From the Ethicist:
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.
In the light of these consequences, the mother’s judgment about the wisest course here seems to me sound. (I acknowledge that there are thoughtful people who believe that abortion involves a terrible wrong and who will disagree.) But as you also recognize, thinking that this is the right decision doesn’t settle the issue of whose choice it is. If the girl were five years younger or five years older, the situation would be clear to you. Ethically, we would not, in normal circumstances, require an 8-year-old to make medical decisions, nor subject an 18-year-old to a procedure without her assent. And in this ambiguous zone of early adolescence? We have to start with the enormity represented by terminating a pregnancy against someone’s will. (In New York State, a minor who is pregnant has the right to choose abortion or to continue the pregnancy, as long as she is mature enough to meet the standard for informed consent.)
Over the course of the past century, we have come to place great weight on bodily autonomy, even for those whose decisional capacity is limited. That’s especially the case when it comes to interventions that are both consequential and elective, in the strict sense of not being medically necessary. Putting aside the legal and practical questions, I’ll note that this girl is plainly someone who has some understanding of her situation. Nor is the equivocation she expresses unknown among grown-ups. The fact that she is far from the ideal of full autonomy doesn’t justify terminating her pregnancy by force or by guile. This teenager may not have an adult’s decision-making capacity; she does have the capacity to experience profound violation from undergoing an abortion against her will, an experience that could result in psychological harm.