King: Cassandra and the ‘Mature Minor’ Doctrine

January 9, 2015

by Stephen M. King, Ph.D.

Your 17-year-old daughter, diagnosed with Hodgkin’s lymphoma, calmly but determinedly refuses chemotherapy. Her refusal is not based on religious beliefs; she simply does not want to ingest poison in her body, suffering the side effects and incurring further damage to her internal organs as a result of the treatment.

What would you as a parent say? Would you support her decision?

Cassandra, the name given a 17-year-old Connecticut student in state court documents, is such a person. Her mother supports her daughter’s wishes but Connecticut’s Department of Children and Families (DCF) disagrees.

The department seized Cassandra from her home, moved her to the Connecticut Children’s Medical Center in Hartford and forced her to receive chemotherapy there. After two days, Cassandra refused further treatments and left the hospital; she was missing for a week. Based on a trial court’s grant of authority, Cassandra was again seized by the DCF (“temporary custody”), moved to the hospital and “force fed” the chemicals. A guard is now posted outside her hospital room.

Welcome to “1984.”

Legally, what is under consideration is the Connecticut Supreme Court’s consideration of the constitutionality of the “mature-minor doctrine.” The doctrine, which is recognized by several states, not including Indiana, effectively permits 16- and 17-year-olds to prove they are mature enough to make challenging medical decisions for themselves.

The key phrase is “for themselves.” This cannot be read to mean that a bureaucratic agency supersedes the right of a mature individual, even one who is not legally an adult, to make an important decision that will affect not only their own well-being but likely the well-being of others around them.

Interestingly, the American Civil Liberties Union filed an amicus curiae brief on Cassandra’s behalf, arguing for a court hearing to determine whether she is mature in this legal sense.

What else is at stake in this case? Nothing less than the individual freedom to make decisions outside the purview of the state’s oversight.

The state should have the responsibility to make decisions, pass laws or enforce regulations that contribute to an individual’s and a society’s general well-being or welfare, including physical health. These might be age restrictions on driving, requiring seat belts or children’s car seats, and other similar health and safety requirements. (Actually, though, common sense and love and respect for our children should be sufficient motivation to follow these practices.)

But when is it the state’s responsibility to circumvent the constitutional right of a mature and competent individual to refuse medical treatment? The question is particularly troubling in light of the fact that some states such as Oregon have legal statutes providing for the ability of “mature and competent” individuals to enlist the aid of doctors to end their own lives.

How should state responsibility and individual constitutional rights be reconciled?

At the core of our constitutional republic are several important values, including liberty, order and security. Order is the domain of law-enforcement officials, keeping our streets safe from crime. Security is the responsibility of the military, ensuring that our borders are secure and our defenses are in place.

Liberty, though, is the responsibility of all of us. Liberty, or libertas, the freedom from state oppression, is the key value that our Founding Fathers knew separated us from other nations. It is at the heart of our constitutional rights — our First Amendment rights.

Liberty must be balanced with order and security but it cannot be abandoned, suppressed or eliminated completely in favor of the other two values. If it is, then we no longer will live in a constitutional republic but in a centralized state-based country — no different than most European nations, whose citizenry long ago lost true freedom and independence.

Cassandra’s decision to forgo chemotherapy may not be the norm for most 17-year-olds, but is no less important for the continuation and preservation of human liberty, in danger in her case of being relegated to a secondary value.

Stephen M. King, Ph.D., an adjunct scholar of the Indiana Policy Review Foundation, holds the R. Philip Loy Endowed Chair of Political Science at Taylor University.

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