...We called
Dr. Eric Kodish, a pediatric oncologist who directs the Cleveland Clinic's Center for Ethics, Humanities and Spiritual Care, to talk about why we struggle with giving minors control over their medical fates. This version of our conversation has been edited for length and clarity.
Did you expect the court to side with the doctors on requiring treatment?
I was surprised by the Connecticut Supreme Court's decision. The black letter of the law may indicate that 18 is a bright-line, hard cutoff,
but I think there's a pretty clear consensus that with most upper teenagers, if you're able to make decisions they should be respected.
The law in this case
seems to be moving toward forced treatment, and I think the ethics of modern American life suggest that
if people have the capacity to make a decision, they should be free to refuse treatment.
We clearly allow adults to make their own decisions, even with tragic consequences.
How do you know if someone is capable of making that kind of life-or-death decision?
It think it's really important to explore the reasons why she's making these decisions; a formal capacity evaluation is super important. It's not clear to me that the court had a
formal capacity evaluation, or even an ethics consult. I read one thing that the court had made its decision based on her previous actions, that she hadn't shown up for appointments, that she had refused chemotherapy in the past. That becomes a very circular argument.
But Cassandra's age seems to be a big factor in the court's ruling. How do doctors ethically consider a child's age?
Have you heard of the rule of sevens? From ages 0 till 7, there's no voice of the child. From 7 to 14, there's assent; the voice of the child should be integrated into decision-making, but it's not determinative. And above age 14, kids should be able to make their own decisions.
There are nuances here; we allow kids much younger than this sometimes to make decisions about issues that are not as grave as this, but for potentially life-threatening situations there's a higher bar...