Who Decides for Children?

One of the meta-questions surrounding the oddly large volume of writing about transgender youth these days is the question of who makes decisions for children.

Liberalism generally endorses the view that people should be able to make decisions for themselves. All of the expository devices of liberal philosophy take rational individuals as the fundamental unit of society and then build from there, generally in the direction of letting people do what they want provided that they do not prevent others from doing what they want.

But children, and adults with severe cognitive deficits, are not fully rational individuals in the sense that liberalism needs someone to be. And so liberalism doesn’t really know what to do with them.

Liberal philosophy wants so badly for societies to avoid taking positions on certain final questions about right and wrong and what constitutes the good life, but it needs to take at least some positions on those questions in order to make decisions for children and other people who cannot decide for themselves.

The default approach to dealing with this problem when it comes to kids is to allocate decision-making to parents and guardians. This allows the society to remain neutral on final questions in the way that liberalism prescribes.

This approach works in a lot of cases, but, in other cases, it generates outcomes many regard as unacceptable. The cases where the outcome is deemed unacceptable take two forms:

  1. A parent making a decision that most consider to be extremely bad.
  2. A parent making a decision that goes against the wishes of their child when the child is sufficiently mature and the decision pertains to a topic that society for one reason or another thinks the child should have a say in.

An example of the first case is a parent deciding against authorizing routine medical care that would prevent their child from dying. In the US, such decisions are frequently overridden by society based on a view that most in society share about a child having an individual right to life. Parents who make this decision typically do so as part of their religious beliefs, which makes society’s decision to override them doubly difficult from a liberal perspective: not only is the society taking a position on a final question but it is doing so against a sincere religious belief.

Another example of the first case is a parent deciding that their child can get a tattoo. Some states allow parents to make that decision. Others override it and do not allow any tattoos until adulthood.

A recent example of the second case can be found in COVID vaccination policy. For young kids, the society generally took the position that parents will decide whether their child is vaccinated, though that decision, like childhood vaccination decisions generally, was often heavily nudged in the direction of doing it by conditioning the receipt of basic services on vaccination.

For older kids, some states in the US have a “mature minor doctrine” that allows children above a certain age who also demonstrate a certain mature cognitive ability to decide to get the vaccine even in the absence of parental consent.

Another example of the second case can be found in abortion policy. Although most states require some kind of parental involvement when it comes to the abortion decision-making of pregnant minors, all but one have some version of a mature minor doctrine that allows pregnant minors to obtain an abortion without parental consent.

There are of course many other cases that fall into these two categories.

There is no general way to determine in what circumstances the society should step in to override a parent or allocate decision-making authority to a child. All of these special rules are fundamentally illiberal in that they are rooted in societal judgments about final questions. Thus, the general principles of liberalism that we tend to rely upon for our public reasoning offers very little guidance.

In the case of gender-affirming care for transgender youth, both sides of the public discourse seem to agree that parental decision-making is not appropriate. But one side thinks it is inappropriate in the sense of case one above, meaning that they think society should override any parent that decides to medically transition their child. And the other side thinks it is inappropriate in sense of case two above, meaning that they think society should allocate decision-making authority about medical transitioning to mature minors.

As noted already, liberalism offers absolutely nothing to help resolve this disagreement. Both positions proceed from divergent answers people have reached on contestable final questions about gender and identity. It’s a necessarily illiberal debate occurring in the context of a liberal society, which leads to a lot of frantic grasping for straws and rhetorical confusion.

The fact that what to do with children is a weak spot of liberal philosophy is also probably why children so frequently become the focal points of various cultural battles. For adults, liberalism has an answer to divergent cultural views: live and let live. For children, this is not really possible. So by focusing the debate on children, you get to fight a cultural battle that would otherwise be waived off as an illiberal grievance that is irrelevant to public policy.