The Choice is Not Always Yours: A Minor’s Right to Make Medical Decisions

The Connecticut Supreme Court has removed a teenager from her home and forced her to undergo cancer treatment.

Photo by Ryan Ozawa (Flickr)

A seventeen-year-old identified in court documents as “Cassandra C.” has been forced by the Connecticut Supreme Court to accept potential life-saving treatments.  Diagnosed with Hodgkin’s Lymphoma, the teenager was found incompetent to make decisions regarding her own health.  The state of Connecticut is now responsible for her health and well-being, including ensuring that she receives the treatment that could possibly rid her of cancer.

Cassandra was diagnosed with Hodgkin’s Lymphoma, a cancer of lymph tissue, in the fall of 2014.  When treated with chemotherapy, a Hodgkin’s patient has approximately an eighty-five percent chance of survival.  If left untreated, the chance of survival is slim.  In an editorial she wrote for the Hartford Courant, Cassandra explained that she wants to make the choice of what happens to her body, including the choice to forego chemotherapy.  She believes medical decisions should be left to her, not the government.

The court ultimately found that Cassandra was not mature enough to make medical decisions for herself, and placed her in state custody to ensure she received proper treatment.

Cassandra’s legal counsel asked the state of Connecticut to adopt the “mature minor” doctrine when considering if Cassandra is mature enough to make her own decisions about her treatment.  The Connecticut Supreme Court chose not to adopt the doctrine, but used it as a guideline.  The court ultimately found that Cassandra was not mature enough to make medical decisions for herself, and placed her in state custody to ensure she received proper treatment.  This holding echoed the Connecticut Superior Court findings, which heavily relied on testimony from doctors who stated that Cassandra would likely die without treatment.

The mature minor doctrine was developed in the 1967 case Smith v. Seibly.  Albert G. Smith sought a vasectomy after finding he had a muscular disease that could affect his ability to provide for his family in the future.  At the time, the age of consent in Smith’s home state of Washington was twenty-one, but Smith was only eighteen at the time of the operation.  Smith later sued the doctor, claiming that the doctor neglected to inform Smith of the permanency of the operation.  The Washington Supreme Court found that Smith had the necessary mental capacity to consent to the surgery, considering Smith’s life circumstances at the time: he was emancipated, held a job, was married and had started a family.

Since the 1960s, the mature minor doctrine has been used in nearly twenty states to determine if a minor has the capacity and maturity to make health decisions for himself or herself.  The courts have not developed a set of factors to determine if a minor is mature or not, rather the circumstances of each individual case are taken into account.  The Connecticut court did not specify exactly why Cassandra was not mature enough to make her own medical decisions.  However, it has been reported that Cassandra has taken numerous actions to avoid treatment, including running away from home, which may have led to the court’s decision.

Courts have heard a multitude of cases regarding the right to make medical choices.  Most recently, Brittany Maynard exercised her right to die after being diagnosed with brain cancer.  Maynard moved from California to Oregon, which permitted her to obtain life-ending medicine that would allow her to choose how and when she was to die.  On November 1, 2014, Maynard chose to pass away in her home, surrounded by her family.  Currently, four states permit assisted suicide while other states have bills in process.

Furthermore, the courts have struggled with finding a balance between religious freedom and compelled medical treatment.  The Wisconsin Supreme Court declined to hear the case of Dane County v. Sheila W., in which a fifteen-year-old girl refused a blood transfusion necessary to treat anemia based on religious objections.  Sheila W. is a Jehovah’s Witness, a religion that forbids accepting the blood of others.  Dane County took custody of Sheila in order to provide the healthcare that she was deemed to need.  Sheila asked the court to adopt the mature minor doctrine, which would allow her to make her own medical decisions.  The Wisconsin court did not adopt the doctrine, but rather maintained the definition of emancipated minor.  As a result, Sheila W. was forced to remain under the state’s care and therefore receive medical attention.

In most instances, competent adults are free to refuse medical treatment, regardless of their religious beliefs or life circumstances.

The courts have taken a different approach when an adult refuses medical care.  In most instances, competent adults are free to refuse medical treatment, regardless of their religious beliefs or life circumstances.  Informed consent requires that a medical employee provide all treatment options available to a patient before the patient takes any action.  The case of Salgo v. Leland Stanford etc. Bd. Of Trustees coined the term “informed consent,” but the concept dates back to Ancient Greece, where the concept was mentioned in Hippocrates’ writings.

The well-known case of Canterbury v. Spence further described the concept of informed consent.  Plaintiff Canterbury had back surgery to alleviate pain.  While recovering from surgery, the plaintiff fell from his bed and was paralyzed from the waist down.  He was again operated on.  Although his back pain improved, he sued the defendant Dr. Spence for failing to inform him of the risks of back surgery.  The defendant admitted that he chose not to inform Canterbury of the inherent risks of the operation due to the fear that Canterbury would choose to forego the surgery.  The district court found for the defendant; the decision was overturned on appeal and granted a new trial.  Ultimately, the decision further highlighted the need for doctors to ensure that each patient is informed of the risks of medical procedures.

Informed consent and the ability to make personal medical decisions have also been hot issues in abortion law.  In North Carolina, a minor is not able to receive an abortion without obtaining parental consent, unless a medical emergency is present.  To satisfy the informed consent requirement for an adult female in North Carolina, a doctor will inform her of the risks of the procedure as well as the risks of carrying a fetus to term.  She will then be required to wait twenty-four hours before she is able to receive an abortion.  Recently, a rule requiring a doctor to show a woman seeking an abortion an ultrasound of the fetus was struck down.

Since Cassandra does not turn eighteen until September 2015, she will have to comply with the court’s ruling and continue to undergo chemotherapy until that time.  

Generally, a parent will be consulted to fulfill the informed consent requirement when a minor is being treated.  If possible, the minor child will be also consulted, but the ultimate decision lies with the parent.  Cassandra C.’s mother, Jackie Fortin, lost her right to make Cassandra’s medical decisions based on the court’s finding that Fortin was not making the best choices for Cassandra’s health.  Cassandra’s doctors had earlier reported Fortin to the Connecticut Department of Children and Families (DCF) for child neglect.  Fortin has maintained that Cassandra has a right to decide what is done with her own body.

The ruling in favor of the state was delivered after only an hour-long hearing and ten minutes of deliberation among judges.  Cassandra has since been confined to a hospital with a guard standing watch.  DCF is looking into moving Cassandra to a group home while she is not undergoing chemotherapy.  Fearful that Cassandra will again run away, DCF has refused to let Cassandra go home to her mother.  Since Cassandra does not turn eighteen until September 2015, she will have to comply with the court’s ruling and continue to undergo chemotherapy until that time.  

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About Paige Miles Feldmann, Managing Editor (20 Articles)
Paige Miles Feldmann is a 2016 graduate and served as the Managing Editor of the Campbell Law Observer for the 2015-2016 academic year. Originally from Erie, Pennsylvania, she graduated from Penn State with a finance degree. Following her first year of law school, she interned with the Clerk of Superior Court for Chatham County, the Wake County Family Court, and the Wake County Public Defender. She also competed on a Campbell Law Trial Team in the Buffalo-Niagara Mock Trial Competition. Paige worked with the Wake County District Attorney as an intern in the misdemeanor section during her third year.
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