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Raw Truths, Instinct, and Justice: The Cassandra C. Case

By Risham Dhillon

“How long is a person actually supposed to live, and why?” writes a teenager ordered by the Connecticut Supreme Court to undergo chemotherapy. “Who determines that?”

The teen, known in court as Cassandra C., was diagnosed last year with Hodgkin’s lymphoma, a disease with around an 80% post-chemotherapy survival rate. Despite these favorable odds, Cassandra and her mother have been fighting a legal battle with the state to gain the right to refuse treatment. The most recent ruling by the Connecticut Supreme Court has determined that Cassandra does not have this right and must undergo chemotherapy.

In life or death situations, it seems instinctive to fight for survival. When I first heard of Cassandra’s case, I couldn’t help but wonder why anyone with an 8 out of 10 shot would not go for it, and why anyone would refuse chemotherapy. I hoped she would change her mind.

But instinct, I’ve come to realize, isn’t infallible. In fact, as much as I wish Cassandra would lean towards treatment, I do not stand fully with the state’s decision.

For the most part, legal adults (those above age 18) or those practicing certain religious beliefs may refuse certain medical procedures altogether. Cassandra’s case is complicated by the fact that she is a minor who is not citing a religious belief as her reason for refusal of chemotherapy. In certain states, the mature minor doctrine allows minor teenagers who demonstrate maturity to make such decisions. Although Connecticut doesn’t employ such a doctrine, Cassandra’s lawyer argued it should–but to no avail. The court decided that “even assuming that the mature minor doctrine applies in this state, the respondents have failed to meet their burden of proving under any standard that Cassandra was a mature minor and capable of acting independently concerning her life threatening medical condition.” This conclusion was based on the fact that following an initial trial court decision, she ran away from home and missed court-mandated chemotherapy appointments. Furthermore, the court was concerned that certain external prejudices, like those of her mother, may have heavily influenced her.

But the decision the court has come to, I feel, has its faults.

For one, there is no magic age that determines maturity. I’m sure I’m not the first to say that 18 doesn’t feel much different than 17, and though I recognize that our legal system functions on fine lines and categories, not all societal issues clearly fit within said fine lines and categories.

But more importantly, as a blog post in the Economist highlights, Cassandra was judged to be an immature minor because she ran away from home in an attempt to avoid court-ordered chemotherapy treatments. In other words, because she actively decided not to follow the first court’s decision, the appeals court refused to give her a voice as a mature minor. This is unfair; the state should not have the right to base the legitimacy of its authority over her on the fact that she challenged the court’s legitimacy in the first place.

If Cassandra’s case were a bit different—if she were a Jehovah’s Witness in critical condition refusing life-saving blood transfusions—the courts would more likely be in her favor. In fact, in 2007, the Seattle Times reported that a judge had affirmed a 14-year old boy’s right to refuse such treatment for leukemia, stating that the boy knew that such a decision was akin to a death sentence. Fast forward a few years, change the disease, and we have a similar scenario but different results: for Cassandra, the state is not on her side.

It is agonizingly difficult to readily accept a young death that is preventable. But focusing only on the post-treatment survival statistics does not do justice to recognizing the immense physical and emotional tolls individuals like Cassandra go through, and this is not a peripheral point. The state does not have the right to force her to endure physical and emotional pain, regardless of how pure the intentions. The end doesn’t always justify the means.

Instincts can fail. The Supreme Court can be wrong. And here, the raw truth is that both have fallen short in doing justice.

Risham Dhillon ’18 is a Crimson editorial writer living in Stoughton Hall. 

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