Ethics Ages and stages Decision making for young adults With and without capacity Dr Richard Hain Lead Clinician, Welsh PPM Network, Cardiff, UK Visiting Professor, South Wales University Transition in Palliative Care Study Day 24th September 2013

Introduction What is ethics ? What is a person ? What is a young person ? What does this mean for decision-making ?

What is ethics ? “The first step in the evolution of ethics is a sense of solidarity with other people” Albert Schweitzer

What is a person ? “A person is a rational being of an individual substance.” Boethius (480-525 AD) Rational (able to formulate intention on basis of reason) Individual (able to act independently of influence of others)

What is a person ? Reason and individuality are key concepts in ethics. Reason is broadly reflected in concept of interests. Individuality is broadly reflected in concept of autonomy.

What is a young person ? Ten Tasks of Adolescence1: Task 1: Adjust to Sexually Maturing Bodies and Feelings Task 2: Develop and Apply Abstract Thinking Skills Task 3: Develop and Apply a More Complex Level of Perspective Taking Task 4: Develop and Apply New Coping Skills (decision-making, problem-solving, conflict resolution) Task 5: Identify Meaningful Moral Standards, Values, and Belief Systems Task 6: Understand and Express More Complex Emotional Experience Task 7: Form Friendships that are Mutually Close and Supportive Task 8: Establish Key Aspects of Identity Task 9: Meet the Demands of Increasingly Mature Roles & Responsibilities Task 10: Renegotiate Relationships with Parents/Guardians 1Raising Teens: A synthesis of research and a foundation for action. Center for Health Communication, Harvard School of Public Health (www.hsph.harvard.edu/chc/parenting/raising.html)

What is a young person ? Ten Tasks of Adolescence1: Task 1: Adjust to Sexually Maturing Bodies and Feelings Task 2: Develop and Apply Abstract Thinking Skills Task 3: Develop and Apply a More Complex Level of Perspective Taking Task 4: Develop and Apply New Coping Skills (decision-making, problem-solving, conflict resolution) Task 5: Identify Meaningful Moral Standards, Values, and Belief Systems Task 6: Understand and Express More Complex Emotional Experience Task 7: Form Friendships that are Mutually Close and Supportive Task 8: Establish Key Aspects of Identity Task 9: Meet the Demands of Increasingly Mature Roles & Responsibilities Task 10: Renegotiate Relationships with Parents/Guardians 1Raising Teens: A synthesis of research and a foundation for action. Center for Health Communication, Harvard School of Public Health (www.hsph.harvard.edu/chc/parenting/raising.html)

What is a young person ? Ten Tasks of Adolescence1: Task 1: Adjust to Sexually Maturing Bodies and Feelings Task 2: Develop and Apply Abstract Thinking Skills Task 3: Develop and Apply a More Complex Level of Perspective Taking Task 4: Develop and Apply New Coping Skills (decision-making, problem-solving, conflict resolution) Task 5: Identify Meaningful Moral Standards, Values, and Belief Systems Task 6: Understand and Express More Complex Emotional Experience Task 7: Form Friendships that are Mutually Close and Supportive Task 8: Establish Key Aspects of Identity Task 9: Meet the Demands of Increasingly Mature Roles & Responsibilities Task 10: Renegotiate Relationships with Parents/Guardians 1Raising Teens: A synthesis of research and a foundation for action. Center for Health Communication, Harvard School of Public Health (www.hsph.harvard.edu/chc/parenting/raising.html)

What is a young person ? Defined largely by the facts that: Rational skills are developing: ‘a work in progress’ So not yet fully rational in adult sense, then. Relationships with others are changing: re-evaluating, re-negotiating So not really independent of others, then.

What is a young person ? Young people do not reason like adults. Prioritise interests differently Do not always prioritise reason over intuitions Young people are deeply dependent on those around them. Influenced by what others want for them Influenced by what they want for others

What is a person ? Ethics that might make sense in mature adults can’t always easily accommodate young people “A person is a rational being of an individual substance.” Boethius (480-525 AD) Rational (able to formulate intention on basis of reason) Individual (able to act independently of influence of others)

What does this mean for decision-making ? ‘Interests’ requires us to know a young person’s point of view. ‘Respect for autonomy’ means accommodating a young person’s achievable objectives.

Ambiguous – freedom from others’ influence ? Control of others ? Not clear in children

What does this mean for decision-making ? ‘Interests’ requires us to know a young person’s point of view. ‘Respect for autonomy’ means accommodating a young person’s achievable objectives.

What does this mean for decision-making ? The only way to find out both… …is to talk to the young person !

Family Care team Young person

Family Care team Young person

Family Care team Young person

Family Care team Young person

Family Care team Young person

Family Care team Young person

Family Care team Young person

Family Care team Young person

Family Care team Young person

Family Care team Young person

Family Care team Young person

Summary: Ethics in transition 1. Reason and interests: Interests of young person are not always separable from interests of family and friends. Even where they can be separated in principle, they may not be separable in practice.

Summary: Ethics in transition 2. Independence and respect for autonomy: It is relationship (not independence) that characterises young people.

Summary: Ethics in transition Autonomy is a myth. Respect is not.