Autonomy: The Ethical and Legal Issues facing Adolescents ‘You can bring a youth to college but you can’t make him think’ Kant

Background: Autonomy is considered a major principle in making decisions about an individual’s health. Children and particularly adolescents have the capacity to partake in medical decision-making to some extent. In most cases, the parent-doctor-adolescent triangle sides are in agreement, but this is not always the reality, causing ethical and legal issues for physicians to consider.

Objective: The overall aim is to evaluate the legal and ethical aspects of autonomy afforded to adolescents.

Methods: The databases perused for relevant papers were Pubmed and Westlaw. Based on their likelihood to produce hits, the Journal of Medical Ethics and Justis database were further examined.

Results: Autonomy is a basic human right, but not an absolute one. Contemporary challenges include arguments regarding the status of autonomy, often heralded by communitarian critiques versus individualist liberalists. Different legal decisions are defined by differing ages, which leads to confusion in terms of autonomy. Patients have a right to ‘positive autonomy’, i.e. to be facilitated in directing one’s care, but they also have a right to ‘negative autonomy’; i.e. the right to refuse treatment, and that is often more contentious, especially in adolescent medicine. In terms of the articulation of children`s rights, the two most significant documents are the Constitution and the United Nations Convention on the Rights of the Child.

Conclusion: In the context of healthcare, the reality is that adolescents do not go through the same transitions at the same time. My own experience as a paediatric doctor has led me not to use chronological age as a determinant of capacity, as there is a continuum of development and we should hear the views of children and adolescents first before making any decisions.