The Ethics of Forced Chemotherapy on Minors with Good Prognoses

Each family approaches a cancer diagnosis differently. While some families pursue traditional treatments to the fullest extent, others attempt to refuse chemotherapy, often in favor of alternative medicines. When the patient is a minor, his or her parents have the authority to make medical decisions on their behalf, and this authority is constitutionally protected and socially upheld. However, when the decision to forgo chemotherapy does not comply with minimum standard of care and puts the minor's life in danger, legal action can and has been taken to force the minor to undergo chemotherapy. Legal precedent and biomedical ethics principles guide the decision-making process of the physicians and judges involved, although there is no official framework by which to prioritize these principles. Neglect and abuse procedures, as well as capacity determinations, mature minor doctrines, and religious convictions, add complexity to each forced chemotherapy case. These complexities were explored through the context of four case studies: Cassandra Callendar, who was not granted mature minor status and was forced into treatment by the Connecticut Supreme court; Starchild Abraham Cherrix, who was allowed to pursue the alternative Hoxsey therapy with the consent of his parents and the local court; Dennis Lindberg, a 14-year-old Jehovah's Witness who was permitted to refuse blood transfusions under the Mature Minor Doctrine; and Daniel Hauser, a developmentally delayed teen who was forced to undergo therapy against his parents' religious convictions. In the analysis and comprehensive comparison of these cases, it was concluded that an attempt to establish a protocol by which to determine the ethics of forcing chemotherapy, while well-intended, would ultimately be ineffective and extremely complex. Thus, each forced chemotherapy case must be evaluated on an individual basis.