Manson Neil C
Bioethics. 2015 Feb;29(2):66-73. doi: 10.1111/bioe.12086. Epub 2014 Feb 19.
In many jurisdictions, adolescents acquire the right to consent to treatment; but in some cases their refusals - e.g. of life-saving treatment - may not be respected. This asymmetry of adolescent consent and refusal seems puzzling, even incoherent. The aim here is to offer an original explanation, and a justification, of this asymmetry. Rather than trying to explain the asymmetry in terms of a variable standard of competence - where the adolescent is competent to consent to, but not refuse, certain interventions - the account offered here focuses more closely on the normative power to render actions permissible. Where normative powers are shared they can readily give rise to an asymmetry between consent and refusal. We then turn to why it is justifiable that normative powers be shared in adolescence. Transitional paternalism holds that the acquisition of normative powers by competent adolescents should not be an instant one, achieved in a single step, but that there should be a transitional period where paternalistic protection is rolled back, but not entirely withdrawn until a later date. Transitional paternalism could be implemented without generating the asymmetry between consent and refusal but, it is argued, the asymmetric version of transitional paternalism is to be preferred insofar as it offers a greater respect for the adolescent's decisions than the symmetrical alternative.
在许多司法管辖区，青少年获得了同意接受治疗的权利；但在某些情况下，他们的拒绝——例如拒绝接受挽救生命的治疗——可能得不到尊重。青少年同意与拒绝的这种不对称似乎令人困惑，甚至前后矛盾。本文旨在对这种不对称给出一种原创性的解释及正当理由。这里提出的解释并非试图从能力的可变标准角度来解释这种不对称——即青少年有能力同意，但无能力拒绝某些干预措施——而是更密切地关注使行为具有可允许性的规范权力。当规范权力被共享时，它们很容易导致同意与拒绝之间的不对称。然后我们转向为何在青少年时期共享规范权力是合理的。过渡性家长主义认为，有能力的青少年获得规范权力不应是一蹴而就的，而应有一个过渡时期，在此期间家长式保护逐步减少，但直到更晚些时候才完全撤销。过渡性家长主义可以在不产生同意与拒绝之间不对称的情况下实施，但有人认为，过渡性家长主义的不对称版本更可取，因为与对称版本相比，它对青少年的决定给予了更大的尊重。
