The Minor Ethical DilemmaForced Chemotherapy on a

Teen

By: Mary K., Naia K., Marilyn C., Naomi M., Tami W., & Jennifer K.-R.

Summary of Issue
o 17 year old Connecticut girl diagnosed w/stage 3-4 Hodgkins lymphoma
o Underwent 2 chemotherapy treatments but believed it to be toxic to her body and therefore refused
anymore treatments; wanted alternative cancer treatments
o Mother of teen supports her daughters decision
o Physician reports mother for medical neglect
o Teen is taken into custody by the Department of Children & Families, a guardian ad litem from the
department is appointed for the teen to make medical decisions for her & Supreme Court rules that
the state can force the teen to receive the chemotherapy treatment that she doesnt want but that
the physician believes is necessary
o Teen undergoes 5 months of chemotherapy treatment at the hospital; she has to be sedated and
restrained in order to administer the chemotherapy; she is not allowed to speak to her mother on
the phone, leave her room, and if her mother visits it is with supervision
o This occurs 9-10 months before the teen is to turn 18 years old

Viewpoints
o Teen & mother
o Chemotherapy is toxic to the body with long term side effects that are possibly worse than the cancer;
interested in alternative cancer treatments (Billy Best story); applying the ethical principle of autonomy
o Some medical professionals believe that children after ages 12 or 13 who appear to be mature have or ought to
have the right to consent or to withhold consent to general medical treatment (Coleman & Rosoff, 2013). In fact
14 states permit mature minors to consent either in all or a range of restricted circumstances, and 3 states allow
minors regardless of their age or maturity to consent to treatment in either all or limited circumstances.
o Research has shown that there are long term effects of chemotherapy, such as increased risk for diabetes mellitus,
osteoporosis, and thyroid disorders (Gebauer et al., 2015).

o Physician, nurses, & guardian appointed from Department of Children & Families
o Mother is medically neglecting her daughter; the teen is not mature enough to make an informed decision
regarding cancer treatment; patient will die without chemotherapy treatment so they are upholding the
ethical principles of beneficence & nonmaleficence
o Mavrides and Pao (2014) maintain that some studies of adolescent brain development suggest that judgement and
responsibility do not develop fully until even the mid 20s, implying that younger adolescents may be less competent
decision-makers. With this thought in mind a physician may not think the judgement of a 17 year old is competent
for decision making.

Ethical Principles Involved

o Teen & her mother
o Autonomy

o Physician and hospital staff

o Beneficence & nonmaleficence
Beneficence & nonmaleficence are the ethical principles to promote goodness, kindness, and
charity and implies a duty to not inflict harm (Cherry & Jacob, 2014) but the act of forcing a
treatment that a patient does not want on her by sedation and restraint and not allowing her
to leave her hospital room or speak to her mother on the phone are acts that are inflicting
emotional, psychological, & physical harm to the patient
Patient is not able to exert her autonomy in this situation because she is not of legal age and
according to the physician, she therefore not mature enough to make an informed medical
decision involving her cancer treatment; the Supreme Court agrees
o https://thetruthaboutcancer.com/the-medical-kidnapping-of-cassandra-c/

Alternative
Actions/Options
o

The physician should have discussed with the mother and daughter all cancer
treatments available with their related side effects and then listened to which
treatments they were interested in pursuing. Physicians are supposed to work with
patients and their family members in creating a treatment plan that all parties
involved agree with and I feel the physician in this case failed to do so.
o It is the physicians responsibility to inform the patient and their family members of all
treatments available and go over side effects and the pros and cons of each treatment; in this
situation the physician failed to do so stating that chemotherapy was the only available option
for the teen

o Physician could have exhausted all alternative treatments the patient and her mother
were interested in before reporting the mother for medical neglect and involving the
courts
o Mother was not medically neglecting her daughter; she was supporting her daughters wishes
to seek alternative cancer treatment that did not involve chemotherapy

Resources
o American Cancer Society. (2014, September 10). Hodgkin disease. Retrieved from
htpp://www.cancer.org/acs/groups/cid/documents/webcontent/003105-pdf.pdf
o Cherry, B. & Jacob, S. (2014). Contemporary nursing-issues, trends, & management (6th ed.). St. Louis, MO:
Elsevier.
o Coleman, D. L., & Rosoff, P. M. (2013). The legal authority of mature minors to consent to general medical
treatment. Pediatrics, 131(4), 786-793.
o Gormley-Fleming, L. & Campbell, A. (2011). Factors involved in young people's decisions about their health
care. Nursing Children & Young People, 23(9), 19-22.
o Gebauer, J., Fick, E., Waldmann, A., Langer, T., Kreitschmann-Andermahr, I., Lehnert, H., Brabant, G.
(2015). Self-reported endocrine late effects in adults treated for brain tumours, Hodgkin and non-Hodgkin
lymphoma: a registry based study in Northern Germany. European Journal Of Endocrinology/European
Federation Of Endocrine Societies, 173(2),139-148.
o Macklin, R. (2015, January 12). The Ethical Dilemma of Forced Chemotherapy on a Teen. Retrieved from
http://blogs.einstein.yu.edu/the-ethical-dilemma-of-forced-chemotherapy-on-a-teen/
o Mavrides, N. & Pao, M. (2014). Updates in paediatric psycho-oncology. International review
o

of psychiatry, 26(1), 6373.

o Silberstein, S. (2015). Cassandra: Cancer and the Mature Minor Doctrine. Retrieved from
http://beatcancer.org/2015/01/cassandra-cancer-and-the-mature-minor-doctrine/