Forced Chemotherapy
In 2014, 17-year-old Cassandra Callender was diagnosed with Hodgkin’s lymphoma, a treatable form of immune cell cancer in the lymphatic system. In young adults and children with Cassandra’s condition, treatment with chemotherapy and radiation provides an 85% chance of long-term survival [1]. Cassandra, however, objected to undergoing chemotherapy because she did not want “such toxic harmful drugs” in her body and wished instead to explore alternative treatments. She understood that, without chemotherapy, she would most likely die. But in Cassandra’s view, the negative side effects of chemotherapy would decrease her quality of life to such an extent that any gain in length of life provided by the treatment would not be worth it.
Although minors cannot make their own medical decisions in most cases, Cassandra’s parents agreed with her choice to refuse chemotherapy. However, courts have the authority to overrule parental decisions when those decisions threaten the life of their child. When courts do this, they temporarily remove parental custody and appoint a guardian to make medical decisions for the minor. In 2015, the Connecticut Supreme Court, after consulting with medical professionals, ruled that Cassandra was to undergo chemotherapy against her will.
This ruling was met with controversy. Many supported the decision of the court and the opinion of the medical community. After all, most people would judge that an 85% chance of long-term survival is worth undergoing the temporary suffering caused by chemotherapy. Physicians are morally required to avoid causing harm as well as to act in the best interests of their patients. Allowing Cassandra to decline chemotherapy would more than likely have resulted in her death and therefore, many would argue, was not in her best interest.
Others, however, argue that the judicial ruling violated Cassandra’s autonomy. Though she was legally a minor, at 17 years old she was no less well equipped than an 18-year-old to make her own medical decisions. Cassandra appealed to the “mature minor” doctrine, which grants minors the authority to make their own medical decisions if the court deems they are mature enough do so. This request was denied not because of concerns that Cassandra was too immature, but strictly on the medical advice of health professionals. As a consequence, Cassandra was forced to undergo the chemotherapy against her will. This kind of treatment can require up to six months of intense treatment and care: In Cassandra’s case, she first went through surgery to have a port in her chest installed for drug administration. She was then confined to a hospital, with her cell phone taken away, often strapped to her bed and sedated [2].
DISCUSSION QUESTIONS
Was it morally right for Cassandra to be forced to undergo chemotherapy in this case?
Who should have the power to make medical decisions for minors? Parents? Physicians? Courts?
What kinds of medical decisions, if any, should minors be permitted to make for themselves?
References
[1] Science-Based Medicine, “The sad but unexpectedly hopeful cancer saga of Cassandra Callender”
[2] http://blogs.einstein.yu.edu/the-ethical-dilemma-of-forced-chemotherapy-on-a-teen/
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