While much criticism has surrounded the seemingly incoherent law governing decision-making for adolescents, relatively little work has sought to address the question of whether and when adolescents will be acting autonomously in decisions to refuse treatment, particularly in cases where their choices are motivated by religious beliefs inculcated from a young age. This is important, not just because it goes to the heart of when an adolescent ought to be able to exercise a right to self-determination, but also because an analysis of the case law indicates that judges are taking account of concerns about the authenticity of the values or beliefs which motivate a given decision when deciding cases. This paper will examine how different accounts of autonomy and authentic choice map onto the psychological development of adolescents, and thus the extent to which adolescent’s decisions to refuse treatment on religious grounds can be regarded as truly authentic. It will conclude by considering how such cases ought to be approached by the courts, suggesting a modified Mental Capacity Act 2005 test for assessing adolescent capacity, and offering an empirically-grounded justification for overriding the choices of even capacitous adolescents.

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