children possess basic rights over themselves and, as a result, should be understood as possessing greater authority to make their own lifestyle choices, based on their own moral values and personal interests, independent of the wishes of their parents (see, e.g., the United Nations Convention on the Rights of the Child). The child's participation rights in medical decisions are appreciated as having greater standing insofar as the child appears to demonstrate more maturity. Minor children who demonstrate adequate maturity, it is urged, ought to be appreciated as having rights to confidentiality and healthcare treatment in accordance with their own wishes. Such a conclusion urges a shift away from recognizing any particular age threshold as presumptively indicating adult decision-making capacity, to recognizing the "mature minor" as in authority over himself and as the best judge of his own best interests, and thus as able to consent to medical research on his own behalf.
While individuals mature at various rates, with developing capacities for understanding and appreciating pertinent information, age thresholds have usually functioned as an established, if conventional, criterion for the capacity to make competent and mature decisions. It is unclear why either physicians or medical researchers should be permitted to act on their own judgments regarding the child's "sufficient maturity" to consent on his own behalf, independent of the actual consent of the child's parents or legal guardians. In part, it is very difficult to provide a satisfactory assessment of the child's actual decision-making capacity. As Dunn et al. argued in a review of numerous instruments for assessing decisional capacity, significant further research is needed in this area. They acknowledge that all assessment tools have significant limitations and that there is even a lack of agreement regarding the relevant standards for properly assessing such capacities. The need for reliable and valid capacity assessment tools is very real. Yet, as Ana litis points out,
1. What do you think are your ethical issues from reading this viewpoint.
2. What do you think would be your ethical support for your position of this viewpoint.