Introduction and Thesis
An individual’s right to determine if they should undergo medical treatment is ethically and legally essential in the relationships between patients and physicians. Allowing patients to make this crucial decision shows respect for their autonomy and well-being, increasing their trust and confidence in the healthcare providers. The main determinants of valid informed consent are an individual’s ability and capacity to consent, their full access and understanding of information regarding the treatment, and whether they give the consent freely and voluntarily. The first determinant of valid consent regards an individual’s capacity or competence to give consent. This ability can link to an individual’s age and whether they are mature enough to consent or refuse to undergo certain medical treatments. Since age is directly related to the ability to understand information regarding one’s health status, adolescents would not be mature enough to consent or refuse to be subjected to treatment to save their life.
Case Description and background
Adolescents refusing to consent to medical treatment is one of the modern problems experienced in medical ethics. Many adolescents as young as 15 years old suffer from serious medical conditions such as cancer and mental health issues refusing to undergo medical procedures. Some major reasons for refusing medical treatment include lack of trust, apathy, treatment’s side effects, and denial of the problem (Gebauer et al., 2019). For example, a follower of Jehovah’s Witness may refuse to accept blood transfusion as their faith is against such medical procedures. However, when patients refuse to accept medical treatment, they endanger their life and well-being, which health workers are mandated to secure. In such circumstances, especially when doctors believe a patient is at risk of serious health consequences, doctors are left at crossroads and are sometimes forced to seek legal advice on the right decision to make (Haahr et al., 2020). One such case involved a 17-year-old who refused to undergo chemotherapy as a treatment for her cancer.
In this case, a 17-year-old Cassandra had refused to be subjected to chemotherapy, citing its adverse side effects. Cassandra had been diagnosed with Hodgkin’s lymphoma, a type of cancer affecting the lymphatic system, which is the body’s immunity system. In Hodgkin’s lymphoma, lymphocytes grow out of control leading to swollen lymph nodes and growths throughout the patient’s body. Chemotherapy is the main treatment procedure involving using powerful chemicals to kill excess lymphocytes. However, although the treatment method is very effective, it is associated with many side effects, including hair loss, loss of appetite, tiredness, feeling of being sick, bruising and bleeding, and skin and nail changes, among others. In worst cases, chemotherapy could lead to early menopause, peripheral neuropathy, infertility, and heart and lung problems (Lupkin, 2015). Due to these side effects, some patients refuse to undergo the procedure due to consequences on their health.
Cassandra’s refusal to undergo the treatment was based on its side effects prompting her doctor to seek the court’s advice. According to the court summary, Cassandra had undergone two chemotherapy sessions but refused to complete the treatment, a decision that her mother supported. However, the Department of Children and Families intervened and ordered her mother to comply with recommended treatment. A court hearing followed, and doctors testified in support of the procedure, arguing that the patient had an 80 to 85 percent chance of surviving if she was subjected to chemotherapy. Following the testimonies, the court ordered she be taken under state custody so that the state could make medical decisions on her behalf. Following the court’s ruling, the teenager was held at Connecticut Children’s Medical Center, where she was forced to undergo chemotherapy sessions (Lupkin, 2015). Such directives involving patients’ right to make decisions regarding their health raise serious moral and ethical arguments that continue to guide the decisions made in the medical profession.
Argument
The decision made by the court on Cassandra’s case involves what is referred to as the involuntary treatment of what critics refer to as forced drugging. This refers to subjecting patients to medical treatment without their consent. In some countries, such as the United States, involuntary treatment is allowed by the law and enforced by the judiciary through court orders. Supporters of involuntary treatment argue that physicians’ role involves treating patients through the means they dim fit to achieve the best treatment outcomes (Szmukler, 2020). Further, they argue that medical practitioners act in the patient’s best interests and, therefore, patients are responsible for being strictly obedient to the orders given by physicians. When the patient is involved in a child or an adolescent, parents or medical doctors are allowed to provide the best care for patients even when their decisions are at odds with the patient of their parent’s wishes. Such decisions are based on the parens patriae principle, which allows the state to assume parental responsibilities for any child in order to protect them (Diekema, 2020). However, there are various arguments against the parens patriae principle, especially concerning medical treatment.
One major argument against parens patriae is that respecting patients’ autonomy is crucial in building trust in healthcare. According to Haahr et al. (2020), patients should be allowed to make decisions involving their health issues since it is their life and body. He further insists that as long as patients are not harming themselves, it should not be anyone’s business to decide the medical treatment they wish to accept or reject. Even if doctors act in the patient’s best interests, respecting their wishes should guide their decision-making. Where children or adolescents are involved, their parent’s wishes should guide physicians’ decisions. This is because; parents are competent to make informed decisions, and their values and views regarding their children’s health should be respected. However, Diekema (2020) argues that while this view is important to consider, it should have limits. While parents understand their children more than any other party, their wishes are not in the objective best interest of their children (Diekema, 2020). In the case of Cassandra, her best interest is subjecting her to the best treatment method that would increase her probability of recovering by over 80% (Lupkin, 2015). By opposing the treatment, Cassandra and her parent were not acting in the patient’s best interest.
Moral Theory
Many decisions regarding moral and ethical issues in medicine are made based on the arguments of various moral and ethical theorists. One such theorist is Jeremy Bentham, the founder of modern Utilitarianism. According to Utilitarianism, the morally right decision is the one that promotes happiness, while decisions that promote pain are morally wrong. Regarding Cassandra’s case, the treatment and healing of her cancer will lead to a better life devoid of tremendous pain caused by cancer illnesses. On the other hand, failure to subject her to chemotherapy treatment will lead to suffering, and she will eventually succumb to cancer (Shin et al., 2022). Therefore, the government’s decision to apply parens patriae is aimed at reducing her pain and increasing her pleasure which is the basis of the utilitarianism moral argument.
Social and Moral Significance
The ruling by the Connecticut Supreme Court regarding Cassandra’s case has a moral significance in health and other aspects of society. The fact that the court applies the principles of Utilitarianism shows the theory’s importance in making decisions involving ethical and moral dilemmas. In healthcare, some decisions involve introducing some aspect of pain to patients to heal other forms of pain. For example, physicians are sometimes forced to amputate body organs such as limbs, breasts, and the uterus to prevent the spreading of cancerous cells in other body parts. While such decisions induce lifetime pain, such as childlessness, and inability to walk, they prevent patients from succumbing to cancer. In addition to healthcare, Utilitarianism helps in moral reasoning and other types of rational decision-making in a wide range of contexts. In addition, Utilitarianism rejects moral codes such as taboos based on traditions, customs, or orders perceived to be given by some supernatural beings (Shin et al., 2022). Some decisions based on such moral codes may subject society to unnecessary suffering, which necessitates the government to develop counteractive policies.
Conclusion
Ethical deliberations regarding compulsory treatment are contemporary issues affecting health care. The main reason for the issue’s importance is that it violates patients’ autonomy and neglects their decision-making capacity. The crash between the patient’s autonomy and the physicians’ roles to act in the patient’s best interest has made some cases end in court. The Connecticut Supreme Court’s Ruling regarding Cassandra’s case demonstrates the role of ethical and moral theories in solving problems involving dilemmas experienced in healthcare. In addition, the ruling demonstrated that the laws guiding healthcare practice leave room for moral judgments regarding issues such as involuntary treatment. On the other hand, such moral judgments apply popular moral and ethical theories that ensure making rational decisions. In this regard, Utilitarianism is one of the moral theories with a wide range of applications in the health sector. The theory justifies using treatment methods such as organ amputation and chemotherapy that have short-term or long-term negative consequences. However, the positive impacts of such treatments supersede the negative consequences, and such decisions are made in the patient’s best interests.
References
Diekema, D. S. (2020). Adolescent brain development and medical decision-making. Pediatrics, 146(Supplement_1), S18-S24.
Gebauer, J., Higham, C., Langer, T., Denzer, C., & Brabant, G. (2019). Long-term endocrine and metabolic consequences of cancer treatment: a systematic review. Endocrine Reviews, 40(3), 711-767.
Haahr, A., Norlyk, A., Martinsen, B., & Dreyer, P. (2020). Nurses experiences of ethical dilemmas: A review. Nursing ethics, 27(1), 258-272.
Lupkin, S. (2015) Conn. Supreme Court Rules 17-Year-Old Cancer Patient Must Have Chemo, ABC News. ABC News Network. Available at: https://abcnews.go.com/Health/conn-supreme-court-rules-17-year-cancer-patient/story?id=28093594#:~:text=Conn.-,Supreme%20Court%20Rules%2017%2DYear%2DOld%20Cancer%20Patient%20Must%20Have,ruled%20on%20the%20case%20Thursday.&text=Jackie%20Fortin%20supports%2017%2Dyear,orders%20teen%20to%20undergo%20treatment. (Accessed: November 27, 2022).
Shin, Y., Kim, S., Kim, D. H., Lee, S., Cho, M., & Ihm, J. (2022). The effect of the deliberative process on the self-sacrificial decisions of utilitarian healthcare students. BMC medical ethics, 23(1), 1-10.
Szmukler, G. (2020). Involuntary detention and treatment: Are we edging toward a “Paradigm Shift”?. Schizophrenia bulletin, 46(2), 231-235.
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