Saturday, September 5, 2015

LD Sep/Oct 2015 - Adolescent Right to Make Medical Choices - Introduction

Resolved: Adolescents ought to have the right to make autonomous medical choices.


This is the first topic of the 2015/2016 NSDA debate season so I know many of you will be debating for the first time.  Welcome to Lincoln-Douglas debate. On these pages I support the traditional form of Lincoln-Douglas debate very much in the style seen in the final round of the NSDA National Tournament.  If you are new to Lincoln-Douglas you can click the Lincoln-Douglas tab above and find links to other resources on this site which can help you get started. Debate tests a high-school student's ability to think on ones feet, make strategic decisions, and analyze facts; skills which are at the core of the resolution we will be analyzing.  This resolution forces us to look at the relationship between parents and their children and examine the question of when individuals are capable of making rational decisions with respect to their own medical care. In keeping with the tradition of Lincoln-Douglas debate, we will examine both sides of the question while focused upon some overarching principles such as; what is right?, what is just?, what is fair?  After all, at the end of the round, it is the answer to these larger questions which wins the debate in Lincoln-Douglas.

Generally speaking adolescents are individuals whose level of maturity is somewhere between puberty and legal adulthood.  In the U.S., for example, with a few exceptions, individuals are considered legal adults at the age of 18 (even though you can't buy certain controlled substances or rent a car until you are older). The age of puberty, is much more difficult to pin down since it depends on a lot of biological factors but we can assume, for the purposes of this debate that all high-school debaters under the age of 18 are adolescents.

An article in Psychology Today states:
Adolescence describes the teenage years between 13 and 19 and can be considered the transitional stage from childhood to adulthood. However, the physical and psychological changes that occur in adolescence can start earlier, during the preteen or "tween" years (ages 9 through 12). Adolescence can be a time of both disorientation and discovery. The transitional period can bring up issues of independence and self-identity; many adolescents and their peers face tough choices regarding schoolwork, sexuality, drugs, alcohol, and social life. Peer groups, romantic interests and external appearance tend to naturally increase in importance for some time during a teen's journey toward adulthood.

The age-range of adolescence is likely not going to be an issue. Even if everyone has a slightly different conception of when a child enters adolescence most people understand we are talking about young people who, though they may live under the guardianship of adults are transitioning to independence and will soon be considered adults themselves with all associated rights and responsibilities.

ought to
I have often quibbled over the verb 'ought to', which finds its root in the word 'owe', hence, it suggests a duty or obligation to give something which is owed.  Indeed, quite often I hear debaters declare the word 'ought' as virtually synonymous with a moral imperative. The oft-time substitute word 'should' conveys a sense of permitting an action which is perhaps necessary but not obligatory. Ought and should are often used interchangeably in modern English/American language and whether or not the meaning of the two words are interchangeable in this resolution depends upon on the context of your case. So why quibble?  In this resolution we debate the bestowing of a right (which we discuss below) and the force we put behind the interpretation of 'ought' drives one toward the idea this right is universal to all adolescents and withholding it violates some universal principle of what is correct behavior. Or, we can interpret ought like 'should' and suggest the bestowing of the right is acceptable because its risks are no worse than those found in the status-quo but it offers advantages which make it a good idea.

have the right
Because the resolution says 'have the right' we debate a world where adolescents do not currently have this 'right' and the affirmative side will argue we ought to overturn the status-quo and grant the right. I like this wording because we don't need to spend time focusing too deeply on legal differences between nations.  We merely debate the idea, that given a world where the right is not granted to adolescents, should it be? Basically, rights are what individuals are entitled to in the form of conditions or qualities (right to happiness) or permissions (right to vote).  Generally, in Lincoln-Douglas debate, we make distinction between two classes of rights; civil rights (legal rights) and natural rights. Civil rights are those granted by governments or society and vary by jurisdiction and societal views, such as the right to education, vote, drive, protest, speak freely, etc.  Natural rights are the so-called god-given rights, the ones common to all human beings regardless of physical attributes, location or ideology. It is commonly argued in Lincoln-Douglas debate that no legitimate law can deny a person their natural rights, such as life, liberty, happiness, or property (although they may be forfeited). In this resolution, the right to make autonomous medical choices would not be considered a natural right. It is one of the legal rights granted by a government. For completeness, I should mention the so-called Human Rights such as those which appear in the Universal Declaration of Human Rights.  These are formulated from natural rights, and in my opinion, tend to codify specific entitlements which support natural rights. Finally, rights may be positive or negative in nature. A positive right is one a person must perform to secure. For example, to exercise my right to vote I must go out and vote.  A negative right places an obligation upon others to uphold. For example, to secure my right to privacy, others are under obligation not to violate or expose my personal spaces.

autonomous (autonomy)
Autonomy is simply self-governance; the capacity to make decisions and take actions free of coercion from others. Autonomy is considered an important ideal closely related to individualism and often in Lincoln-Douglas debate can serve as a value premise (as we shall explore in the Affirmative position).

Christman (2003)
Autonomy can play a role in moral theory without that theory being fully Kantian in structure. For example, it is possible to argue that personal autonomy has intrinsic value independent of a fully worked out view of practical reason. Following John Stuart Mill, for example, one can claim that autonomy is “one of the elements of well-being” (Mill 1859/1975, ch. III). Viewing autonomy as an intrinsic value or as a constitutive element in personal well-being in this way opens the door to a generally consequentialist moral framework while paying heed to the importance of self-government to a fulfilling life (for discussion see Sumner 1996).

medical choices
The act of choosing is the act of picking from a list of two or more options. The decided item is the 'choice'.  The adjective 'medical' describes things related to medicine or the treatment of health related issues. So we are talking about allowing individuals the right to choose medical treatments for themselves.


This resolution could be worded, the right of informed consent ought to be extended to adolescents. The idea is very similar and by researching informed consent, the debater may find justifications for the Aff or Neg positions. 

DeBord (undated)
Informed consent is the process by which the treating health care provider discloses appropriate information to a competent patient so that the patient may make a voluntary choice to accept or refuse treatment. (Appelbaum, 2007) It originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care.

The real issue at the heart of this debate is whether or not adolescents are capable of making informed decisions related to their medical treatment and care. I believe several perspectives on the issue will be contentions in this debate.  One important consideration is the role of the parent or 'guardian' in the decision-making process.  In many matters of law, minors are often considered to be not fully aware of the consequences of their choices. As a result, their parents or guardians are sometimes held responsible for consequences arising from the poor choices of minors. Conversely, we have seen many cases where the parents or guardians make choices which are contrary to societal sensibilities and result in legal prosecution in some jurisdictions. Another important consideration is when do minors actually achieve the ability to make the kind of medical choices that any rational adult would make and should the fact that others would make the same choice even be a criterion for granting the right? We can also consider the impact of siding with the Affirmative upon other types of decisions adolescents make and the extent of parental responsibility. If adolescents can make autonomous medical choices then are they capable of making other kinds of autonomous rational choices when it comes to things like whether to stay in school or being held responsible for making choices which violate the law?

About Values

Every year students ask me to help them choose values and value criterion for their cases. That is not easy without knowing the particulars of the case you plan to present. Sometimes I can clarify some ideas for values, but deciding on good criterion requires knowing the case and understanding how the case supports the selected value. That is something best discussed with your coach or more experienced team members. Nevertheless, by clicking the Lincoln-Douglas tab above you will find links to articles about how to select values and how to setup a value criterion. I will try this year, to present ideas for values as I layout the Aff and Neg positions, much like I tried to do last year but these will only be suggestions to stimulate your thinking. if all else fails and you still have no idea of what value to choose, consider 'autonomy'. The NSDA has handed that one to you on a silver platter.


Christman, John, 2003, "Autonomy in Moral and Political Philosophy", The Stanford Encyclopedia of Philosophy (Spring 2015 Edition), Edward N. Zalta (ed.).

DeBord, J, Informed Consent, ETHICS IN MEDICINE, University of Washington School of Medicine.

Dryden, J, Autonomy,  The Internet Encyclopedia of Philosophy, ISSN 2161-0002

Psychology Today, (undated), Psychology Today © 1991-2015 Sussex Publishers, LLC

Wenar, Leif, "Rights", The Stanford Encyclopedia of Philosophy (Fall 2011 Edition), Edward N. Zalta (ed.).

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