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Healthy Case for Letting Doctors Judge Teens' Best Interests

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A TEENAGER who is a Jehovah's Witness declines a potentially life-saving blood transfusion. Another teenager, self-conscious and strongly believing that it will make her happier, requests surgery to enlarge her breasts.

When children and adolescents make decisions that may be against their best interests, should we respect their choice?

In Britain last week, there was much discussion about the decision of 13-year-old Hannah Jones to refuse a heart transplant. Without one it seems likely that she will die in the next six months. The transplant would probably prolong her life by at least several years, and improve her ability to get around, be active and independent. About half the adults in Britain who receive heart transplants live for 10 years or longer. In Hannah's case, the transplant would carry the extra risk of a recurrence of leukaemia, which she had when she was a young child.

Last month an article was published in the Journal of Adolescent Health describing the rising popularity in the US of plastic surgery for teenagers. These include liposuction, breast enlargements and tummy tucks. But the surgery can have complications, and there is no evidence that it leads to improved body image in the long term.

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Some might see these contrasting cases as patient choice gone too far. Medical decisions for minors have traditionally been guided by their "best interests". Doctors are supposed to try to maximise the benefits for their young patients while minimising the harms. Parents frequently make decisions for their children that go against the child's wishes. When parents insist that children go to the dentist, take medicine, or avoid junk food, they have their long-term wellbeing in mind. This is a form of paternalism that is justified because children's ability to weigh up the pros and cons of decisions is still developing. However,

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