SEARCH

SEARCH BY CITATION

Great deeds are usually wrought at great risks.

Herodotus (484 BC–430 BCE)

image

“Sailing”. By Henry Kilham.

Growing up to be happy and fulfilled is an achievement in itself, but we know that across society, some children will achieve great things. Some do so at an early age and are truly inspiring. They mostly come to attention in the arts or sport, but can also demonstrate thought and intellect ‘before their time’, whenever that is. As a clinician, I frequently meet young people who achieve greatness in their own way.

Recently, a Dutch court prevented 13-year-old Laura Dekker from attempting to sail solo around the world, pending further psychological assessment. Such a journey entails significant risk and difficult decision-making. Those who have undertaken solo round-the-world journeys report facing life-threatening dangers. It is the risk to life and decision-making under extreme pressure that makes completing adventures all the more challenging for the adventurer and inspiring for the rest of us.

This case raises several questions for child health professionals. Can a 13-year-old sail around the world single-handed? How about this 13-year-old? Should she be allowed to try?

The developmental perspective on this is relatively straightforward. To embark on such an adventure, one needs to be able to plan systematically and hypothesise, consider alternative courses of action and problem-solve in a logical, systematic manner. Piaget called this cognitive stage Formal Operations, distinguished from Concrete Operations and its reliance on trial and error. Younger children rely on inductive logic, learning from a real-life experience rather than the ability to employ deductive logic which uses theory and principle to solve specific problems. Most 13-year-olds have this cognitive ability already. Thinking in this manner is necessary but not sufficient to reach the correct answers to complex problems as there may not be adequate knowledge or experience.

By my reckoning, there are approximately 120 million 13-year-olds alive in the world today. There is no way of calculating it, but the probability is probably greater than 1 in 120 million that one of these young people has the blend of developmental thought processes, knowledge and experience to sail around the world solo successfully. It is likely there are several 13-year-olds in the world capable of such a feat, possibly some younger than that too. Laura Dekker was reportedly born on a yacht during her parents' round-the-world sailing experience and has grown up surrounded by all things sailing, dreaming of this adventure from the age of six. If anyone is capable of this at the age of 13, maybe it is her.

Parents witness the development of decision-making and are undoubtedly in the best position to inform on the capabilities of their child. However, parent objectivity is clouded by pride, and perhaps their own needs and desires. A parent vicariously receives kudos, pleasure and enormous satisfaction from their child's successes. One only needs to visit a sports oval at the weekend to realise that some parents' investment in a child's sports performance is more about their own gains than the child's, clearly clouding their perception. Inform? – yes. Make the final decision? – no.

While parents generally are in the best position to make judgements for their children, we don't always allow them to do so when the stakes are high. For example, in Australia, a parent may request but cannot consent to a disabled child having a hysterectomy to manage difficult menstrual bleeding, instead requiring a court appointed guardian to make the decision on behalf of the child. In addition, there are numerous examples of recourse to the legal system where parents' ability to decide medical treatment for their child is thought to be compromised, and their ability to make risk versus benefit decisions for their child is removed.1,2

With her father, Laura Dekker has planned a number of ‘hops’ no longer than 3 weeks each, to complete her journey. However, it is not the duration of each hop but the total duration of the adventure which makes it almost certain she would face adversity. Other sailors report that the vagaries of weather, high seas, other boats both friendly and unfriendly, whales and other uncontrollable variables are the elements of danger which make the adventure risky, and are why we are uncomfortable about parents letting a girl this young attempt this quest. Our discomfort would be lessened if an objective group of experts from different disciplines agreed with her parents that this girl had the cognitive maturity, knowledge and experience to mitigate the risk of undertaking this high risk, high stakes adventure. Such a panel might comprise those with experience in child development, familiarity with issues of competence and consent, and expert knowledge in the field of sailing.

Regardless of the decision by the Dutch court in this case, it is certain that young people will continue to push boundaries as they navigate the future.

References

  1. Top of page
  2. References
  • 1
    Skene L. Terminally ill infants, parents and the courts. Med. Law 2005; 24: 66371.
  • 2
    Wolf L, Lo B, Beckerman K, Dorenbaum A, Kilpatrick S, Weintrub P. When parents reject interventions to reduce postnatal human immunodeficiency virus transmission. Arch. Pediatr. Adolesc. Med. 2001; 155: 92733.