Abstract
Adolescents present a puzzle. There are foundational unclarities about how they should be regarded as decision-makers. Although superficially adolescents may appear to have mature decisional capacity, their decision-making is in many ways unlike that of adults. Despite this seemingly obvious fact, a concern for the claims of autonomy has led to the development of the legal doctrine of the mature minor. This legal construct considers adolescents, as far as possible, as equivalent to adults for the purpose of medical decision-making. The movement to support independent decision-making by adolescents through providing information to them and securing their consent apart from their parents is encouraged by those legal understandings that hold that unemancipated minors should generally be considered as possessing effective decisional capacity. Such legal structures, however, do not adequately take account of the wide variations in adolescent capacities, the immaturity of most adolescent decision-makers, or the important contributions made by parents to the development of their adolescents through parental partnering in the adolescent’s decision-making. The data available indicate that in general adolescents should be regarded as apprentice decision-makers who should make decisions in collaboration with their parents until at least the age of 18. Steps should not be taken pre-emptively to isolate adolescents from the guidance of their parents. As a general rule, what Piker has referred to as “collaborative paternalism” appears most likely both to protect adolescents from their own untoward choices, while also very importantly helping them with parental guidance to develop into mature decision-makers with the capacity to make medical choices on their own.
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Notes
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Although there is no law or apparent official public policy in Michigan mandating private conversations of adolescents with a physician or nurse in the course of the medical treatment, evidently some parents have been informed that such conversations are standard policy. For information on the controversy, see http://www.infowars.com/new-medical-law-mandates-private-conversation-with-child-before-every-doctor-visit/.
References
Adaljarnardottir, S., & Hafsteinsson, L. G. (2001). Adolescents’ perceived parenting styles and their substance use: Concurrent and longitudinal analyses. Journal of Research on Adolescence, 11, 401–423.
Albert, D., Chein, J., & Steinberg, L. (2014). The teenage brain: Peer influences on adolescent decision making. Current Directions in Psychological Science, 22(2), 114–120.
Blakemore, S. J., & Robbins, T. W. (2012). Decision-making in the adolescent brain. Nature Neuroscience, 15, 1184–1191.
Blustein, J. (1982). Parents and children: The ethics of the family. New York: Oxford University Press.
Bravender, T., Price, N., & English, A. (2004). Primary care providers’ willingness to see unaccompanied adolescents. Journal of Adolescent Health, 34, 30–36.
Chambers, R. A., & Potenza, M. N. (2003). Neurodevelopment, impulsivity, and adolescent gambling. Journal of Gambling Studies, 19, 53–84.
Commendador, K. (2010). The relationship between maternal parenting style, female adolescent decision making, and contraceptive use. Journal of the American Academy of Nurse Practitioners, 23, 561–572.
Cutter, M. A., & Shelp, E. E. (Eds.). (1991). Competency. Dordrecht: Kluwer.
Daly, A. M. (2014). What influences adolescents’ contraceptive decision-making? A meta-ethnography. Journal of Pediatric Nursing,. doi:10.1016/j.pedn.2014.05.001.
Eaton, D. K., Kann L., Kinchen, S., Ross, J., Hawkins J., Harris, W. A., et al. (2005). Youth risk behavior surveillance—United States, 2005. MMWR Surveillance Summary, 55, 1108.
Galvan, A. (2010). Adolescent development of the reward system. Front Hum Neurosci, 4(6). doi:10.3389/neuro.09.006.2010.
Galvan, A., & Rahdar, A. (2013). The neurobiological effects of stress on adolescent decision making. Neuroscience, 249, 223–231.
Galvan, T. A., Hare, C. E., Parra, J., Penn, H., Voss, S., Glober, G., et al. (2006). Earlier development of the accumbens relative to orbitofrontal cortex might underlie risk-taking behavior in adolescents. Journal of Neuroscience, 26, 6885–6892.
Gardner, M., & Steinberg, L. (2005). Peer influence on risk taking, risk preference, and risky decision making in adolescent and adulthood: An experimental study. Developmental Psychology, 41, 625–635.
Goldstein, J. (1977). Medical care for the child at risk: On state supervention of parental autonomy. Yale Law Journal, 86, 645–663.
Huver, R. M. E., Engels, M. C. M. E., van Breukelen, G., & de Vries, H. (2007). Parenting style and adolescent smoking cognitions and behavior. Psychology and Health, 22, 575–593.
Kincaid, C., Jones, D. J., Sterrett, E., & McKee, L. (2012). A review of parenting and adolescent sexual behavior: The moderating role of gender. Clinical Psychology Review, 32, 177–188.
Kun, J.-M. (1996). Rejecting the adage children should be seen and not heard—the mature minor doctrine. Pace Law Review, 16(2), 423–462.
McCabe, M. A., Rushton, C. H., Glover, J., Murray, M., & Leikin, S. (1996). Implications of the patient self-determination act: Guidelines for involving adolescents in medical decision making. Journal of Adolescent Health, 19, 319–324.
Partridge, B. C. (2013). The mature minor: some critical psychological reflections on the empirical bases. Journal of Medicine and Philosophy, 38(3), 283–299.
Piker, A. (2011). Balancing liberation and protection: A moderate approach to adolescent health care decision-making. Bioethics, 25(4), 202–208.
Reyna, V. F., & Farley, F. (2006). Risk and rationality in adolescent decision making: Implications for theory, practice, and public policy. Psychological Science in the Public Interest, 7, 1–44.
Rilling, J. K., & Sanfey, A. G. (2011). The neuroscience of social decision-making. Annual Review of Psychology, 62, 23–48.
Rodrigo, M. J., Padrón, I., de Vega, M., & Ferstl, E. C. (2014). Adolescents’ risky decision-making activates neural networks related to social cognition and cognitive control processes. Frontiers in Human Neuroscience, 8, 60. Retrieved February 14, 2014. doi:10.3389/fnhum.2014.00060.
Romer, D., Duckworth, A. L., Sznitman, S., & Park, S. (2010). Can adolescents learn self-control? Delay of gratification in the development of control over risk taking. Prevention Science, 11, 319–330.
Ross, L. F. (1998). Children, families, and health care decision making. New York: Oxford University Press.
Ross, C. J. (1999). An emerging right for mature minors to receive information. University of Pennsylvania Journal of Constitutional Law, 2(1), 223–275.
Schroeder, D. S., & Mowen, T. J. (2014). Parenting style transitions and delinquency. Youth & Society, 46(2), 228–254.
Shad, M. U., Bidesi, A. S., Chen, L.-A., Thomas, B. P., Ernst, M., & Rao, U. (2011). Neurobiology of decision-making in adolescents. Behavioural Brain Research, 217, 67–76.
Sovet, L., & Metz, A. J. (2014). Parenting styles and career decision-making among French and Korean adolescents. Journal of Vocational Behavior, 84, 345–355.
Spear, L. (2000). Neurobehavioural changes in adolescence. Current Directions in Psychological Science, 9, 111–114.
Steinberg, L. (2004). Risk taking in adolescence: what changes, and why? Annals of the New York Academy of Science, 1021, 51–58.
Steinberg, L. (2008). A social neuroscience perspective on adolescent risk-taking. Developmental Review, 28(1), 78–106.
Steinberg, L. (2013). Does recent research on adolescent brain development inform the mature minor doctrine? Journal of Medicine and Philosophy, 38(3), 256–267.
Steinberg, L., Elmen, D. J., & Mounts, N. S. (1989). Authoritative parenting, psychosocial maturity, and academic success among adolescents. Child Development, 60, 1424–1436.
Steinberg, L., Lamborn, S. D., & Dornbusch, S. M. (1992). Impact of parenting practices on adolescent achievement: Authoritative parenting, school involvement, and encouragement to succeed. Child Development, 63, 1266–1281.
Strauch, B. (2003). The primal teen: What the new discoveries about the teenage brain tell us about our kids. New York: Anchor Books.
United Nations Office of the High Commissioner for Human Rights. (1990). Convention on the Rights of the Child. New York: United Nations.
Van den Bos, W., van Dijk, E., Westenberg, M., Rombouts, S. A. R. B., & Crone, E. A. (2011). Changing brains, changing perspectives: The neurocognitive development of reciprocity. Psychological Science, 22(1), 60–70.
Van Duijvenvoorde, A. C. K., & Crone, E. A. (2013). The teenage brain: A neuroeconomic approach to adolescent decision making. Current Directions in Psychological Science, 22(2), 108–113.
Van Leijenhorst, L., Moor, B. G., Op de Macks, Z. A., Rombouts, S. A. R. B., Westenberg, P. M., & Crone, E. A. (2010). Adolescent risky decision-making: Neurocognitive development of reward and control regions. Neuroimage, 51, 345–355.
Watabe, A., & Hibbard, D. R. (2014). The influence of authoritarian and authoritative parenting on children’s academic achievement motivation: A comparison between the United States and Japan. North American Journal of Psychology, 16(2), 359–382.
Weiss, L. H., & Conrad Schwartz, J. (1996). The relationship between parenting types and older adolescents’ personality, academic achievement, adjustment, and substance use. Child Development, 67, 2101–2114.
White, B. (1995). Competence to Consent. Washington, DC: Georgetown University Press.
Wilhelms, E. A., & Reyna, V. F. (2013). Fuzzy trace theory and medical decisions by minors: differences in reasoning between adolescents and adults. Journal of Medicine and Philosophy, 38(3), 268–282.
Wilkins, L. P. (1975). Children’s rights: Removing the parental consent barrier to medical treatment of minors. Arizona State Law Journal, 31, 31–92.
Xiao, L., Bechara, A., Palmer, P. H., Trinidad, D. R., Wei, Y., Jia, Y., et al. (2011). Parent-child engagement in decision-making and the development of adolescent affective decision capacity and binge-drinking. Personality and Individual Differences, 51, 285–292.
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Partridge, B. Adolescent Pediatric Decision-Making: A Critical Reconsideration in the Light of the Data. HEC Forum 26, 299–308 (2014). https://doi.org/10.1007/s10730-014-9250-8
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DOI: https://doi.org/10.1007/s10730-014-9250-8