In the case of breast augmentation, the parent must guide the minor to the right decision -- and that is usually not to have the surgery unless it is necessary for the teen's overall health. It is up to the adult to think responsibly. There are dangers to any surgery and infections are not among the least of them. Perhaps low self-esteem is a reason for counseling by a professional, but not necessarily reason to alter one's body artificially.
The ethical responsibilities of the parent in a discussion with their underage teen regarding whether or not to have her breast augmented, are even greater and more impacting than the legal issues.
The 1800 girls under the age of 18 who had their breasts augmented last year alone are under the ethical (and rational) reasoning of the parent. These are the parents who are taking out financing to do the surgery -- which costs in the thousands to do. When ethics and morality enter the picture it is difficult to comprehend all the ways this is wrong-thinking.
Teenagers are at a very vulnerable age, and, for the most part, an immature stage in their lives. They are in the process of acquiring an identity and a set of values which they acquire from their parents for the most part. They also want to be liked and even admired, but definitely respected. The parent has a responsibility here to model some behaviors such as showing and teaching them how to accept who they already are and modeling how to focus on their strengths.
The focus for the parent has to be on the child's -- and yes, they are still children -- self-worth, not on whether they are an a or B. cup. What happens, according to the experts, is that parents who buy into breast augmentation for their teen, who is going through all of this, are helping them to adapt a shallow picture of who women are in society and what their depth of value is to themselves, to others, and to the world.
It is true that, ethically, it is always best to focus on all sides of an issue, and to listen to the validity of all those reasons and arguments that oppose our own. However, it is difficult to understand what the "other" side might be in this argument. And it equally as easy to see that, though the emotional issues for a teen girl are great and easy to succumb to, the ethics -- substitute morality -- call for cool heads and firm leadership on the parents' part.
Minor's Legal and Ethical Rights and Responsibilities
In the medical decision-making world, there are minors, mature minors, and emancipated minors. If a minor is found to be a competent "mature minor" or "emancipated minor" by the courts, they may make certain decisions concerning their own healthcare with or without the consent of parent or guardian.
The courts, over time, have established a policy that allows them to evaluate the status of a minor as to his or her maturity and/or emancipation status: "A minor who is deemed able to understand short- and long-term consequences is considered to be mature and thus able to provide informed consent/refusal for medical treatment. This maturity authorizes the minor to make decisions regarding his or her medical treatment" (Hickey 102). It is a policy that, due to courts in many states following legal precedent, has been adopted by most states, but not all. It is not, by any means, comprehensive permission for a minor to make any and all healthcare decisions for themselves, but it does allow certain freedom of consent to mature teens that had not been existant before.
And when we look at the specific criteria the court has established to determine the capability of a mature minor to make these decisions, it too seems open-ended: a minor must be a minimum age of 14; the minor is capable of giving informed consent; the treatment will benefit the minor; there is no significant risk to the patient; the treatment is an established medical protocol (Hickey).
It is not that these definitions allow too much freedom right now to teens to make their own medical decisions in an area such as breast augmentation, but it leaves an open path to get there in the future. These guidelines, as they exist today, could easily be interpreted to allow a teen to make an independent decision to have breast augmentation with or without parental consent.
Right now, this policy may be put into effect by the courts for venereal disease treatment, contraception, prenatal care, abortion, mental health treatment, emergency care, and alcohol or drug abuse (Hickey 102). As we study this list, we can see that, since mental health treatment is one of those circumstances where a "mature teen" may make their own medical decisions, it is not a far stretch to say that the effects of not getting a breast augmentation can be low self-esteem, loss of self-confidence, and those two can lead to depression -- a mental health issue.
Does a minor have the right to make his or her own medical decisions? Based on our research, in certain cases, the response would have to be "yes." Does a minor have the right to decide for herself whether or not to have breast augmentation surgery without parental consent?
The answer is no, they do not. But the future may hold a different answer.
Ethical rights and responsibilities of the minor as it concerns breast augmentation surgery are significant. As a matter of fact, it is these ethical considerations that go towards determining if a teen is "mature" or "emancipated." Though a teen of this status is able to reason maturely and has the thinking capacity and skill of an adult, what about the ethical and moral implications of breast augmentation that must be a part of any such decision to modify the human body.
Does the teen have the moral responsibility, judgement, and experience to understand the outcomes of their actions and decisions? Teens are volatile emotionally, especially girls. How does this impact their inclination to make a "short-term" emotional decision vs. A longer term, more reasoned, well thought-out approach to the decision?
The legal determination of a teen's capability to make their own decisions about healthcare is relatively straight-forward. Age, competence, and maturity or emancipation status are considered and a decision rendered by the courts. However, the determination is not so easy with the ethical evaluation of the minor's decision-making capabilities.
Shouldn't a responsibility of the "mature teen" be to display an understanding of the purpose of the breast augmentation, its risks, and more importantly, its short- and long-term consequences, and benefits? Isn't it an obligation for the teen to know and understand the alternatives to the procedure? And isn't it imperative that the minor display evidence that they are making an informed decision?
The answer has to be "yes." While the minor patient has certain rights to ethical and legal medical treatment, it would seem that, even in the presence of parental consent, the patient must understand the purpose, risks, and consequences of whatever is being done to his or her body.
And, particularly, in the case of breast augmentation or any surgery, the patient has a responsibility to know the alternatives, such as counseling, to having a surgeon apply the knife and alter her body. Psychiatrists, psychologists, and other professional counselors deal with the trauma of low self-esteem all the time. To use that as the soul excuse for breast augmentation, which is what is often done, surgery seems premature at best.
The American Society of Plastic Surgeons' (ASPS) "Statement of Principle on Informed Consent" lists in detail all of the considerations we mentioned above. It is the doctor's ethical responsibility to ensure the patient has been read or has heard all of that information prior to consenting to the surgery. It is NOT the physician's responsibility to force the teen to understand all that she has been told. Yes, she must sign the document, or the parents or guardian in her stead, but does that fulfill the teen's ethical responsibility?
The reason it is so crucial, especially to a teenage girl, that she understand everything she is being told about the breast augmentation, is that there can be serious complications -- not often -- but any surgery brings risk. And being caught up in the moment of emotion in which she pictures herself with the perfect body and ignores all else, is irresponsible.
As we saw in the beginning of our paper, it is possible that the surgery may have triggered a reaction that caused Miss Kuleba to pass away after having the breast augmentation surgery. We will never know. And that is an extreme to be sure. Potential problems with surgery always include: a bad reaction to anesthesia, bleeding, and…