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Not too long ago, the Connecticut Supreme Court ruled on a case called in re Cassanda C. The case dealt with a mature minor; someone not quite 18, but close, and whether they are entitled to make their own medical decisions. If any reader has teenage children, you will readily appreciate they can be headstrong.

The name Cassandra goes back to Greek mythology. In an effort to seduce her, Apollo gave Cassandra the power of prophecy. When she rebuffed Apollo’s advances, he spat into her mouth and inflicted a curse where nobody would believe her prophecies. Modernly, Cassandra refers to someone whose accurate prophecies of disaster are disregarded.

But, I digress.

Historically, children have been considered legally incompetent to make medical decisions. Such decisions are made by the child’s parent, guardian, or court. There are exceptions. For example, a child does not need parental consent to receive treatment for a venereal disease or treatment regarding pregnancy. If a child has been emancipated by the courts, they do not need parental consent for medical treatment. The modern view in many states is that a child may make medical decisions if the child understands the information provided and if the child has an appropriate level of maturity.

Let’s see this play out in the real world.

Cassandra was a 17 year old minor in Connecticut. She lived with her mother. Her father was not meaningfully involved with her life. Her mother delayed approval of treatment for Cassandra’s diagnosis of non-Hodgkins lymphoma to the extent that it endangered her life. (After Cassandra developed a mass on the right side of her neck, the mother repeatedly failed to bring her to medical appointments concerning the diagnosis of the mass, repeatedly fought with her doctors over the accuracy of their eventual diagnosis, and repeatedly argued with the doctors over how they communicated Cassandra’s diagnosis to her.)

She was placed under the care of a state appointed guardian. Cassandra refused treatment believing it would be traumatic and unnecessary. She did not want to endure side effects of chemotherapy. She discussed the treatment options with her doctor and agreed to undergo therapy as long as she could remain at home.

She received two treatments. Bruising appeared around the treatment area. Her doctors recommended a port-a-cath as the best way to continue treatments. The next day, when a state health employee went to take Cassandra to get the procedure done, she was gone. She had returned home after several days and refused to receive further treatment. She said she did not trust her doctors; she would soon be 18 and she should not be forced to undergo treatment against her wishes.

The commissioner for the Department of Children and Families filed for a re-hearing. The lower court held that because of Cassandra’s behavior, her mother’s viewpoint on the diagnosis, and the likelihood the cancer would worsen, the state could take physical custody and force her to undergo treatment.

This worked its way up to the Connecticut Supreme Court quickly. The issue whether a minor could be considered a mature minor had not been addressed previously by that court.

It held that the common law assumes that a minor is incompetent to make medical decisions until the child has shown the ability to make reasoned decisions and act independently. The court bases its analysis on the minor’s conduct, ability to act and live independently from parental aid, ability to reason in a mature manner, and understanding of their current situation.

Here, the Connecticut Supreme Court held that Cassandra’s dependence on her mother, her behavior, and her lack of honesty with the lower court and healthcare providers showed she lacked the level of maturity needed to meet a mature minor standard. She was removed from her mother’s custody and forced to undergo treatments.

Dealing with teenagers can sometimes be difficult. There is no difference between the cognitive faculties of a patient who is 17 years old and 364 days and one who just celebrated her 18th birthday. The court suggested in a roundabout way – if you want to be treated like an adult, act like one.

What do you think?