For the state's child-protection agency and the cancer doctors at Connecticut Children's Medical Center, there is no debate: 17-year-old Cassandra C. will die of Hodgkin's lymphoma without chemotherapy, and the teen doesn't have the legal standing to reject the treatments on her own.
But the state Supreme Court Thursday began hearing arguments from lawyers for Cassandra and her mother, Jackie Fortin, who supports her daughter's decision to reject chemotherapy treatments. The Department of Children and Families won temporary custody of Cassandra at the Superior Court level and Cassandra, of Windsor Locks, has been receiving regular treatments for more than four weeks at CCMC.
The question, says Cassandra's lawyer, Assistant Public Defender Joshua Michtom, is whether, despite an encouraging prognosis, "a smart and knowledgeable 17-year-old (can) make the same choice, for better or worse, than she would be able to make without state interference nine months from now, when she turns 18," said Michtom.
Wednesday, as Michtom made final preparations for his argument, he noted that society permits children to be tried in adult court for certain crimes, or conversely, to be tried in juvenile court for the same crime, depending on the history of that child. He pointed out that minors can seek an abortion, receive addiction treatment, or give blood without parental consent.
"We're asking the court to apply that same logic to a major medical decision," said Michtom. "Maturity isn't something that just happens overnight at the age of 18. Maturity occurs over the course of adolescence."
In accepting the case, the state's highest court is saying this argument, and the trial's court's ruling, are worthy of examination. The court has agreed to an expedited ruling in this rare case involving the "mature minor doctrine," which holds that some minors possess the maturity to make their own medical decisions, even if younger than the age of majority.
But DCF is resolute, and the agency is laying the responsibility at the feet of Cassandra's mother.
The department is obligated to act "when experts, such as the several physicians involved in this case, tell us with certainty that a child will die as a result of leaving a decision up to a parent," the agency said in statement.
Even CCMC issued a statement, something the hospital normally doesn't do. "Connecticut Children's is working closely with the Department of Children and Families. We are grateful that the Supreme Court has agreed to take on this very important case and we look forward to their guidance."
Fortin strongly denies that she influenced Cassandra's decision. Mother and daughter initially complied with the court order and Cassandra received two chemotherapy treatments _ but she then ran away from home and became a subject of a police-issued Silver Alert. When she returned home, Cassandra went back to CCMC, where she had had a portion of her lymph node removed.
Fortin said doctors had "to strap her down on the bed" to do the preparatory surgery before resuming the regimen of chemotherapy.
Fortin said Cassandra believes the chemical toxins could do more damage to her body than the cancer. Michtom has said that doctors involved with her care have pegged Cassandra's chances of surviving her bout with Hodgkin's lymphoma at 80 percent to 85 percent if she continues with the court-ordered treatments.
DCF maintains that "(e)ven if the decision might result in criticism; we have an obligation to protect the life of the child when there is consensus among the medical experts."
Fortin said this should be her daughter's choice to make. Cassandra was first diagnosed with Hodgkin's lymphoma in September.
Michtom and lawyer Michael Taylor of West Hartford, who represents Fortin, said they do not fault the order from the trial judge or DCF's actions.
"This is an untested legal area in Connecticut and there is not much guidance," said Michtom. "All I am asking the Supreme Court to do is send this case back to the trial court for a full hearing on the question of her legal competency to make this choice. That way, you will have psychologists and others testifying."
Fortin said that in a letter to the Superior Court judge, Cassandra wrote that "no one has let her breathe."
Fortin said that the decision was not motivated by a religious belief, and that her daughter once remarked years ago that she wouldn't want chemotherapy if she ever got cancer.
(c)2015 The Hartford Courant
