It’s unusual for a 17-year-old to take a stand against receiving medical treatment for a disease that could kill her. Connecticut-based teenager Cassandra C, refused chemotherapy for a cancer called Hodgkin’s disease that she had been diagnosed with. She and her mother initiated a legal battle with the state over her right to refuse treatment, despite doctor’s insistence that chemotherapy was imperative to save her life.
Last week, Connecticut’s Supreme Court ruled that Cassandra must continue with the therapy, on the basis of her inability to show that she was a “mature minor”, capable of making her own medical decisions. Her mother’s influence on her decision to refuse medication also stood against Cassandra. Today this 17-year-old is in hospital undergoing chemotherapy, which experts say will now give someone like her an 85 per cent chance of being disease-free after five years.
Medical decision-making on behalf of children is a complex process ethically and legally. Although the legal age for consent to medical treatment is 18, there are many exceptions to this rule in the USA. Patient and child rights are taken seriously, yet the court has a right to intervene in a circumstance like Cassandra’s – where both a minor and her parent are refusing life-saving treatment.
The assumption that those under the age of 18 aren’t mature enough to give consent, and parents are in a better position to decide what’s in their child’s best interest isn’t necessarily true. Many teens are intellectually and emotionally capable of giving informed consent. Adolescents are on the brink between childhood and adulthood, and have an extended capacity for critical thought. Parental consent shouldn’t be essential for all their healthcare decisions.
Several countries acknowledge a minor’s right to privacy and body integrity and most states in the US have enacted statutes to authorise minors to give their own consent for healthcare in some circumstances: consent of a parent isn’t required when it comes to contraceptive and pregnancy related care, counselling and treatment for substance and alcohol-related issues, and mental health services, for instance. But attitudes, laws and healthcare services for adolescents in India lag. Despite the UN Convention on the Rights of the Child, healthcare decisions for teenagers are still made by parents.
“It’s rare for anyone below 18 to come for help by themselves,” says Dr Samir Parikh, director, Department of Mental Health and Behavioural Sciences, Fortis Healthcare. Nearly all adolescents are accompanied by parents or sometimes referred through the school. “When it comes to drug or alcohol abuse, it’s least common for an adolescent to seek help,” says Dr Parikh, who attributes this behaviour to the financial and emotional dependency that characterises Asian teens.
Making healthcare solely a parent’s responsibility deprives adolescents from making crucial decisions about their bodies and well-being, with implications that last a lifetime. What we need is adolescent friendly health services that ensure confidentiality and encourage teenagers to develop health-seeking behaviour. Young people should be able to get counselling and treatment for mental health problems, addictions, and reproductive health issues without always involving their parents. Across the world, healthcare settings geared for adolescents are proven to enable youth to develop self-responsibility and adopt healthy behaviour. Public policies supporting young people in this endeavour need formulation. This would enable creation of payment mechanisms via public funding or insurance coverage that would enable independent decision-making for adolescents in some circumstances.