Whether it is for terminal illness, addiction, a mental disorder or even cancer, the decision to go through treatment isn’t always a black and white one, especially when the question of consent comes into play.
One such issue related to consent is whether or not a teen should be allowed to make their own decisions regarding the necessity of a medical procedure or treatment.
In most states, 18 is the age at which a person may decide to undergo or reject a procedure or treatment. The term ‘informed consent’ means that a doctor has explained to a patient the nature of the illness or injury, the treatment or procedure used to treat the illness or injury, the expected outcome and any complications that may reasonably occur. A patient may then read and sign the consent form.
Prior to the age of 18, a parent or guardian signs the consent form on behalf of the patient. One exception is in the case of a life-threatening emergency when the parent or guardian is either unable to be contacted or time dictates action, such as in severe hemorrhage necessitating surgery. In such cases, courts look favorably on dispensing with consent if, in a doctor’s judgment, the patient’s life may be threatened if treatment is withheld.
Months before her 18th birthday, Connecticut resident Cassandra C. was told by her state’s supreme court that she must undergo chemotherapy for Hodgkin’s lymphoma, cancer of the lymphatic system, against her wishes. According to the Leukemia and Lymphoma Society, the disease is highly curable with an 85 percent chance of survival. A six-month course of chemotherapy was prescribed, which Cassandra refused. Without it, she is likely to die within two years. Cassandra said she wanted the chance to look into other options, a decision her mother supported.
Connecticut’s Department of Children and Families (DCF) petitioned the court for an order of temporary custody to act as Cassandra’s medical decision maker, Cassandra, her mother and her doctor testified in court. The judge ruled Cassandra’s mother was guilty of neglect of her daughter’s physical welfare and Cassandra not competent to make her own medical decisions. An appeal was filed to the Supreme Court of Connecticut. Her lawyers appealed for use of the ‘mature minor doctrine’ in which a minor is considered bright enough to grasp the consequences of his or her own medical decision. The appeal was denied.
In November 2014, Cassandra said under oath that she would undergo treatment if she was allowed to go home, but ran away after only two days. Court documents stated, “She either intentionally misrepresented her intentions to the trial court or she changed her mind on this issue of life and death.” The court gave the state temporary custody.
The Connecticut DCF thanked the court and said it will allow for the provision of medical treatment to save Cassandra’s life. The statement read, “This is a curable illness and we will continue to ensure that Cassandra receives the treatment she needs to become a healthy and happy adult.” Connecticut Children’s Medical Center in Hartford would not comment other than to say it respects the court’s decision and they will continue to work with DCF.
Dr. Stacey Berg, professor of pediatrics at Baylor College of Medicine said, “Cassandra’s case is also unusual because refusing treatment is rare. Most people who have a disease and hear there is a well established treatment will do it because they still want to live and think it’s the best thing for them.”
Cassandra wrote an Op-Ed in the Hartford Courant on January 8th about life in the hospital. She said she was sedated and strapped by her wrists and ankles to a hospital bed to receive treatment. “I want the right to make my medical decisions, it’s disgusting that I’m fighting for a right that I and anyone in my situation should already have. This is my life and my body, not the state’s. I am a human, I should be able to decide if I do or don’t want chemotherapy. Whether I live 17 years or 100 years should not be anyone’s choice but mine.”
The Connecticut welfare system would not confirm whether force was used, but it said in a statement that most often the state works with families to come up with solutions.
Unfortunately in this situation, the law does not have grey areas and individuals must resort to appeals to win over a court. The best thing for patients involved in such cases would be for the patient, doctor and family to find some common ground that is in the best interest of the patient. In the case of Cassandra, an 85 percent chance of full recovery would seem to be a green light for treatment.
Whether the decision for treatment is an easy one or a hard one, treatment for issues such as mental health disorders or addiction can often make a huge difference in the life of a struggling teen. Sovereign Health of Rancho San Diego is a treatment center specifically for teens that specializes in the treatment of substance abuse, mental health disorders and co-occurring disorders. If you would like further information, please call 866-615-7266 to speak with a member of our team who will be happy to assist you.
Written by Veronica McNamara, Sovereign Health Group writer