Should we trust fourteen-year-olds to make decisions about their own bodies?
Recently, there has been significant controversy over gender-confirming surgery for the LGBTQ+ community, especially transgender youth. In the US, for example, 25 states have officially banned the surgery1. Many parents and state governments continue to consider whether they should let children and minors seek such surgery, enabling them to become what they feel their true gender is, and not the gender that they were assigned at birth. Similarly, in the UK, changing its previously “welcoming” approach to transgender care, the National Health Service has recently stopped the prescription of “puberty blockers” to young adults and teenagers2. The controversy about gender-confirming care and surgery is just one current example of decisions about the bodies of teenagers that can be permanent and even extreme.
In answering the question of whether or not we should trust fourteen-year-olds to make decisions about their own bodies, it is necessary to consider the consequences. To determine whether such actions should be permissible or not, it is also important to explore how we gain the knowledge needed for our actions. Specifically, is our knowledge about actions and consequences innate, or is it built on experience, including being taught and passed down by adults, such as parents, teachers, and guardians? The question of how a child gains knowledge will directly impact how much trust states and parents should place on teenagers, and how much guidance teenagers need from others. For example, if children have innate knowledge, we could trust them more, because they would already know, or be able to reason, what to do or not do, or the likely consequences of their actions. If they do not have innate knowledge about the world, however, parents should have more control, to prevent teenagers from taking potentially regrettable actions related to their bodies, with consequences that will continue throughout their lives. There exists a spectrum of examples running from clearly permissible to absolutely not permissible actions, and the following analysis will help establish a line for decision-making about them.
“We,” “Trust,” and the Relationship between Identity and the Body
Before defining the line by considering a few examples that are either “clearly permissible,” “clearly impermissible,” or “ambiguous,” it is necessary first to examine some of the concepts in the question.
Firstly, to define the concept of “We”, it is important to consider the different perspectives and opinions of multiple stakeholders. For this essay’s purposes, and to answer the question, it would be optimal to define the concept of “We” as the parent of the teenager, rather than society in general. The parent, as a stakeholder, has the child’s future, safety, and wellbeing directly in mind, whereas society has many other factors to take into consideration and is not as pure as the parents in their wishes for the child.
Secondly, to define “Trust,” it is giving someone the responsibility to do something on their own without any outside interference. By assessing factors such as mental health, physical health, economic situation, age, and similar things, parents or guardians decide how much they should trust children to make decisions on their own. In other words, they decide whether to prevent or provide guidance for things teenagers may regret later in life, such as actions with serious consequences for their bodies. Scientists have concluded that teenagers’ brains go through “several major morphological and functional changes [that] occur …during adolescence.” One recent study, for example, has suggested that “neurocircuitry and myelinogenesis remain under construction during adolescence because these events in the central nervous system (CNS) are transcriptionally regulated by sex hormones that are specifically increased during puberty.”3 Given these significant changes that teenagers experience as they grow, parents should think carefully about how much trust they are allowing their teenagers to have.
Finally, to define the relationship between “self-identity” and the body, Locke argued that the identity of a person is “the sameness of a rational being”4. Feelings that last across that being’s life, like regret, play a part in how a person understands his or her own identity. These long-term feelings and other factors help children discover themselves, and changes to their bodies have a central role in forming their identities. As researchers Elizabeth Daniels and Meghan Gillen state, “[the relation between] body image [and] identity construction [is] a key developmental task for young people.”5 In addition, one more important factor is the way an individual, his or her peers, and society respond to his or her physical appearance, which can shape how they understand themselves, and lead to emotions ranging from pride to disgust, and even self-hate.
Locke and Descartes on Knowledge and Learning
The philosopher John Locke argued that all knowledge is gained through experience. Human beings start out as “white paper, void of all characters, without any ideas”6. They gain knowledge by learning. As Locke writes: “Whence has it all the materials of reason and knowledge? To this I answer, in one word, from experience. In that all our knowledge is founded; and from that it ultimately derives itself”7. The opposite view was held by Rene Descartes. In his book Meditations on First Philosophy, he argued that the senses and experience lead human beings into error: “Whatever I have hitherto admitted as most true, that I received either from, or by my Senses; but these I have often found to deceive me”8. He explains that there are many things human beings can understand about the world the moment they are born, using materials that are innate in their minds, to construct the world in both mathematical and philosophical ways.9
When thinking about the question of whether fourteen-year-olds should be able to make decisions for themselves about their bodies, the distinction between Locke’s ideas and Descartes’ ideas is helpful. Locke believes that if a person had not experienced something before, he or she would not have knowledge about its consequences: “No man’s knowledge here can go beyond his experience.”10 For example, when children first touch a hot kettle, they immediately learn not to do that in the future because it will burn their fingers. However, the consequences of that action are not so extreme that the hand becomes disfigured. It is not an irreversible event, and it also gives the child knowledge for the future. In other words, the child learns. However, there are things that are irreversible. The first time a child does a particular action that is irreversible, he or she will have to face its consequences permanently. Agreeing with Locke’s view that we learn through experience, we should want to avoid any permanent consequences that children may regret later on in life. The standard, therefore, for answering the question will be whether the consequences of the child’s action will be extreme and/or permanent.
Drawing the Line: Examples
To establish and reinforce the standard, consider three examples: one clearly permissible, one clearly impermissible, and one ambiguous. For a clearly permissible example, we can consider haircuts. When getting a haircut, we are altering our bodies by changing our hairstyles, but the consequences are minimal because the hair will grow back weeks or months later. According to Locke’s view, the first time a child gets a haircut, he or she will learn new things, such as that hair gets shorter, and that they may end up with a bad hairstyle. Their peers may laugh at or joke about them, and it may be an unpleasant experience. However, even a bad haircut is a good form of learning, because the consequences are minimal. The child can use that knowledge to make better decisions the next time they are getting a haircut.
For the clearly impermissible example, we can return to gender-confirming surgery. People might agree that a small number of boys and girls feel that they are born as the wrong gender. However, the decision to have surgery is permanent, while the feeling of being born in the wrong body may turn out to be temporary. The first time such a child seeks surgery, according to Locke’s view, he or she will also learn new things, such as the physical consequences of becoming a different gender. Their peers, family, and friends may or may not accept that decision. In addition, they themselves might either accept or not accept the change to their own body. This second example is a bad form of learning, because if the child regrets the decision, it will be permanent; it cannot be reversed. The child cannot use that knowledge to make better decisions the next time, because there is no “next time.” The decision has been made, and it is final.
Finally, there are examples that are ambiguous and up for debate. For the ambiguous examples, it may be possible to reverse the results or some of the consequences after a long time, although some alterations of the body short-term are definitely noticeable. As one ambiguous example, imagine that a fourteen-year-old teenager was extremely interested in communism and decided to get a tattoo of a communist leader on his arm. The child will now have a semi-permanent tattoo of a socialist leader that he may be only temporarily attracted to. It is a major change to the body, but not to the extent of gender-confirming surgery. According to a survey conducted by Reuters, 78% of US parents would not allow their teenagers to get a tattoo on any part of their body, let alone having a full-arm tattoo.11 The data suggests that the majority of parents think that tattoos are a negative or harmful change to a teenager’s body, and presumably, also a long-term one. Although tattoos can be alleviated via laser surgery or long periods of time, they cannot be fully removed. Therefore, using the standard stated before, specifically “whether the consequences of the child’s action will be extreme and/or permanent,” and applying it to this scenario, it could be deduced that the child should not be trusted to make decisions on this subject, because the action is extreme and semi-permanent.
There are other ambiguous and debatable examples which can be explored. Firstly, getting ear piercings or ear-rings: from the standard set earlier, the child should be trusted to make decisions on getting ear-piercings on their own, since the action is not permanent (the ear could be healed after some time), and it is not extreme. This is because even if it goes badly, the ear is still quite an unnoticeable region on the body, and the consequences are quite minimal. On the other hand, there are cosmetic surgeries or plastic surgeries. Although each situation depends on context and some cosmetic surgeries, such as rhytidectomy (face lift), rhinoplasty (nose job), and blepharoplasty (eyelid surgery), have comparatively minimal consequences, 60% of people regret cosmetic surgery, according to a British survey.12 Thus, children should still not be trusted to make their own decisions about such changes, because of the sheer percentage of people that end up regretting it.
Conclusion
The challenge in answering the question was to establish a clear line of reasoning for parents to decide whether or not it is a good idea to trust children on certain decisions. There is no clear-cut, simple answer. Thus, the standard established in this essay should help when making decisions in difficult or ambiguous situations. In such cases, one should ask: “Are the consequences extreme and/or permanent? And if so, what is a safe thing that children could learn from, and how can they apply those lessons in future decisions?” If the answer to the first question is “yes”, then it is best not to trust a fourteen-year-old with the decision about their body.
Endnotes
1. “Policy Tracker: Youth Access to Gender Affirming Care and State Policy Restrictions.” KFF. Accessed June 26, 2024. https://www.kff.org/other/dashboard/gender-affirming-care-policy-tracker/.
2. Denis Campbell. “Children to Stop Getting Puberty Blockers at Gender Identity Clinics, Says NHS England.” The Guardian. (March 12, 2024.) Accessed June 26, 2024. https://www.theguardian.com/society/2024/mar/12/children-to-stop-getting-puberty-blockers-at- gender-identity-clinics-says-nhs-england.
3. Mariam Arain, et al. “Maturation of the adolescent brain.” Neuropsychiatric disease and treatment vol. 9 (2013): 449-61. Accessed June 26, 2024. doi:10.2147/NDT.S39776
4. John Locke. “An Essay Concerning Humane Understanding, Volume II.27.11.” (1689) Project Gutenberg. Accessed June 26, 2024. https://www.gutenberg.org/files/10615/10615-h/10615-h.htm.
5. Elizabeth A. Daniels and Meghan M. Gillen, “Body Image and Identity: A Call for New Research,” in Kate C. McLean, and Moin Syed (eds), The Oxford Handbook of Identity Development, (2015; online edn, Oxford Academic, 5 Dec. 2014). Accessed 26 June 2024. https://doi.org/10.1093/oxfordhb/9780199936564.013.013.
6. John Locke. “An Essay Concerning Humane Understanding, Volume I.1.2.” (1689) Project Gutenberg. Accessed June 26, 2024. https://www.gutenberg.org/files/10615/10615-h/10615-h.htm.
7. Ibid.
8. René Descartes. “Six Metaphysical Meditations, Meditation I.” (1680) Project Gutenberg. Accessed June 26, 2024. https://www.gutenberg.org/cache/epub/70091/pg70091-images.html.
9. Gareth Matthews. “The Philosophy of Childhood.” Stanford Encyclopedia of Philosophy. (2023) Accessed June 26, 2024. https://plato.stanford.edu/entries/childhood/.
10. John Locke. “An Essay Concerning Humane Understanding, Volume II.1.19.” (1689) Project Gutenberg. Accessed June 26, 2024. https://www.gutenberg.org/files/10615/10615-h/10615-h.htm.
11. Linda Carroll. “Most Parents Are against Teen Tattoos.” Reuters. (August 20, 2018) Accessed June 26, 2024. https://www.reuters.com/article/business/healthcare-pharmaceuticals/most-parents-are-against-te en-tattoos-idUSKCN1L51XR/.
12. Hannah Elizabeth Jones, et al. “Decision Regret in Plastic Surgery: A Summary.” Plastic and reconstructive surgery. Global open vol. 11,6 e5098. (June 27, 2023) Accessed June 26, 2024. doi:10.1097/GOX.0000000000005098.
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