Teen Has Right to Refuse Treatment

The story of “Cassandra C.” hit the national spotlight in January, occupying mainstream news and blowing up social media.

Cassandra, a 17-year-old girl with Hodgkin’s lymphoma, was being forced to undergo chemotherapy by the State of Connecticut.

Chemo and radiation can give patients like her up to an 85 percent chance of survival. Sounds like good odds to most people. To Cassandra, the idea is dreadful.

She underwent two chemo treatments and wanted to stop. The pain, discomfort and other side effects were enough to make her want no more.

Cassandra failed to return to the hospital, which called Connecticut’s Department of Children and Families.

The state stripped her mother, Jackie Fortin, who has supported her wishes, of custodial rights due to “medical neglect.” Then it ordered Cassandra to resume chemo.

What? How can the government make such a decision for a human being?

Fortin and Cassandra’s lawyer, Josh Michtom, asked the courts to designate Cassandra as a “mature minor,” giving her control over her own medical decisions.

Here’s how the mature minor doctrine is presented by the informational website uslegal.com:

“(It is) a relatively new legal concept, and as of 2002, only a few states, such as Arkansas and Nevada, have enacted the doctrine into statute. In several other states, including Pennsylvania, Tennessee, Illinois, Maine and Massachusetts, state high courts have adopted the doctrine as law.”

In a Jan. 8 hearing, the Connecticut Supreme Court ruled against Cassandra and upheld the state’s order that she must submit to chemo.

According to the American Medical Association website, this is AMA Policy on Provision of Life-Sustaining Medical Treatment:

“Patients have a right to participate in decisions about their medical care. This fundamental principle of medical ethics holds true for all types of medical treatments.  Patients can refuse treatments, even when such refusal is likely to result in death.”

The hospital, courts and Connecticut Department of Children and Families shouldn’t ignore this policy or the ethical reasoning behind it.  The AMA doesn’t like the idea of physician-assisted suicide, but it supports a person’s ability to refuse treatment and choose natural death.

Opinions on Cassandra’s situation range from empathetic to patronizing. One in particular was expressed by a nurse, Joann Carlson, in a Letter to the editor section of the Hartford Courant:

“At her tender age, Cassandra has not the knowledge nor the emotional maturity to realize what a gift life is,” Carlson wrote.

Cassandra is only eight months shy of 18. Carlson would never have said anything like this had an “adult” made the same decision.

Much of the media coverage on Cassandra’s case has implied that the teenager wanted to die rather than undergo chemo. That isn’t true. She and her mother were pursuing alternative treatments when the state intervened.

“What is the difference between the ages of 17 and 18?” has been a common question asked on social media.

The answer? Twelve months. That’s it. At 17, you can graduate from high school, enroll in college, live on your own and get married.

Cassandra really isn’t that different from Brittany Maynard, a 30-year-old California woman with terminal brain cancer.

Maynard chose to die before her disease killed her and moved to Washington, one of five states where physician-assisted suicide is legal.

Her case also was controversial. Some people celebrated her bravery while others called her a “coward.” All she sought was an end to the pain and death with dignity.

Cassandra wants nothing more than to make the same choice for herself. She has at least two years to change her mind before the Hodgkin’s would kill her.

She just wants to determine her own quality of life. One of the few quotes we have seen in the media from Cassandra expresses just that:

“Whether I live 17 years or 100 years should not be anyone’s choice but mine. How long is a person actually supposed to live, and why? Who determines that? I care about the quality of my life, not just the quantity.”

Cassandra will turn 18 in September.  What will stop her from ceasing chemo then if she hasn’t already finished her treatment?

Her feelings are not going to change overnight. If anything, they’re going to be strengthened, as her wishes are not being respected.

This column was a winner at the Missouri College Media Association in 2016 in the Columns category.

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