The right to autonomy fades out when they become a danger to society
Transgender issues for teenagers rank very high amongst the (very few) bioethical issues covered by newspapers. In one development, anti “conversion therapy” are being laws are being enacted in many jurisdictions, making it a crime to dissuade young people from expressing a sexual orientation or changing gender. In another, the shibboleth in transgender medicine is “believe the children” about their feelings on gender transition.
The message, therefore, is consistent: respect children’s autonomy. Do not direct their sexuality.
It comes as a surprise, then, to read an article in the leading journal Bioethics which proposes that young people with serious misbehaviour problems like delinquency, aggression, and antisocial behaviour should be compelled to undergo “moral neurorehabilitation”. Some adolescents are “devoid of any culpability, boasting satisfaction at having perpetrated calculated acts of harm”.
How should we deal with this kind of anti-social behaviour? Some of them are “so difficult to treat as to be next to untreatable”. A number of psychologists and bioethicists contend that there are “instances where a compulsory moral enhancement might actually be more responsible of the state than leaving such interventions up to individual choice”.
What kind of interventions? Drugs, the “love drug” oxytocin, and brain stimulation are all mentioned.
On what ethical basis can this be justified? The authors cite several. Psychologist Carol Gilligan’s care ethics is one of them: “A care ethics approach would justify case‐specific compulsory treatment when an individual’s dysfunctional behaviour negatively impacts other family members, significant others, or community members within the individual’s sphere of interaction and influence.”.
What about the adolescents’ autonomy? It must be respected, but “when antisocial behaviours result in school suspension/expulsion, work discharge, interpersonal strife, legal trouble and even incarceration, it can be argued that moral neurohabilitation would potentially increase individual autonomy and options for improved educational, employment, and relationship opportunities.”
They conclude: “Perhaps one day in the not too distant future, adolescents and adults diagnosed with [conduct disorder] and [antisocial personality disorder] may finally be helped to care about others, enjoying the rewards that come with healthy interpersonal interactions, empathic concern, and social affiliation. And the people with whom they interact will no longer have to live in fear.”
Michael Cook is editor of BioEdge
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