Introduction
Cassandra’s case brings to the fore critical legal and ethical issues surrounding informed consent and competence. The patient and her mother were opposed to life-saving chemotherapy for her Hodgkin lymphoma diagnosis because they considered it poisonous (Harris, 2015). Since she was 17 years old at the time, she could not legally refuse the therapy. Cassandra’s refusal to undergo chemo was overruled by the courts on grounds that she could not prove that she had the maturity to make therapeutic choices (Harris, 2015). From an ethical viewpoint, two issues stand out: minor maturity and overruling a patient’s refusal of treatment.
Minor Maturity
While Cassandra was a minor, patient education was needed first before commencing chemo. Additionally, an assessment of Cassandra’s knowledge of her condition, treatment options, and chemotherapy benefits and risks was necessary to determine her competence to make medical choices. Further, it is not clear if steps to address her fears and concerns were considered. Instead, the Department of Children and Families (DCF) sought custody of the patient to facilitate chemotherapy.
Adult patients have exclusive informed consent rights. However, young children lack the cognitive ability to make medical decisions, hence, parents or guardians have to choose on their behalf (Hickey, 2007). However, teenagers may take exception to the claim of assumed incompetence since they are at a transitional age. Their cognitive capacity is comparable to that of adults (Hickey, 2007). Cassandra is almost 18 years and will soon have the right to make autonomous medical choices (Harris, 2015). Thus, even if her mother consented to the chemotherapy, it was only ethical to seek her approval too. It is possible her fears could be grounded in a good knowledge of the risks and benefits of the prescribed treatment. A conversation with Cassandra could have helped clarify the effects of her choices and convince her to assent. In this case, the presumed incompetence of the girl could have led to the withholding of information on treatment risks, benefits, and options, which is ethically remiss.
Overruling Patient Refusal
Another critical ethical issue is overruling a patient’s consent or refusal to receive treatment. Thus, despite the mother standing by her daughter’s position, the courts still chose to overrule the two. The ethical issue here is whether the chemotherapy was in the patient’s best interest to warrant decisions that went against Cassandra’s wishes. Apparently, considerations like the life-threatening nature of her illness and her maturity may have informed the decision to override the patient’s choice. However, since she had not abdicated her decision-making role, it was unethical to subject her to forced chemotherapy. The doctors strapped Cassandra to her hospital bed and implanted a port in her body for the administration of drugs in spite of her objections to the treatment (Goldschmidt, 2015).
Although the state is required to protect children from danger or abuse, the DCF should have engaged the patient and mother before taking Cassandra into custody. Treatment alternatives to chemotherapy should have been explored as opposed to limiting her to only a single option. Reports indicate that although her Hodgkin lymphoma went into remission after starting the chemo, she is now confronting a new health issue – a growth in her lungs (CBS News, 2016). Thus, clearly, the level of risk of chemotherapy was not discussed with the patient, which was ethically remiss.
Conclusion
While Cassandra is a minor, adolescent maturity to make informed decisions has been medically ascertained (Hickey, 2007). The key ethical issues pertinent to this case include informed consent, patient competence/knowledge, choosing the 17-year-old’s best interests over her objections, and forceful treatment. Cassandra should have been left to make her medical choices. Alternatively, the state (DCF) should have addressed her concerns, knowledge gaps, and offer alternative therapies as opposed to forcing her to undergo chemo.
References
CBS News. (2016). Connecticut teen forced into chemo suffers new health issue.CBS News. Web.
Goldschmidt, D. (2015). Connecticut teen in remission as forced chemo nears end.CNN. Web.
Harris, E. A. (2015). Connecticut teenager with cancer loses court fight to refuse chemotherapy.The New York Times. Web.
Hickey, K. (2007). Minors’ rights in medical decision making. JONA’S Healthcare Law, Ethics, and Regulation, 9(3), 100-104. Web.