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Cassandra C., choice and public health


What choice should parents and children have in selecting their own course of treatment? For a 17 year-old Connecticut girl, Cassandra C., the state has gone to considerable lengths to limit her autonomy. While the mandated chemotherapy will likely extend her life, the court decision requires us to consider the extent to which the state should intrude upon the autonomy of young people in health care choices, and how they may do so.

To force her to undergo treatment, the state’s Department of Children and Families (“DCF”) took a circuitous route, which included removing Cassandra from her home and placing her in foster care, and her mother agreeing with her decision to forego treatment seems to be at least one reason for the placement. The state actions leading to her treatment should worry all parents faced with situations in which their children make their own medical decisions, even if the result of that intervention is what they might secretly hope. And while the Connecticut Supreme Court might disagree, based on an op-ed published in the Hartford Courant, it seems clear that she is mature, rational, and understood the repercussions of her choice, assuming she wrote the piece herself.

Which situations the State chooses to step into, requiring specific action on the part of individuals, seems incongruous with reality given current public health concerns. As we face a measles outbreak that has spread from Disneyland to seven states, one has to wonder where public health related resources should be focused. Should they be spent on the isolated case of a young woman on the verge of adulthood making her own choice? Or should we spend time and money on known public health threats, to quell outbreaks of diseases, which were once well controlled or altogether eradicated (as was the case for measles in the United States in 2000), affecting very young children with no other options to protect themselves outside of herd immunity?