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Argument In Favor of Adolescents Making Life and Death Decisions

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Bobbi Kowash

on 6 August 2014

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Transcript of Argument In Favor of Adolescents Making Life and Death Decisions

End of Life (EOL)
End of life discussions are a priority in providing comprehensive palliative care to "
all patients".
- (Field & Behrman, 2002)

The key to any life-and-death decision is to develop an advanced directives (AD).
Adolescents and Self Autonomy

cognitive ability
self opinion
self identity
hypothetical reasoning.
(Larcher, 2005)
They Know
when they are in pain
when their body has received enough
how much their body can handle
These are not learned behaviors; they are inherent abilities

Literature Reviews on Competency
Study by Weithorn and Campbell (1982):

14 yr olds demonstrated a level of competency as the same as two "adult" groups
Proved that adolescents do have the capacity and maturity to make decisions about their health care

American Academy of Pediatrics Committee on Bioethics (1995):

"....a child's voice be given greater weight as the child matures because it has been proven they have decision-making capacity,"
Advanced Directives
Adolescents Making Life and Death Decisions
An Argument in Favor
Violet, Bobbi & Richard (2014)

Advanced Directives Reflections
Adolescent AD could help (Kaebnick, 2013, p. 50):

Address how all parties involved respond to adolescents' EOL and self determined desires.

Alleviate the question of what the preferences of the patients are.

Allow the patients to express peacefully, how they wish to live out their final moments

American Academy of Pediatrics Committee on Bioethics (1995). “Informed consent, parental permission, and assent in
pediatric practice.”
95, 314-317.

Field, M. J. & Behrman, R. E. (Eds.) (2002). Committee on palliative and end-of-life care for children and their families, board on
health sciences policy.
When Children Die: Improving Palliative and End-of-Life Care for Children and their Families.

Washington, D.C.: National Academies Press.

Kaebnick, G. E. (Ed.). (2013). Issue 3: Should Adolescents be allowed to make their own life and death decisions?

Taking sides: Clashing views on controversial bioethical issues
(15th ed. p. 50). New York, NY: McGraw-Hill. ISBN:

National Healthcare Decision Day (2013a).
Why do you Have an Advanced Directives?
Retrieved from

National Healthcare Decision Day (2013b).
NHDD is Tomorrow.
Retrieved from

Larcher, V. (2005). ABC of adolescent: Consent, competence, and confidentiality.
British Medical Journal, 330
(7487), 353–356.
doi: 10.1136/bmj.330.7487.353. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC548737/

Strauss, C. (2014).
Stuart Scott's ESPY's Speech was his Finest Television Moment.
Retrieved from

Weithorn, L. A., & Campbell, S. B. ( 1982). The competency of children and adolescents to make Informed treatment decisions.

Child Development, 53
(6), 1589-1598.

Weir, R. F., & Peters, C. (1997). Affirming the decisions adolescents make about life and death.
Hastings Center Report, 27

Impact of Advanced Directives
Adolescents, who are contemplating advanced directives (AD), usually have had
multiple opportunities to think
about the inescapable suffering that characterizes their lives, the features of life that makes it worth continuing, the benefits and burdens that accompany medical treatment, and the prospect of death.
- (Weir & Peters, 1997)
(National Healthcare Decisions Day, 2013a & 2013b)
Life Decisions..........
.........living it on your own terms.
Handling End of Life Discussions

Stress, pain or suffering is subjective to the uniqueness of each individual and each experiences
Lack of full disclosure could be detrimental to all parties in the long run
Helps relieve the guilt of the family
“When you die, it does not mean that you lose to cancer. You beat cancer by how you live, why you live, and in the manner in which you live.”
(Strauss citing Scott, 2014)
"I have to feel as much as I can as though I don’t have cancer, although I think about cancer 20 times a day.”
(Strauss citing Scott, 2014)
Critical Reflections
How does one define/ascertain competency?

Do the words "competency" and "capacity" mean the same thing?

Does chronological age standard correlate with competency and/or capacity?

Can adolescents be proven not to possess autonomic capacity or competency?

Is "culture of hope" not worth preserving in the adult population?

Why deprive them of the right to make this last thoughtful wish?
Any adolescent, especially those with chronic terminal illness, that request to develop an AD and meet the competency standards should not be deprived of such right.
The Best EOL Family Gift...........
Full transcript