Carolyn E. Fiorillo
"Teenagers....raise serious questions for those responsible for their physical or educational well-being, and those who care for them....The central ethical question we face with teenagers is'Who decides?'....Adolescents, with one foot still in the land of children they were, the other in the realm of the adults they will become, inhabit a challenging niche in our culture. Are these beings great big children or little adults? In fact, they are both and neitherand therein lies the confusion....Nobodynot adults, not the courts, and certainly not the teenagers themselvescan agree on just what capabilities they do, or should, have. (37)
"In general, society is torn between permitting teenagers to decide and permitting the parent to decide even over the objection of the adolescent. We let teens go to war and vote for president, yet in most states they cannot drink alcohol. In California, prosecutors have attempted to hold parents responsible for the gang behavior of their children. In New York, on the other hand, adolescents who commit horribly depraved and shocking crimes are now tried in adult criminal court where they cannot hide behind the curtain of protection of the juvenile justice system. The same confusion runs through our health laws. In Alabama, a 14-year-old can choose her own medical care; in Oregon, she must wait until age 15; in most other states she must be 18, and in Nebraska and Wyoming, she is not legally able to do so until she's 19. (38)
"Our legal system struggles to keep pace with the massive social changes our culture has undergone. Never before have so many adolescents made their own decisions, lived apart from their parents and families. Tens of millions more are independently engaging in 'adult behaviors', earning money, having sex, conceiving and bearing children, using and abusing drugs and alcohol....Such decisions carry medical implications. They raise complex questions for doctors, nurses, and social workers, questions that arise every day in our clinics, doctors'offices, hospitals and courts." (39)
"The specter of HIV-related disease has made things more complex around adolescents and sex. Where once these decisions involved only the teenager and the family, in the age of AIDS, they involve our whole society. Personal health now blurs into public health, which raises the stakes enormously....Often, adolescents' newfound right to make sexual and health decisions outstrips their willingness to take responsibility for those decisions. Where once that meant 'shotgun weddings', today it can mean death. (40)
"Many adolescent medical doctors will likely tell parents and the teenager that what happens between the child and the physician is confidential unless the child is in direct physical or psychological danger of harmin which case the protections for privacy will be breached and the parents involved....It also makes pure medical sense to try to include young people to the degree that they can participate....this is particularly true for older chronically ill children and teenagers. These young patients are often remarkably wise and perceptive. They alone know the pain and suffering that disease has brought into their lives, and this knowledge can powerfully inform their decisions...America has come a long way from the days when a child was considered a parent's property, to be dealt with, decided for, and disposed of at the parents' whim. Collectively, we still wrestle with the roles of parent and child, struggling to assure our newborns, children, and our youngest adults of the rights they deserve, while affording them the protections they require." (41)