Let’s leave aside all the arguments about any of these as medical treatments, since that’s actually not necessary to make the point here.
What matters here is personal choice, consent and consistency.
So let’s look at these four issues.
Are they personal choices, to which the affected person gives consent?
And, to the extent that they are, does U.S. law treat them consistently?
Tattoos are generally forbidden to minors.
The minimum age to get a tattoo varies by state, but the vast majority of them set it at 18 years old. Many allow it at 16 with written parental consent.
These laws are justified with the argument that in the U.S. legal system minors may not make permanent decisions. They can’t make binding contracts, for example. So the law forbidding tattooing a minor even with their consent is consistent with the law’s general treatment of minors.
Parental consent exemptions are problematic, since in general parents are not allowed to make binding, permanent decision about a minor either. But they are common as a holdover from the time when children were essentially parental property and moreover are usually only applied to create a mixed state between minority and majority for late adolescents, which is probably a good idea to do somehow.
All states forbid tattooing without consent, so that’s good.
Cosmetic surgery is generally only allowed to minors with parental consent.
This is, in general, consistent with the concept that minors may not make permanent decisions.
But while tattoos are generally not allowed to minors regardless of parental consent, cosmetic surgery generally is.
This is inconsistent with the general principle, so that should probably be either eliminated or restricted to 16 years and older to at least be consistent with how we treat tattooing.
Circumcision law is really messed up.
You’d expect, based on how the law on minors and contracts informs the law around tattoos that circumcision would be similar: forbidden to the under-18s in general. Most other common forms of body modification do follow that principle, after all.
But no, circumcision in U.S. law is considered a parental choice in infancy and then forbidden until majority, at which point it is a mater of consent.
This is extremely inconsistent with the principle that neither minors nor guardians may make permanent choices about a minor’s life or body. To be consistent, you’d have to forbid circumcision of infants as a permanent body modification.
And the law should be consistent, so we should do that.
So how should we treat puberty blocking medications?
(I’m leaving aside related surgical procedures here, since those would be covered above under cosmetic surgery.)
I am not a medical expert, but I have read statements from medical experts that puberty blocking medications do not have permanent side-effects. They prevent the bodily changes from puberty only while the minor is taking them, and then puberty proceeds normally after they stop.
This is probably not completely true, since the human body is absurdly complicated, but may well be true enough that the difference is not (as doctors say) clinically relevant.
If that’s the case, then puberty blockers don’t constitute a permanent change. In fact, they are better viewed as delaying the decision over making a permanent change until the minor can legally make that decision for themselves.
In which case forbidding them would be clearly inconsistent with the general principles involved here. Even requiring parental consent would be inconsistent, since that would constitute the parent making a permanent decision for the minor.
So, what would a consistent legal approach look like?
Tattoos, cosmetic surgery and circumcision are all permanent body modifications in which the State has no legitimate reason to interfere other than to protect the requirement that the affected person consent.
In general, a consistent approach to these would look like:
- they may not be done without consent
- minors under the age of 16 cannot give consent
- minors aged 16 can give consent if attested to by a guardian
- a person aged 18 may give consent
To the extent that puberty blocking medications have any permanent side-effects, they should also be treated like that; there’s no real argument for treating them differently from any other permanent body modification.
If they actually have no permanent side effects, then there’s a good argument that they should be allowed at any relevant age without parental consent, since not allowing them would constitute making a permanent decision about a minor.
It’s important that the law approach these issues consistently.
Without consistency, the law becomes just a collection of issue-specific rules. The law needs to be derived from principles to be defensible.
