Something I keep thinking about is how a lot of people consider it a good thing that children cannot by themselves consent (or refuse consent) to medical treatments. Some people do kinda get it that maybe it might be a problem with stuff like kids not being able to access trans healthcare, or kids being refused vaccination by antivaxx parents. But in general I see that most people are actually okay with this idea for the most part.
And like... you do get that that is kinda insane, right?
Because this is something that so often leads to suffering. And I am saying this as someone disabled, who had so many issues due to this in his childhood.
Just three examples: when I was 7, I was supposed to get checked for autism. My mother did not want an autistic child. Since she just could have a "neurotypical" child by refusing diagnosis, she did just that.
When I was 12, my mother had decided I needed a certain plastic surgery (one that had a minor health benefit, but still was largely a beauty thing). I did not want it. I really, really did not want it. We still went through almost the entire process until thankfully there was a doctor who went: "Wait, this is elective. I am refusing to do this on a child that does not want it."
And when I was 14 my mother refused to get me to the hospital when I had severe food poisoning. She refused me hospital treatment for almost two weeks. By the time I got actually taken to the hospital I was almost dead.
And here is the thing: all of this should just not happen. The doctor when I was 12 was cool, but... he refused to do the surgery because he had the right to make a conscience call. Legally my mother was in the right to force me into that elective surgery. And that just should not be the case.
A lot of children die and suffer due to their legal inability to consent - or refuse consent - to medical treatments. And I wish y'all would understand that.
Whenever this is brought up, people will go: "Oh, but parents will decide what is best for the child." And here is the thing: No, they are not. There is so much stuff out there showing that indeed, a lot of parents suck at this. Some out of malice, some because they are religious nuts, and some because they literally treat their kids like some sort of doll or some shit.
There is a flip side to this, and I absolutely do not say this as a "gotcha," but rather as "there is no easy solution to this and we need to figure out a balance."
Consider: a parent takes a child in for a flu shot. The child is afraid it will hurt, so they refuse it. The child is now unprotected. If enough children refuse vaccination, we now have pandemics on our hands.
A child doesn't like the taste of their medicine (valid) and so refuses to take it, at all. Their illness gets worse.
A child has an accident that's not actually that bad from an adult standpoint but is horribly traumatic from a child's standpoint--let's say a broken arm. Touching the arm hurts horribly, but it can't be set or put in a cast without touching it. The child is still in hysterics because this is the worst thing that has ever happened to them, and injures themselves worse before calming down enough to consent to treatment.
Like yes, bodily autonomy is important. But a five-year-old has no frame of reference for how bad a lot of PCIs are, or what "antibiotic-resistant bacteria" means. A lot of kids that age have never encountered death. So how do you balance autonomy with "sometimes the kid doesn't know best either"?
I mean the antivax movement is spearheaded by adults. and plenty of adults outside of that also make arguably poor medical decisions due to ignorance or fear. but no one argues that their autonomy should be taken from them (well unless they're disabled then people love taking autonomy from adults). but because people think children are uniquely incapable of thought it's totally fine to say they shouldn't have final say over what happens to their own body. like sure children might not have the same frame of reference that an adult would have that just means you need to frame the pros of the medical procedure in a way they do have reference for. like I'm pretty sure most 5 year olds have had a bad cold at least once, so if you want them to get the flu shot but they're too scared, you explain that the flu is WAy worse than even their worse cold and the shot will take just a second and will protect them from getting the flu. will that work on 100% of kids? probably not but there are plenty of adults who also don't get flu shots even tho they medically can. because children are still people and can be reasoned with just the same as an adult can be, source, me I am a person who from the age of I think 5 or 6 developed a strong fear of needles, and hated having to get vaccinated, but my parents were very much in favour of their kids bodily autonomy so wouldn't have forced me to get vaccinated if I insisted after getting the explanation on why they were important. but the explanation worked, and even tho I hated (and still hate) needles I still got every vaccination I needed growing up even when I was single digits years old. (I know not every kid is me and this is purely anecdotal. but I still think it's worth bringing it up)
You're not wrong. I should note that I have a very specific frame of reference here: I needed sinus surgery when I was four. I didn't know what a sinus was. I didn't know what a surgery was. I'm not sure I would have been able to understand the concept, and the way surgery was performed at the time would have sounded like a big NOPE no matter how much you tried to make it accessible to me (today the same procedure uses lasers; at the time they had to put metal rods in your face). Not having it would very literally have killed me. I wouldn't have understood that concept, either.
So...what do we do in situations like that? This is why I say there's no easy answer. Does a four-year-old have a right to choose death when they don't even know what that means? Is allowing them to make that choice cruel or kind? Would they make the same choice if they had a better frame of reference? You see the problem.
I do see the problem yeah. I wonder if a good compromise is if the child refusing due to not understanding the concepts of what the risks are, would lead to their death if the final say should then be given to the parents. till the kid is a bit older, like maybe 6 or 7? tho that still feels wrong to me I do very much understand that both forcing a medical decision on a child, and letting them die just because they don't fully understand what death is so can't make a truly informed decision, is unfair to the child. yeah this is a complex difficult problem
It's one of those things where I'm not even sure there is a right answer. Even going by age isn't surefire. Some twelve-year-olds are great babysitters. Some twelve-year-olds need babysitters. So how to provide the greatest amount of autonomy while also understanding that some things kids are simply not equipped to understand yet? And how to navigate stuff like "sometimes kids insist they understand, but they've come up with an absolutely buckwild understanding of the thing"?
(I also remember insisting to my mom when I was five that 100 pounds was way too big for a human being and anyone over that would fall through the floor. This was not based in fatphobia, but rather the fact that I'd just learned my numbers up to 100, and had decided the whole extra number meant something was MASSIVE. I didn't grok that 99lbs and 100lbs were a loaf of bread apart. Clearly 100lbs was like, an anvil or something.)
So, when I was in medical school, one of the historical medical ethics cases we debated was about a 17-year-old girl who didn’t want chemotherapy. The chemotherapy was going to save her life with like a 90% chance, but, she was morally and philosophically opposed to chemotherapy.
She ran away from the hospital. Police tracked her down and she was handcuffed to a hospital bed, then given chemotherapy.
Now, I was the only person in the room who said that she should’ve been given her own choice there. Everyone else disagreed: “She’s not 18! It’s against the law!” A year later, she discontinued chemotherapy and died.
I’m with prismatic here. I don’t think there is a right answer. I don’t think even the most intelligent five-year-old has enough life experience to understand the risks and benefits of surgery. On the flipside, I don’t think there’s a magic switch that flips the day you turn 18. I think maturity has multiple dimensions to it, and a person can be very mature in one way and very immature in another.
I'm just stuck on being morally opposed to chemo. What...is the logic there?
The professor didn’t have that information for us, but ultimately, I don’t think it really matters whatever the person’s objection is, so long they’re of sound mind and they’ve been appropriately given informed consent. Like, if I don’t want to have heart surgery for whatever reason, ultimately my body, my choice, and all that.
If I had to guess, something like Jehovah’s Witness or something. I think I’ve heard that there are also some Native American cultures that are opposed to chemotherapy?
JWs don't object to it, but it did occur to me Christian Scientists do.
I would say the likely best potential compromise would be a staggered age thing? like until the age of mm 8 or 9, then parents have full control over all procedures
then for 10-13 its control over certain treatments considered more minor/less risky or more cosmetic require consent for example if the parents say no shot but the kid says yes shot the kid gets the shot unless there's serious risks (like say the kid is allergic to a type of shot then no amount of yes will override the fact the kids allergic) but if the kid was like no surgery for my broken leg but parents say yes surgery sorry Timmy you're getting surgery
then 14-16 it's for more serious medical stuff but not anything thats like "if you dont do this you'll die" not cosmetic dental stuff for example would be included here
and then 17+ is full control no exceptions
Kids deserve autonomy, kids lack a lot of experience to understand some topics like why they need to go to school, and kids of different age brackets may have extremely different needs/understandings of the world are all things that need to coexist. A one size fit all flat age simply does not works because an 8 year old and a 15 year old are going to have very little in common when it comes to understanding the world and their own bodies.
I feel a lot of people get caught up in having One age to solve everything but you can divide up and stagger things, both allowing to save more huge life changing things for when people are old enough to actually understand and conceptualize that scale while also allowing people to get experience and practice before hand with smaller things so it's less intimidating and you have a better idea of the systems you're navigating.
This is a fantastic idea except for one thing:
Define "less risky procedure."
This would have to be so heavily legislated to avoid what we're seeing in Texas right now. I'm not saying it couldn't work, just...I still have concerns.
I don't have anything to add, really. I haven't even thought hard about these questions, much less studied them specifically. On just a moment's reflection (so, not worth much I realize), I'm not sure the answer ought to be full medical consent on medical matters for children equal to an adult across the board. (An oversimplification, I know.) But I for sure do wish the notion, sometimes all but outright, other times implicit but very real, that parents own their children was something we as a society actually grappled with and worked to seriously reform.
