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The Case of Cassandra C: The Mature Minor Doctrine

THE CASE OF CASSANDRA C.

Cassandra C. is a 17-year-old in Connecticut who has made headlines recently for the unfortunate reason of being subject to court-ordered medical treatment. Her case began last September when she was diagnosed with Hodgkin's lymphoma. When told that she needed chemotherapy treatments, Cassandra underwent two initial treatments, but then ran away. Cassandra's mother refused to force her daughter to undergo further treatments, so Cassandra was placed in the temporary custody of Connecticut's Department of Children and Families (DCF).

At a court hearing, Cassandra agreed to resume her treatments and the court allowed her to return home to her mother. However, Cassandra ran away again to avoid the chemotherapy. On December 9, 2014, the trial court once again placed Cassandra in the custody of DCF. On December 10, 2014, she was admitted to Connecticut Children's Medical Center, and on December 18, 2014, daily chemotherapy treatments were begun.

THE MATURE MINOR DOCTRINE

Cassandra's lawyers argued that even though she was not yet 18 years old, and therefore not legally allowed to make medical decisions on her own, under the mature minor doctrine theory she could decide to forgo chemotherapy treatments. As the name suggests, a party raising the mature minor doctrine must persuade a court that the minor is sufficiently mature to make decisions that affect his or her health or welfare. The common law doctrine is typically reserved for teens 16 or older, and is normally used to prevent the necessity of gaining parental consent for certain medical treatments or procedures. Raising the doctrine to avoid state intervention is highly unusual.

The Connecticut Supreme Court affirmed the decision of the trial court, saying that not enough evidence had been introduced at trial to invoke the mature minor doctrine. In addition, the actions of Cassandra that led to her being placed in the custody of DCF did not indicate a level of maturity necessary for the doctrine to apply. Cassandra remains in the Children's Medical Center receiving chemotherapy.

THE ETHICS OF INTERVENTION

Some have questioned the intervention by the state, but the state has a duty to protect a child under 18 from abuse and neglect, including medical neglect. Medical experts testified that with chemotherapy, Cassandra has an 85% chance of surviving her cancer; without, she will die within two years. Although Cassandra and her mother claim say that refusing treatment is not akin to suicide, and that Cassandra does not want to die, medical experts all agree that without treatment she will do just that. Because Cassandra and her mother would not commit to the life-saving treatments, the state had a duty to intervene and ensure that the treatments were received.

Another consideration in deciding to intervene in such cases is whether the objection to medical treatment is based on religious grounds. Cassandra's objections were not; she stated that she did not want to put "poison" in her body and was fearful of the long-term impact of chemotherapy. While understandable, these claims do not rise to the level of religious objections.

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