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Teens

An Open Letter to My Late, Great, Childhood Best Friend

By October 19, 2015 No Comments
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 To highlight the importance of safety training for teen drivers and the impacts of losing someone to an accident, Managing Editor Julia Bennett writes an open letter to her childhood best friend, who died in a crash thirteen years ago today.

 

Ashwee

My friend, Ashley

Dear Ashley,

Today marks the beginning of my thirteenth year on this planet without you, the thirteenth year that the gaping hole of where you should be in my life screams out a reminder to my brain and my heart.

When we were kids, I never imagined that you wouldn’t be around for our adulthood together. It was incomprehensible to me when that thought first crossed my mind a few months after your death. It was like trying to wrap my mind around the concept of infinity. This first up-close experience with the loss of someone close to me, someone whom I had mapped out well into my future self’s life – it did not make any coherent sense. I took it for granted that you would be here.

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Categories: Accidents, Injuries, + Abuse, Ages + Stages, Tweens + Teens

When Can Your Child Ask for Birth Control Without Your Consent + Other Uncomfortable Issues

By July 20, 2015 No Comments
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As parents we’re used to knowing every detail of our kids’ lives. We have video baby monitors in their rooms, their clothing can track their breathing and temperature and daycares and sitters leave us detailed written records of their days when we’re not there. Sometimes it’s hard for us to tell when our kids deserve the right to privacy and when they’re able to make certain decisions on their own.

The issue of a child’s right to autonomy – the right to make decisions about one’s own healthcare – is a common, but messy, topic in health care. We see this most often in issues of reproductive health, for example, when a minor seeks a prescription for birth control or access to an abortion without the parents’ knowledge.

The issue of a child’s medical autonomy raises many ethical questions, all of which tend to make parents uncomfortable. Recently, this notion came up again in response to a post on Reddit, in which a mother, who is opposed to vaccines and did not vaccinate any of her children, relates how she discovered her eldest daughter got herself vaccinated in secret, much to the mother’s chagrin. The mother asks if she can take any legal action against the doctor who vaccinated her daughter without her knowledge.

A screen capture of the original question posed on Reddit, which has since been removed by the author.

A screen capture of the original question posed on Reddit, which has since been removed by the author.

The July 8, 2015 post to the legal advice subreddit was eventually removed, but not before garnering a robust response. Quite a few commenters pointed out that given the girl’s age (16 years), she is fully entitled to make her own health care decisions without her parents’ consent. For those who support vaccines, it’s a great story: a teenage act of rebellion where the teen is the smart one, taking her health into her own hands.

Before we go on, I want to address that there is some question as to whether this story is actually true or not. Some details cast doubt on it, such as the idea of the girl paying for any of the vaccines with her babysitting money as Canada has universal healthcare, which covers all routine vaccinations. While some private clinics would charge for a vaccine, they are uncommon, and many of the nurses and doctors staffing a walk-in clinic are still covered by the Ontario Health Insurance Plan. None of this means it did not happen, but there are reasons to doubt and no means of verifying the elements of the story.

Whether the story is true or not, it brings up an important question: do the parents have a right to their daughter’s medical records? Do they have a right to legal action against the clinics for vaccinating their daughter without their consent? Do the parents’ rights supersede their daughter’s right to privacy and autonomy over her own healthcare?

Capacity to consent is, in many locations, not so much a matter of ability as it is of arbitrary age cut-offs set by law. For instance, in the United States, as far as the law is concerned, you are incapable of safely operating a car unsupervised until you are 16. Only when you reach 18 are you considered an adult, capable of making your own decisions and even altering how our country functions (via voting). But you cannot make decisions, legally, about drinking alcoholic beverages until you are 21 years old, despite the fact that, in all other regards, you are legally an adult.
As far as the legal question in the Reddit story goes, per Ontario law, anyone who is at least 16 years old has guaranteed medical autonomy, barring any conditions or disorders that impair their decision-making capacity. That means that as soon as a child turns 16, they can make their own medical decisions and their medical records are a private matter between the child and their doctor. The mother in the story has no legal right to view her daughter’s records nor to take action against the clinics or the provincial Department of Public Health for complying with her daughter’s wishes.

But what if she were 15 years old? Would her parents have a right then? Not necessarily.

While Ontario law guarantees autonomy once a person reaches 16 years of age, the province is one of several that recognizes that the ability to make medical decisions for oneself is not a simple matter of age. They employ a “mature minor” standard in that there is no statutory minimum age required for a child to consent to medical treatment on their own. If, in the physician’s judgment, the child understands the nature and consequences of their decision, then they are capable of making the choice for themselves, without any other input from the parents. Before her parents would be able to obtain the medical records relating to her autonomous decision or to take action against the clinics, her parents would need to challenge her capacity as a mature minor in court. In short, they would need to demonstrate that she did not understand the nature or consequences of her decision and that she is therefore unfit to make her own medical decisions.

But what about the ethical angle? Regardless of what the law says, should a parent have unfettered control over their child’s healthcare decisions? Should a child be considered completely autonomous and allowed to make decisions without the consent of their parents? From an ethical perspective, the answer to both questions would tend toward “no”, though more realistically, the answer is, “it depends”.

Some research notes that adolescents are capable of making informed medical decisions, and able to understand the consequences of their decisions, by the time they are 14 years old. Other research argues that people are not fully cognitively developed until they are 21 years old and can’t truly understand consequences.

Obviously, there is variation from individual to individual, and from situation to situation. A child may be capable of an informed medical choice at a young age, where they are free of peer (or parental) influence and the consequences are limited in severity. The same child may be incapable of making a medical decision for themselves when they are under the strong influence of friends or their parents, or where the outcomes are of such a great magnitude that the child is incapable of fully understanding. Whether a child is mature enough to make their own medical decisions, whether to accept or refuse treatment, depends on the child and the situation.
If the child can demonstrate that they understand, that they truly comprehend their situation and the options available, then from an ethical standpoint, they ought to be able to give or refuse consent, without the intervention of their parents. They are individuals in their own right, and as such are deserving of respect as an individual. They are not objects owned by their parents. They are not chattel for the parents to do with as they please. They are individual human beings.

In an ideal world, parents and their children would make medical decisions together, and when the child is mature enough, whether as early as 14 or not until they are legally adults at 18, decision making moves into their hands. It may be difficult for parents to accept that their children are growing up, that their kids do not need them anymore. And it can be even harder for some parents to view their children as individuals capable of making their own decisions rather than property, to put aside their own desires and beliefs in deference to what is objectively best for their child.

But no matter what age a child begins deciding for themselves, the parent does not have an absolute right over their child. When it comes to medical decisions, the parent has an obligation to do what is in the best interests of their child, even if that decision is at odds with the parent’s wishes, as is the case with vaccines and parents opposed to vaccination. Likewise, within the parent-child-doctor relationship, the doctor’s duty is to the child, not to the parents.

Unfortunately, there is no hard and fast rule, no clear cutoff point at which we can say, “This person is now capable of making informed medical decisions on their own.” It is a complex issue that is very situation-dependent. But at the very least, we can respect that parents do not own their children, no matter what misguided Kentucky politicians might say. Parents are not free to do with their children as they please, because children are not property. They are not owned. Children have rights, too. That includes the right to protect themselves when their parents fail to do so. – Edited by Leslie Waghorn

– A version of this post originally appeared on Harpocrates Speaks

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Categories: Ages + Stages, Policy, Politics, + Pop Health, Tweens + Teens

Do the Allegations Against Josh Duggar Constitute Sexual Crimes or “Boys Being Boys”?

By May 26, 2015 7 Comments
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*Please note – this analysis was written prior to the recent discovery that Josh Duggar was exposed in the so-called Ashley Madison hack scandal.

In mid-May, news broke that the oldest of the Duggar siblings (of TLC’s 19 Kids and Counting fame), Josh, had been accused of sexually assaulting five girls when he was 14 years old, four of which were his younger sisters. The internet has been rife with finger-pointing and side-choosing in the wake of the news, dug up from old police reports recently made public. Some have been quick to condemn the eldest Duggar as a sexual predator, while others feel he is being wrongly persecuted for youthful indiscretions.

The allegations against Josh Duggar are difficult for most to understand in isolation because they are layered with our own beliefs about gender norms (“boys will be boys”) and religion (“hypocrites!”). We think that based on the police report, neither side is wholly right in their judgment of the situation, and science has a lot to say about what happened, and whether it was “normal” or not.  In this post, as much as possible, I want to look at the facts and just the facts and remove the layers of politics and religion from the story.

Let’s lay out the facts as we know them from the police report released by the Springdale, Arkansas police department:

  • Josh was 14 when the alleged incidents began, and authorities identified his known victims as ranging in age from 5-11 years at the time.
  • Police say four of his victims were his younger sisters. Most were sleeping at the time Josh was alleged to have fondled their breasts and genitals. One incident allegedly happened when he was reading to one of his sisters. The other alleged incident involved a babysitter who likely would have been older than Josh at the time (also said to have occurred while she was sleeping).
  • Reports say that after the second or third incident Josh’s parents made him confess his sins in front of his church and sent him away for several months to help a family friend with construction; it does not appear he received counseling at this time.
  • Upon his return, reports say that his parents welcomed him back into the house, but it is unclear if any conditions were set or if he was being more closely monitored.

First, regardless of gender, it is natural and normal for teens and tweens to be sexually curious, as uncomfortable as that often makes their parents. It’s also normal for kids this age to be interested in their own bodies and the bodies of the opposite gender. There’s also nothing abnormal with masturbation or consensual kissing and sexual touching at this age.

What is abnormal is to exercise that curiosity when the other party is either unable or does not consent to sexual play. In Josh’s case, his sisters were all sleeping when he allegedly fondled their breasts and genitals (with the exception of one incident).  Obviously, as they were asleep they could not consent to sexual play.  This is the part that concerns me, and that the scientific literature doesn’t support as being “normal.”

joshduggarbio

Recent image of Josh Duggar, c/o FRCAction.org

What also sticks out is that Josh’s victims weren’t his peers, there were significant age gaps (he was older)  in all but the babysitter. His oldest sister was 12 at the time of the assaults and she reports that Josh never touched her inappropriately. This is where we see another level of predatory behavior happening. It’s common for predators to choose victims they feel they can safely control and this often means younger children. In this sense, Josh fits into the bell curve of most teenage sexual abusers.

So now that we’ve established Josh’s reported behavior towards his sisters fits the clinical description of sexual assault, what about how his parents handled the situation?  The police report makes clear that while Josh was sent away for three months, he did not receive clinical counseling at this time.  This is important as a psychological evaluation and psychotherapy, specifically Multisystemic Therapy, are effective at reducing recidivism rates among juvenile sexual offenders.

Jim-Bob and Michelle’s decision to let him back into the house has also been controversial among many and we understand why. Many parents empathize with the Duggar’s situation: their son, the predator, was a minor, as were their daughters, the victims. Were Josh’s parents between a rock and hard place?  Did they have to choose between their son’s future and the safety of their daughters?  The research says that with the proper intervention and careful supervision, certain juvenile sex offenders can return to live in the same family home as their victims.  But, again, it’s unclear if any conditions were placed on Josh when he returned home and we know that at the time of the incidents he did not receive the standard of care.

What I do want to take off the table here is the idea that because Josh was a minor at the time the incidents happened, that it somehow makes the sexual assaults less “real.” Minors (those under the age of 18) can and do commit sexual crimes, in fact they account for 35% of known sexual crimes. His age may make him less culpable in regards to legal consequences, but it doesn’t mean the experience was less real for his victims.

While it is clear from the police report that Josh was likely of low-risk to reoffend with the proper intervention, it also doesn’t appear he received any form of formal, psychological treatment. According to reports, the Duggars initially told police that Josh had been sent to a treatment center, but the parents later admitted to police that he was sent away to help a family friend on a construction site.

While what Josh did to his sisters 12 years ago fits the profile of sexual abuse and we know that his parents didn’t seek the standard of care for him, does that make him currently at risk to sexually abuse again? The research says, maybe, maybe not. Minors that commit sex offenses, have a sexual offense recidivism rate of 7-13% as adults compared to 5-24% of those that offend as adults.* Statistically speaking, if there hasn’t been an incident in the last 12 years, it’s more likely that he won’t reoffend.

Tomorrow, we discuss the impact Josh’s actions may have had on his victims (Editor’s note – those articles can be found here and here).

*Note: it is extremely difficult to accurately measure re-offense and recidivism rates for sexual offenders.

 

Resources:

Tulloch, T. and Kaufman, M. Adolescent Sexuality. Pediatrics in Review. Vol. 34 No. 1 January 1, 2013
pp. 29 -38.

National Center on Sexual Behavior of Youth. Children with Sexual Behavior Problems: Common Misconceptions vs. Current Findings. American Academy of Pediatrics. No 2. 2003.

Sexual Abuse Committee of the National Child Traumatic Stress Network. Understanding and Coping with Sexual Behavior Problems in Children – Information for Parents and Caregivers. April 2009.

Finkelhor, D., Ormrod, R. and Chaffin, M. Juveniles Who Commit Sex Offenses Against Minors. U.S. Department of Justice | Office of Justice Programs | Juvenile Justice and Delinquency Programs. December 2009.

Lobanov-Rostovsky, C. Chapter 3: Recidivism of Juveniles Who Commit Sexual Offenses.   Sex Offender Management Assessment and Planning Initiative. U.S. Department of Justice | Office of Justice Programs | SMART.gov. Retrieved May 25, 2015.

Przybylski, R. Chapter 5: Adult Sex Offender Recidivism. Sex Offender Management Assessment and Planning Initiative. U.S. Department of Justice | Office of Justice Programs | SMART.gov. Retrieved May 25, 2015.

Center for Sex Offender Management. Key Considerations for Reunifying Adult Sex Offenders and their Families. U.S. Department of Justice | Office of Justice Programs. December 2005.

Righthand, S. Juvenile Sex Offense Specific Treatment Needs & Progress Scale and Guide. National Council of Juvenile and Family Court Judges. 2005.

 

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Categories: Accidents, Injuries, + Abuse, Mental, Emotional, + Behavioral Health