INSTRUCTIONS
Read the case below and answer the following questions using a normative moral theory covered in this course, and/or a code of professional ethics covered in this course:
- Was the state morally justified in forcing Cassandra to receive chemotherapy against her wishes? Why or why not?
- Is it morally and professionally permissible for medical professionals such as doctors and nurses to administer treatment to unconsenting adolescent patients at the behest of the state? Why or why not? Is it obligatory for them to do so? Why or why not?
- Under what conditions, if any, is it morally permissible for an adolescent to refuse medical treatment? Why?
CASE
Before Cassandra could have her first round of chemotherapy to treat Hodgkin lymphoma, she had to have a port placed in her body to deliver the cancer-fighting drugs. During this surgical procedure, she had to be strapped to the bed25 against her wishes, for she was adamantly against receiving chemotherapy—a treatment she deemed poisonous to her body, despite knowing that without it she would almost certainly die. Had Cassandra been at least 18 years old, she would have had the legal right to refuse the cancer treatment. From a legal and moral standpoint, the doctrine of informed consent and informed refusal protects the liberty of competent adults to make autonomous medical decisions. However, being only 17, Cassandra’s wishes were dismissed by the Connecticut Supreme Court. The judges unanimously ruled that Cassandra could be forced by the state to receive chemotherapy, because she lacked the necessary maturity to make her own medical decisions.26
After receiving her diagnosis, Cassandra and her mother, Jackie Fortin, began to miss medical appointments, in order to avoid the prescribed chemotherapy. According to Cassandra, her mother urged her to reconsider her staunch position against chemotherapy. Unable to change her daughter’s mind, Fortin ultimately decided to respect the girl’s decision. Given that Hodgkin lymphoma is a highly treatable form of cancer, but fatal without treatment, Cassandra’s doctors reported Fortin for neglect to the Department of Children and Families (DCF).27 Shortly thereafter, Cassandra was removed from her home and placed under the custody of the state. As Kristina Stevens, a DCF representative, declared, “if the system . . . [didn’t] react and respond, this child . . . [would] die.”28
While young children clearly lack the capacity to make autonomous medical decisions, adolescents, especially older ones, pose a challenge to the doctrine of the presumed incompetence (i.e., lack of legal ability) of minors. Adolescents find themselves at a transitional stage between the incompetence of childhood and the competence and autonomy of adulthood. Thus, as Dr. Saskia Nagel, a neuroscientist and philosopher, has argued, “autonomy should not be viewed as an all-or-none phenomenon. One does not have it fully or not at all.”29 Instead, she proposes that autonomy should be considered a “gradual phenomenon that develops over time.”30
This idea was echoed by Joshua Michtom, Cassandra’s public defender, when he said that teenagers “can get contraception. They can get addiction treatment. They can donate blood. They can be tried as adults for certain crimes. So there’s recognition overall that maturity doesn’t happen overnight. You don’t go to sleep a 17-year-old knucklehead and wake up an 18-year-old sage.”31 Thus, some states have adopted the mature minor doctrine, which grants individuals under 18 with a sufficient level of maturity the right to refuse medical treatment. However, the courts have recognized that “this right is not absolute . . . [and] could be limited by the state interest to preserve life.”32
Today Cassandra is in remission. Though she is looking forward to returning to her home and resuming her normal life, she is still troubled by what happened to her: “I will never be okay with how this all happened — being taken away from home, hospitalized and especially being strapped to the bed . . . I still wish I was given the right to explore and go with alternatives . . .Anybody should have that right. Minor or not.”33
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25 Briggs, Bill. “Connecticut Teen Who Refused Chemo Now in ‘Remission,’ Seeks Freedom.” NBC News. July 15,
2015, http://www.nbcnews.com/health/cancer/connecticut-teen-who-refused-chemo-now-remission-seeks-freedom- (Links to an external site.)n320061
26 Nalpathanchil, Lucy. “Can Connecticut Force A Teenage Girl To Undergo Chemotherapy?” NPR July 15, 2015,
http://www.npr.org/sections/health-shots/2015/01/08/375659085/can-connecticut-force-a-teenage-girl-to-undergo- (Links to an external site.)chemotherapy
27 Nalpathanchil, Lucy.
28 Nalpathanchil, Lucy.
29 Nagel, Saskia K. “Autonomy—A Genuinely Gradual Phenomenon.” AJOB Neuroscience 4.4 (2013): 60-61.
30 Nagel, Saskia K.
31 Briggs, Bill. “Connecticut Teen With Curable Cancer Fights to Stop Chemo.” NBC News July 15, 2015, http”://www.nbcnews.com/health/cancer/connecticut-teen-curable-cancer-fights-stop-chemo-n281511 (Links to an external site.)
32 Harvey, Martin T. “Adolescent Competency and The Refusal Of Medical Treatment.” Health Matrix 13 (2003):
297.
33 Briggs, Bill. “Connecticut Teen Who Refused Chemo Now in ‘Remission,’ Seeks Freedom.”
Structure Guidelines
Your paper should be a minimum of 1200 words, not counting citations and quoted material, and should include:
- An introductory paragraph in which you summarize (in a few sentences) the central moral tension or problem in the case. Who stands to be harmed and helped in the case, and how? This paragraph should also include clear statements that answer the questions posed. For example, after summarizing the case you might write that “the state was morally justified according to social contract theory because…” or that “it is sometimes right for adolescents to refuse medical treatment according to utilitarianism because…”
- A paragraph or two in which you elaborate on those details of the case that will be relevant to your moral analysis. Here you will expand on what you summarized in the first paragraph, with an eye towards what is pertinent for the moral theory you have selected. For example, if you are doing a utilitarian analysis, you will focus on those details of the case that show how forced chemotherapy impacts human happiness. If you are doing a deontological analysis, you will present details that will you help you to show the relationship between dutiful action and the choices of Cassandra, her parents, and the state.
- A paragraph or two in which you elaborate on the normative ethical theory you will use to conduct your moral analysis of the case. Clearly identify the moral theory. Explain what the theory identifies as the chief good at which our actions should aim, and describe the decision-making procedure or factors of consideration, if any, that are provided by the theory. Use choice quotes from primary source material to support the claims you make about the central aspects of each theory. For example, if you choose Mill’s utilitarianism you must explain what kind of happiness utilitarians hold to be the good, and explain how the “greatest happiness principle” is meant to guide our decision-making. You would support your summary of these components by pulling quotes from Mill’s book
Here you should also include a paragraph or two summariaing the professional code(s) of ethics you will use in your answer to the questions posed.
- This is perhaps the most important part of the paper since it involves application of theories learned in this course. A paragraph or two in which you assess the details of the case (the same details that you described in section #2 above) through the lens of the theory (the theory you described in section #3 above). Given that the facts of the case are what they are, and given that theory conceives of the good in the way that it does, how can we assess the actions of everyone involved? How does this help to support the answers you provided to the major questions of the paper in section #1? For example, if in your introductory paragraph you stated that it is sometimes morally right for adolescents like Cassandra to refuse medical treatment, you must explain how the theory you have selected supports that assertion.
Here you should also analyze the issue through the lens of the professional code(s) of ethics you have identified above.
- A concession paragraph in which you acknowledge the weaknesses of the theory you selected. Since the theory you chose is not perfect, explain how a rational person might disagree with your decision to use the theory in this particular case. For example, if you chose deontological ethics to support your answers to the major questions of the paper, what are some failings of deontological ethics? These failings may be theoretical or may relate to intuitions people have that fail to be supported by the theory.
- A concluding paragraph that summarizes the paper. In many ways this paragraph will mirror your introductory paragraph. No new information should be provided in the concluding paragraph.
- A citation page in which you cite your sources in MLA format.
- Your final draft should be completely free of spelling and grammar errors.
CassandraCallender
