Should Teens have the Right to

Die?
Can a state can force a 17-year-old cancer patient to
receive chemotherapy treatments against her will?
According to the Connecticut State Supreme Court,
that answer is yes. The court ruled today that the
attorneys or 17-year-old Cassandra C., had the chance to prove her status as a
mature minor in the initial trial, but didn't. Cassandra's case has raised a lot of
questions about medical care, particularly as it applies to minors. When can
children refuse care? When does the state have an interest in intervening? With the
court's ruling made, here's a guide to the issue.

Doctors diagnosed Cassandra in September with Hodgkin's lymphoma, a cancer

that attacks parts of her immune system. Which means that the longer she lives, the
harder it will be for her body to fight infection diseases. This type of cancer is
frequently treated with chemotherapy, which does have possible long-term side
effects including heart damage and lung damage and fertility issues, according to
the Mayo Clinic. The cause of Hodgkin's lymphoma unknown but according to
Cassandra’s doctors say it's highly likely she'd die without chemo.

With that Cassandra had surgery to remove the cancer from her body, but she
needed chemo to ensure it was gone. But before doctors could start the treatment,
she and her mother left against their orders. Cassandra's doctors, reported this as
child abuse and neglect, to the Division of Children and Families (DCF), which took
the case to state Superior Court in November. There, doctors testified Cassandra
needed the treatment, which has an 80 to 95 percent success rate. The court
granted DCF temporary custody of Cassandra. She underwent two chemo
treatments and then ran away from home, refusing at one point to come back for
further care.

After that, the DCF went to court again, to get Cassandra removed from her
mother's home, giving them authority to make all of her medical decisions. She has
been forcibly hospitalized since December, receiving further chemo treatments.
Doctors have said she has an 80 to 85 percent chance of surviving the cancer if
she keeps going with the court-ordered chemo.

Why would a minor refuse care for cancer? In Cassandra's case, she's a
young patient who is deeply concerned about the effect chemotherapy would have
on the rest of her life. She wants to refuse the treatment even though, her attorneys
say, she fully understands that she may die. She's a competent patient who should
be allowed to make her own medical decisions, her attorneys argued. If an adult
made this decision, courts would not interfere. But with minors, the system works
differently: parents or guardians have the final say over what type of medical
treatment occurs. That is, unless the courts rule the patient a mature minor.

This comes to the mature minor doctrine, a legal document that acknowledges that
an unemancipated minor, who received court orders freeing them from their
parents govern, may be mature enough to move forward with or reject a health care
treatment. Cassandra and her mother argued that her status as a mature minor
should have been considered by the court before DCF forcefully took custody of her.

In the past there were many instances of minors turning away cancer care come
from religious or spiritual beliefs. Young Jehovah's Witnesses have refused life-
saving treatments because of their religious beliefs, and courts have respected those
decisions. In 2007, 14-year-old Dennis Lindberg died of leukemia after refusing
to undergo life-saving blood transfusions. As a Jehovah's Witness, he didn't want to
receive blood as the practice is banned in the faith. In that case, a judge ruled
Lindberg had the right to make that decision for himself.

Why would the state intervene? DCF, acting on behalf of the state, says it's
obligated to intervene in this case. It's their duty to act when a child would die if
medical decisions were left up to the parent. DCF's decision is based on experts — in
this case, the doctors who diagnosed and are treating Cassandra who all agree she
needs the chemo. To step in, DCF had to win temporary custody of Cassandra

What are the arguments each side made Connecticut? Cassandra C. and
her mother appealed the court's decision to award custody to the state on three
points:
1. Their constitutional rights were violated when Connecticut overrode their
demands to cease treatment.
2. Cassandra and her mother also want Connecticut to acknowledge the mature
minor doctrine, meaning that the court must decide if Cassandra is mature
enough to make her own decisions before forcing her to receive medical care
against her will.
3. Common law rule in Connecticut that says you can’t give different rulings to
the same cases: based on previous court cases, like 14-year-old Dennis, a
patient can't be forced to receive care.
The state argued that if all the medical experts agree that the chemo is necessary,
then the chemo should be administered to save a child's life. Just like a state would
step in to save a child from abuse or other harms, it argued that it has the same
right in Cassandra's case. "When experts — such as the several physicians involved
in this case — tell us with certainty that a child will die as a result of leaving a
decision up to a parent, then the Department has a responsibility to take action,"
DCF said in a statement.

But the prognosis isn't the point, Cassandra's attorneys argued. For them, it's a
question of her rights as a patient.