The Right to Die: When the Right to Choose Means Something New

The decision of the Connecticut Supreme Court to deny a 17-year-old minor’s attempt to be considered a “mature minor” and thereby refuse lifesaving cancer treatment has brought the right to die back into the headlines in a novel way.  The decision of the Connecticut high court to force a 17-year-old girl to accept medical treatment that she and her mother both attempted to reject calls into question the scope of the right to self-determination and begs questions about what autonomy means.

Diagnosis and Conflict

According to the New York Times coverage of the story, after Cassandra C. was diagnosed with Hodgkin’s lymphoma, a highly treatable form of cancer, Cassandra and her mother, Jackie Fortin, began a protracted battle with the state. After Fortin failed to take Cassandra to some of her doctor’s appointments—during a period of time where she was allegedly looking for a second opinion and alternatives to chemotherapy—the Connecticut Department of Children and Families (DCF) took custody of Cassandra. Two weeks after she was taken into DCF custody, she was allowed to return home on the condition that she underwent chemotherapy. Cassandra underwent two days of treatment and ran away from home.  When she returned—out of fear that her absence would lead to her mother’s incarceration—Cassandra was put back in the custody of DCF, hospitalized, and forced to undergo additional chemotherapy.

Mature Minor Question

Because the state overruled the agreed decision of mother and daughter to reject chemotherapy, Cassandra petitioned the court to consider her a “mature minor” so that she could reject the treatment as an 18-year-old would have been able to do. The court determined that, despite being months shy of her 18th birthday, Cassandra was not competent to make her own medical decisions.  Thus, as discussed in an Economist article, despite being old enough to donate blood, acquire birth control, seek psychiatric treatment, or terminate a pregnancy in the state of Connecticut, Cassandra was forced to accept a medical treatment she did not want. In Cassandra’s particular case, the story is complicated by the DCF decision to take Cassandra into DCF custody and strip Fortin of her rights to make medical decisions on her child’s behalf. Additionally, CNN reported that the court was reluctant to invoke the mature minor doctrine because no psychological evaluation had been conducted to determine the degree of Cassandra’s maturity or competency.

“My Life”

According to a report in the Washington Times, Cassandra wrote in an opinion piece about her story: “How long is a person actually supposed to live, and why? Who determines that? I care about the quality of my life, not just the quantity.” She also said “this is my life and my body, not the DCF’s and not the state’s. I am a human—I should be able to decide.”  Cassandra’s decision to refuse treatment that doctors indicated has an 85 percent success rate is controversial, to say the least. However, for Cassandra—who stands at the threshold between being able to conduct her medical affairs as an adult and being held at the whim of a state agency—the story represents a complex question about liberty. Although chemotherapy is accepted by the majority of those involved as the medically correct choice, are there other choices that deserve to be honored? At what point is a medical choice (irresponsible or otherwise) a personal one?