starbet777 Should a 13-Year-Old Be Pressured Into Having an Abortion?

I am a physician in New York State who considers reproductive autonomy to be a basic human right. Our practice recently started to provide care to a newly pregnant 13-year-old. At this timestarbet777, she does not want to terminate her pregnancy, although it also does not seem that she necessarily wants to continue her pregnancy. It is fair to say that she is approaching the situation as one might expect of a very young adolescent.

Her mother is involved in her care and is walking the fine line of trying to maintain a relationship with her daughter while firmly guiding her toward terminating the pregnancy. The mother is acutely aware of how generational poverty is perpetuated and wants to break the cycle of young teen pregnancy in her family.

My dilemma relates not to the legal issue of consent but to whether a 13-year-old has an ethical right to assent to care. Parents routinely, and appropriately, force children to receive medical care that they don’t want — flu vaccines, needed surgeries — because they have a maturity and an understanding of the situation young children lack. A 13-year-old cannot be expected to understand the ramifications of continuing a pregnancy in the same way that even an older adolescent might be able to.

This situation feels very different from other medical issues, and yet the fact of the patient’s immaturity remains. So does the fact that for this patient, given her demographic, the risk of death is far higher for a full-term pregnancy than for an abortion. But this demographic has also, historically, been subjected to reproductive coercion. Bearing all this in mind, what can a caring parent ethically require? — Name Withheld

From the Ethicist:

“In recent weeks, a conversation around whether to change how we allocate our Electoral College votes has returned to the forefront,” Mr. McDonnell said in a statement on Monday. “I respect the desire of some of my colleagues to have this discussion, and I have taken time to listen carefully to Nebraskans and national leaders on both sides of the issue. After deep consideration, it is clear to me that right now, 43 days from Election Day, is not the moment to make this change.”

Ms. Gray’s 14-year-old son, Colt, is being charged as an adult for murder in the deadliest school shooting in Georgia’s history. He is accused of bringing an AR-15-style rifle to Apalachee High School in Winder, Ga., earlier this month, killing four — two students and two math teachers — and injuring at least nine.

The way we think about freedom relates to ideals of autonomy. John Stuart Mill wrote, in a powerful passage in ‘‘On Liberty,’’ that a free person planning a life ‘‘must use observation to see, reasoning and judgment to foresee, activity to gather materials for decision, discrimination to decide, and when he has decided, firmness and self-control to hold to his deliberate decision.’’ Yet the capacity for reasonable decision-making doesn’t arrive all at once, as if an on switch had been toggled. Many children live somewhere in the borderlands. Born into the world in a state of complete dependency, we grow toward autonomy as we mature, and different people reach different stages along that path at different ages.

When our capacities aren’t fully developed, decisions are entrusted to others — beginning with our parents. And while the law may need to draw sharp boundaries, there’s often uncertainty about whether people have developed the capacities that make it sensible to leave a decision to them. With smaller-stakes decisions, we might want to err on the side of granting youngsters control; one way you grow into autonomy is by practicing taking responsible decisions. But having a baby is not a low-stakes decision. As you recognize, your young patient could suffer all sorts of setbacks if she were to become a mother, especially if she wants to raise the child. Beyond the obvious social and educational consequences, short-term and long-term medical risks are especially high for adolescent girls and for their babies.

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