Running head: Ethical Dilemma

The Minor Ethical Dilemma-Forced Chemotherapy on a Teen

Marilyn Carter, Naia Kassebeer, Mary Kenui,
Jennifer Kiaha-Raquino, Naomi Masuda, Tami Watanabe
NURS 362
Kapiolani Community College

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The Minor Ethical Dilemma-Forced Chemotherapy on a Teen

This is the case of a 17 year old female in Connecticut diagnosed with stage III Hodgkin's
lymphoma who refused chemotherapy treatment. It was her belief that chemotherapy was toxic
to the body and was interested in alternative treatments. The mother of this 17-year-old
supported her daughters decision arguing that her daughter was mature enough to make this
decision. Doctors reported the mother for medical neglect, the teen was placed in the temporary
custody of Connecticuts Department of Children and Families, and the Connecticut Supreme
Court ruled that the state can force the teenager to receive the cancer treatment deemed necessary
by the doctors.
Since the teen was in the custody of the Department of Children and Families, a guardian
ad litem was appointed by the court that allows the guardian to make decisions for the wellbeing
of the minor (Macklin, 2015). This guardian is a unique type that is appointed only for the
duration of the legal action, in this case, the duration of cancer treatment for this minor.
The ethical principles involved are beneficence, nonmaleficence, as well as autonomy.
The physician, nurses, and guardian ad litem from the Department of Children and Families are
upholding the principles of beneficence and nonmaleficence. Cherry and Jacob (2014) state that
beneficence and nonmaleficence is to promote goodness, kindness, and charity and implies a
duty to not inflict harm (p. 175). The patient and her mother are practicing the principle of
autonomy. Cherry and Jacob (2014) maintain autonomy as the principle of respect for a person
(p. 173) which is comprised of the belief that people are self determining agents, entitled to
determine their own destiny (p. 174). They continue saying that autonomy should be respected,
even if the decision ultimately creates risk to his or her health and even if the decision seems
unwise to others (p. 174).

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The American Cancer Society (2014) states that the 5-year survival rate for a patient
diagnosed with stage III Hodgkins lymphoma is 80% with chemotherapy and radiation
treatment. With this high survival rate, it is the physicians, hospitals, and Connecticut Supreme
Courts belief that the chemotherapy treatment is necessary; without it, the teen would die. The
physician reported the teens mother for medical neglect, owing to the physicians view that the
mother of the teen was medically neglecting her child by failing to consent to the chemotherapy
treatments the physician described as necessary for the health of her child. As the physician, it is
within my right to do so. Mavrides and Pao (2014) maintain that some studies of adolescent
brain development suggest that judgement and responsibility do not develop fully until even the
mid-20s, implying that younger adolescents may be less competent decision-makers. With this
thought in mind a physician may not think the judgement of a 17-year-old is competent for
decision making. Mavrides and Pao (2014) also talk about the psychological issues that pediatric
oncology patients are challenged with such as depression, anxiety, delirium, and lack of social
and family support related to having cancer. From a physician's point of view, the adolescent
may not fully comprehend the consequences of refusing treatment due to these various factors.
The physician and nurses administering the chemotherapy treatments believe they are upholding
the principles of beneficence and nonmaleficence but having to restrain a patient in order to
administer those treatments and not allowing the patient the ability to leave her room or speak to
her mother over the phone is inflicting emotional, psychological, and physical harm. This is
violating the beneficence and nonmaleficence principles.
From a nursing point of view, I wouldnt be comfortable treating a 17-year-old who was
unwilling to receive chemotherapy treatment. I would feel that at 17, the patient is old enough to
make her own decisions and that we should respect those decisions; we should respect her

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autonomy. Unfortunately, Connecticut has not adopted the Mature Minor Doctrine, which would
allow the courts to consider evidence on whether this 17-year-old adolescent is competent to
make her own healthcare decisions (Silberstein, 2015).
I think the decision to remove the patient from her mothers custody and take away autonomy
from the patient should be overturned in court. If I, as a nurse, were to have forced treatment on
this patient, wouldnt that be battery? Could I be prosecuted? Fined? Jailed? Isnt keeping a
minor against her will and forcing treatment she doesnt want medical kidnapping? This teen
would be turning 18 in eight months. How significant is 8 months in the maturity of a teen?
From the viewpoint of the daughter, Im a 17-year-old who is mature enough to make my
own medical decisions. Some medical professionals believe that children after ages 12 or 13
who appear to be mature have or ought to have the right to consent or to withhold consent to
general medical treatment (Coleman & Rosoff, 2013). In fact, 14 states permit mature minors
to consent either in all or a range of restricted circumstances, and 3 states allow minors
regardless of their age or maturity to consent to treatment in either all or limited circumstances
(Coleman & Rosoff).
My opinions and beliefs should be considered in my medical treatment. Moreover, my
mother who is the legal authority supports my wish to refuse chemotherapy. The doctor has no
right to act against our decision. His actions do not uphold the principles of beneficence and
nonmaleficence. If we are not fully informed of all the options, including risks and benefits, we
might not make a knowledgeable decision regarding said treatment, however, conveying all the
medical information regarding cancer treatment is the doctors responsibility. The health
professional is the expert in medical knowledge but it must be remembered that parents have

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superior knowledge about their child and their childs best interest, which is often based on
family values (Gormley-Fleming & Campbell, 2011).
From the mothers point of view, Im being a good mother and supporting my daughter.
Im looking into alternative cancer treatments with my daughter that doesnt include
chemotherapy or radiation, since she has informed me that she believes chemotherapy is poison
and its worse than the cancer that is ravaging her body. Research has shown that there are long
term effects of chemotherapy, such as increased risk for diabetes mellitus, osteoporosis, and
thyroid disorders (Gebauer et al., 2015). Quality of life needs to be taken into account in this
situation, which is what my daughter and I are reflecting on and what is driving our mutual
decision to forego chemotherapy the physician deems necessary. For my daughter to be
appointed a guardian ad litem from the Department of Children & Families because the
physician and Supreme Court believe she doesnt have the capacity to make decisions regarding
her medical treatment and then report me for medical neglect is wrong. The physician should
have discussed with us all cancer treatments available with their related side effects and then
listened to which treatments we were interested in pursuing. Physicians are supposed to work
with patients and their family members in creating a treatment plan that all parties involved agree
with and I feel the physician in this case failed to do so.
References
American Cancer Society. (2014, September 10). Hodgkin disease. Retrieved from
htpp://www.cancer.org/acs/groups/cid/documents/webcontent/003105-pdf.pdf
Cherry, B. & Jacob, S. (2014). Contemporary nursing-issues, trends, & management (6th ed.).
St. Louis, MO: Elsevier.

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Coleman, D. L., & Rosoff, P. M. (2013). The legal authority of mature minors to consent to
general medical treatment. Pediatrics, 131(4), 786-793.
Gormley-Fleming, L. & Campbell, A. (2011). Factors involved in young people's decisions
about their health care. Nursing Children & Young People, 23(9), 19-22.
Gebauer, J., Fick, E., Waldmann, A., Langer, T., Kreitschmann-Andermahr, I., Lehnert, H.,
Brabant, G. (2015). Self-reported endocrine late effects in adults treated for brain
tumours, Hodgkin and non-Hodgkin lymphoma: a registry based study in Northern
Germany. European Journal Of Endocrinology/European Federation Of Endocrine
Societies, 173(2),139-148.
Macklin, R. (2015, January 12). The Ethical Dilemma of Forced Chemotherapy on a Teen.
Retrieved from http://blogs.einstein.yu.edu/the-ethical-dilemma-of-forced-chemotherapyon-a-teen/
Mavrides, N. & Pao, M. (2014). Updates in paediatric psycho-oncology. International review
of psychiatry, 26(1), 6373.
Silberstein, S. (2015). Cassandra: Cancer and the Mature Minor Doctrine. Retrieved from
http://beatcancer.org/2015/01/cassandra-cancer-and-the-mature-minor-doctrine/