Adolescent autonomy and minors' legal rights: contraception and abortion

During adolescence, dependent children grow into independent and autonomous adults, and it is necessary to make difficult policy judgements about children's rights. Questions that arise include: shoudl minors have the right to work, to marry, to make legal contracts, and to obtain medical care without parental consent; or should parental consent be required by the state in order to protect minors and to preserve parental authority. This discussion focuses upon the area of family planning, a topic of special interest to policymakers because they now face many questions about minor's contraceptive and abortion rights in Congress, in state legislatures, and in the courts. comprehensive response to policy questions about family planning rights for minors would require information about adolescent development, maturity, and autonomy; about teenagers' sexual and contraceptive attitudes and behavior; about the nature of parent-child communication regarding sexual and contraceptive questions; and about politics and values. Many from the legal system want help in answering questions about minors' rights. As little research has been conducted, policymakers can obtain only limited guidance from social scientists. As the policy issue is fundamentally tied to developmental issues, the better the knowledge about the development of cognitive competence, social competence, and autonomy, the easier it will be to make the difficult legal and policy judgements about minor's rights. Regarding minors' access to contraceptives, the situation is somewhat cloudy. There is only 1 state statute that requires parental consent for access to contraceptive medical services, passed in Utah in 1981, and pertaining to services provided with public funds. Yet, common law requires parental consent for any medical treatment (with exceptions for emancipated or mature minors) and "physicians often hesitate to serve young people without first obtaining parental consent because they fear civil liability." The situation is even more cloudy in the case of abortion. The Supreme Court's present position seems to grant emancipated and mature minors access to abortion without a requirement for parental consent or notification, but states may place some requirements for parental involvement upon other minors, as long as these minors have an alternative route to abortion. A thorough search of the literature on adolescent development reveals that the policy questions loom larger than the alternatives. 2 policy alternatives are: to single out a reasonable age below which minors require either parental consent or some form of adult involvement; or treat family planning and fertility control as basic rights which cannot be abridged because of age.     

The elusive goal of informed consent by adolescents

While parents have traditionally provided proxy consent for minors to participate in research, this has proven inadequate for adolescents who are mentally and emotionally capable of making their own decisions. Research has proven that even young children, and certainly most adolescents, are developmentally prepared to make such decisions for themselves. The author challenges the assumption that both consent and assent are static concepts, and proposes that a sliding scale of competence be created to ascertain the adolescent's comprehension of the proposed research by shifting the burden of proof to those who believe a particular adolescent is unable to provide informed consent.     

Social support network and adjustment of minors in residential child care

In this study, the relationship between the social support network and the personal, social and academic adjustment of minors in residential care is analyzed. The sample consisted of 102 minors who lived in residential care and who completed the Social Support Questionnaire and the TAMAI. The results show that social support from the family, despite its being the greatest provider of support, does not affect the minors' adjustment. Neither does social support from peers affect their adjustment. However, social support from adults outside the family, and mainly their affection, seems to have a positive influence on the minors' adjustment, particularly at school and in social settings. These results are discussed in relation to their implications for the improvement of programs of residential child care.     

(Im)maturity of judgment in adolescence: why adolescents may be less culpable than adults

A crucial step in the establishment of effective policies and regulations concerning legal decisions involving juveniles is the development of a complete understanding of the many factors-psychosocial as well as cognitive-that affect the evolution of judgment over the course of adolescence and into adulthood. This study examines the influence of three psychosocial factors (responsibility, perspective, and temperance) on maturity of judgment in a sample of over 1,000 participants ranging in age from 12 to 48 years. Participants completed assessments of their psychosocial maturity in the aforementioned domains and responded to a series of hypothetical decision-making dilemmas about potentially antisocial or risky behavior. Socially responsible decision making is significantly more common among young adults than among adolescents, but does not increase appreciably after age 19. Individuals exhibiting higher levels of responsibility, perspective, and temperance displayed more mature decision-making than those with lower scores on these psychosocial factors, regardless of age. Adolescents, on average, scored significantly worse than adults, but individual differences in judgment within each adolescent age group were considerable. These findings call into question recent arguments, derived from studies of logical reasoning, that adolescents and adults are equally competent and that laws and social policies should treat them as such.     

A comparison of children who receive and who do not receive permission to participate in research

In a study examining children's social competence in elementary school settings, the authors had the opportunity to compare children who received parental permission to participate to children who did not receive permission. Results indicated that children who were not involved in the study were more likely to be viewed by teachers as having unsatisfactory relationships with peers than children who were in the study. The present results suggest that investigators begin reporting the number of children who do not participate in a given study and begin examining whether minors who receive parental permission differ on important dimensions from minors who do not receive such permission. Ethical considerations of the present study are discussed.     

Peer referencing in adolescent decision making as a function of perceived parenting style

This study examined the relationship between parenting style and adolescent decision making. Two hundred sixty-two college students completed a decision-making scale as well as a parenting scale in an effort to determine if the child-rearing style of their parents was related to the tendency of these late adolescents to reference peers rather than parents or other adults in decision making. The results indicated that adolescents raised by authoritative parents tended to refer to their parents for moral and informational decisions, while adolescents raised by authoritarian, permissive, or neglecting-rejecting parents more often referenced their peers for moral and informational decisions. Adolescents referred to their peers for social decisions regardless of how they were raised. Parental responsiveness was a significant factor in determining the source of adolescent decision-making assistance, but parental demandingness was not. It was concluded that less orientation toward peers during late adolescence seems to be another advantage of authoritative parenting.     

Medical practitioners' competence and confidentiality decisions with a minor: An anorexia nervosa case study

Minors (i.e., those under 18 years of age) hold a tenuous legal position in medical settings. While recent legal authority in numerous jurisdictions affords competent minors the right to consent to medical treatment, the guidelines for assessing competence are often vague or non-existent. In addition, these changes have not adequately addressed the issue of confidentiality, and it is unclear whether general practitioners (GPs) owe a duty of confidentiality to competent minors. As medical practitioners are the first point of contact in medical settings, the present study explored GPs' competence and confidentiality determinations regarding a 16-year-old female patient who presented with symptoms of an eating disorder. Questionnaires and hypothetical scenarios were sent to a sample of 1000 GPs, of which 305 responded. Results indicated that 62% of respondents would have found the patient competent, while 82% would have maintained her confidentiality. However, analysis of the rationales provided for these decisions revealed a wide discrepancy in GPs' understanding and implementation of current legal principles. This research highlights the necessity of providing GPs with clear guidelines regarding competence and confidentiality determinations when dealing with minors.     

Relations of parental status with alcohol use patterns and attitudes about underage drinking

In a sample of 143 adults from a population of households in Idaho, significant differences in patterns of alcohol use and attitudes about underage drinking were related to parental status. Nonparents reported drinking alcohol more frequently than parents. Parents were significantly more likely than nonparents to report that it is never acceptable for minors to drink alcohol, that minors should not be allowed to drink alcohol at parties with no parents present, and that "sting" operations by police are warranted. Surprisingly, nonparents were significantly more likely than parents to report stores and bars are not careful enough about selling alcohol to minors.     

That Many of Us Should Not Parent

In liberal societies (where birth control is generally accepted and available), many people decide whether or not they wish to become parents. One key question in making this decision is, What kind of parent will I be? Parenting competence can be ranked from excellent to competent to poor. Cassidy argues that those who can foresee being poor parents, or even merely competent ones, should opt not to parent.     

Supporting her autonomy: the obligations of guardians and physicians in adolescents' refusals of care

This commentary on "Her Own Decision: Impairment and Authenticity in Adolescence" by Campbell, Derrington, Hester, and Lew adds further consideration of obligations for guardians and physicians of minors who struggle in making serious decisions regarding medical treatment.     

越老越风险规避吗？——年龄对冲动性预测决策行为的调节效应

年老化伴随着风险承担倾向的改变,而决策行为受冲动性的影响是否受到年龄的调节尚不清楚。研究采用两种不同类型的决策任务以及Barratt冲动性量表,考察老年人风险承担在自我报告和决策行为上的改变。结果显示老年人在剑桥博弈任务中更加风险寻求而在模拟充气球任务中更加风险规避。同时冲动性可以显著预测模拟充气球的行为,且该预测受到年龄的调节。研究结果提示,老年人并不是单一的更加风险规避或者风险寻求,而是与任务特异性相关。同时,冲动性可以较好的预测年轻人的决策行为,而对老年人的决策行为没有预测作用。     

Attitude Change Toward Animal Experimentation in an Academic Setting

Social values theory was used to examine how parents make decisions for their adolescent children. Social values theory states that decision making for others is based on the social value of an action, leading to a norm for how to decide for others, whereas self decisions are influenced by a number of additional factors. Consistent with a risk-aversion norm, in hypothetical health and safety scenarios parents made more risk-averse decisions for their adolescent children than for themselves. Further, the level of risk and inconvenience affected self decisions more than decisions for one's child. A second study showed that the norm was stronger for decisions for one's child than for oneself and more related to parents’ decisions for their child than for themselves. In sum, parents’ decisions for their children seem to be largely determined by a norm stating how they are supposed to decide, at least in the domain of health and safety. Implications for both the judgment and decision making and parenting literatures are discussed.     

No bridge too high: Infants decide whether to cross based on the probability of falling not the severity of the potential fall

Do infants, like adults, consider both the probability of falling and the severity of a potential fall when deciding whether to cross a bridge? Crawling and walking infants were encouraged to cross bridges varying in width over a small drop‐off, a large drop‐off, or no drop‐off. Bridge width affects the probability of falling, whereas drop‐off height affects the severity of the potential fall. For both crawlers and walkers, decisions about crossing bridges depended only on the probability of falling: As bridge width decreased, attempts to cross decreased, and gait modifications and exploration increased, but behaviors did not differ between small and large drop‐off conditions. Similarly, decisions about descent depended on the probability of falling: Infants backed or crawled into the small drop‐off, but avoided the large drop‐off. With no drop‐off, infants ran straight across. Results indicate that experienced crawlers and walkers accurately perceive affordances for locomotion, but they do not yet consider the severity of a potential fall when making decisions for action.     

Women to women: facilitating decision-making about contraception

A group of women social scientists and mental health practitioners formed the nucleus of a research project designed to address unacceptably high levels of adolescent pregnancy in Chicago. A central concern was the dilemma teenagers face in contraceptive decision making of balancing self-interests with the need for acceptance by others. To increase teenagers' sense of control over their lives, the group designed a program of 12 weekly meetings for groups of 10-20 adolescent girls. The groups were led by 2-4 peer leaders assisted by 1 professional adult. Each session was organized around a specific topic (e.g., birth control, abortion, teen pregnancy, teenage parenting) and utilized exercises that reinforced appropriate decision making and self-care. Also utilized were techniques for fostering a cost-benefit analysis of the decision to be sexually active. Group leaders supported reserving sexual activity for meaningful relationships and using contraception to delay childbearing until adulthood, but acknowledged the positive and negative consequences of these positions. Peer leaders were invaluable in embodying the message that adolescent girls can think, share ideas, and responsibly function in the sphere of sexual activity. Focused interviews with these peer leaders, conducted 6-12 months after the intervention, indicated they were helped by training sessions, pregroup consultations with the staff, the presence of a professional in the group, and the session outlines. The group's emphasis on control and responsibility for one's decisions seemed to be far more effective than more manipulative interventions that simply tell girls not to be sexually active.     

Emotional sequelae of abortion: implications for clinical practice

For women in therapy who have had abortions, an exploration of the context and aftermath of each abortion has been suggested. This inquiry should include: characteristics of the woman herself before and at the time of the abortion, the nature of the interpersonal and cultural milieu at the time, characteristics of the medical environment and procedure, and any events subsequent to the abortion that may evoke regrets about the earlier decision.
Whether or not such an inquiry results in the identification of unresolved issues surrounding the abortion, it is likely to enhance one's general understanding of the client. Exploring a woman's decision to have an abortion can bring into relief developmental and family issues, relationship conflicts, and her aspirations for education, work, and family. A woman's approach to establishing and asserting her priorities and values in making difficult personal decisions becomes clear as does her ability to tolerate and resolve the ambivalence inherent in making difficult decisions.
In psychotherapy, it is important to understand and address those aspects of experience that women have difficulty resolving. Hence, the emphasis on categories of experience that may have a negative impact on a woman's emotional well-being after abortion. Nevertheless, the clinician should remember that even women who report negative post-abortion sequelae overwhelmingly report that they feel that the decision was the right one for them. Having ambivalent feelings to resolve does not necessarily mean that one has made a wrong choice, only that one has made an emotionally significant choice with far-reaching personal implications, in a sociocultural environment that reinforces the ambivalence inherent in such decisions.     

Predicting problem behaviors with multiple expectancies: expanding expectancy-value theory

Expectancy-value theory emphasizes the importance of outcome expectancies for behavioral decisions, but most tests of the theory focus on a single behavior and a single expectancy. However, the matching law suggests that individuals consider expected outcomes for both the target behavior and alternative behaviors when making decisions. In this study, we expanded expectancy-value theory to evaluate the contributions of two competing expectancies to adolescent behavior problems. One hundred twenty-one high school students completed measures of behavior problems, expectancies for both acting out and academic effort, and perceived academic competence. Students' self-reported behavior problems covaried mostly with perceived competence and academic expectancies and only nominally with problem behavior expectancies. We suggest that behavior problems may result from students perceiving a lack of valued or feasible alternative behaviors, such as studying. We discuss implications for interventions and suggest that future research continue to investigate the contribution of alternative expectancies to behavioral decisions.     

Response to Requests for Abortion: The Influence of Guilt and Knowledge1

Participants who varied in their levels of sex guilt and sexual knowledge indicated the extent of their approval for abortion in response to 10 case histories of abortion applicants. The case histories were varied in terms of the circumstances under which conception had occurred. Sex guilt was significantly related to abortion decisions while sexual knowledge registered little effect. Low sex guilt students were more favorable toward abortion requests than were high sex guilt students, but both groups were more favorable toward abortion when conception was the result of failure of a contraceptive method than when it was due to the applicant's inconsistent use of the method. In addition, high sex guilt students' abortion decisions were significantly influenced by the relationship of the applicant to her coital partner. When the relationship was “steady,” they approved the request, whereas abortion was denied to the applicant who conceived with a casual partner. The results were discussed within the context of the debate over the morality of abortion and the problem of unwanted adolescent pregnancy. It was suggested that sex guilt may play a larger role in these issues than has been previously recognized, and that presenting the “facts” (sexual knowledge) may have little impact in abortion related decisions.     

Competence to proceed in SVP commitment hearings: Irrelevant or fundamental due process right?

Sexually Violent Predator (SVP) civil commitment, intended to incapacitate offenders and protect the public, has been implemented in 21 jurisdictions. While respondents in traditional civil commitment proceedings need not be competent to proceed, SVP commitment may present a greater deprivation of liberty and therefore greater procedural protections may be merited. Statutes and case law regarding competence in this context address two issues: competence to challenge unproven sexual offense allegations and competence to participate in the SVP commitment process. Of the 14 states that have addressed the issue, one concluded that respondents must be competent to challenge unproven allegations and one concluded that all SVP respondents must be competent to participate in the commitment process. Differences between SVP and traditional civil commitment, the rationale underlying the competence requirement, and decisions regarding competence in SVP commitment are reviewed to inform debate regarding whether SVP respondents must be competent to proceed with the commitment process. Copyright © 2010 John Wiley & Sons, Ltd.     

Family Formation and Returning to Institutional Religion in Young Adulthood

Institutional religious involvement wanes during young adulthood, but evidence suggests life‐course factors such as family formation bring people back to religion. Using the National Longitudinal Study of Adolescent to Adult Health (Waves 1, 3, and 4), we examine how often young adults who were involved in institutional religion as adolescents return—measured by religious service attendance and religious affiliation—after leaving in emerging adulthood, and how this return is patterned by family formation. The majority of young adults who leave do not return to regular religious service attendance, regardless of their family formation. But single parents, married parents, and childless married individuals are more likely, and childless cohabiting couples less likely, to return to religious communities than those who are both single and childless. Only married parents are more likely than childless singles to reaffiliate, though there is marginal evidence that childless married adults may also be more likely. Thus, the institutions of religion and family are still linked, even though overall levels of religious return are not as high as expected.