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The main ethical issue in this article resolves around whether an individual should be

forced against his/her will into receiving medical treatment.
In this article, Cassandra C., a 17-year-old in Connecticut with stage 3 Hodgkin’s
lymphoma disease, has been placed under temporary custody of the Connecticut
Department of Children and Families (DCF) for refusing chemotherapy. Having been granted
the authority by the state to make medical decisions on the behalf of Cassandra, DCF
subsequently forced Cassandra to undergo treatment, which consisted of her being strapped
on a bed and sedated. She was also separated from her mother (Fortin) and had her phone
confiscated, leaving communication between mother and daughter to supervised visitation.
Doctors advised that without medical aid, it is highly likely that Cassandra would die.
However, with medical aid, Cassandra has an 85% chance of survival. Cassandra however
has refused treatment, as she believes that chemotherapy would cause more harm than good
to her body. As Cassandra is still considered a minor, she has been deemed to be unaware of
the severity of her prognosis. Thus, granting her parents the legal authority to make health
care decisions on her behalf. Fortin’s decision was to respect Cassandra’s choice to refuse
treatment. However, the state has deemed such a decision to be of threat to Cassandra’s life.
As a result, the state has intervened, and forcibly administered treatment on Cassandra.
The relevant stakeholders to be discussed would be the state, Cassandra, her doctors,
Fortin and the public. In refusing treatment, it is highly likely that Cassandra would die. Thus,
by adopting the Kantian approach, we see that the state is acting from a moral duty to
protect and preserve the life of Cassandra. Thus by intervening, the state could be said to be
demonstrating benevolence by preventing Cassandra from committing suicide. In addition,
the state’s fulfills the principle of humanity, as they are not using Cassandra as a means to
test out a new medical treatment (end), but is instead using a medical treatment as a means
towards the goal of curing Cassandra. With regards to the principle of universality,
assuming that the state would only intervene with an individuals’ decision if it were either
against the notion of life preservation, or if both the individual and the parent is deemed to
be incapable of comprehending the effects of their decision, we can will it to become a
universal law. Having said that, the state finds itself in conflict with the principle of individual

In the context of Cassandra’s case. From the analogy. Does this mean that the state is acting in an unethical manner? Comparing Cassandra’s case to a case where an individual is about to jump off a building. as the impact of the state’s decision would be on her body. the state would also be stripping him/her of autonomy. as there exist a conflict between the Kantian imperatives. we see that the state ranks preservation of life above autonomy of an individual. at the same time. According to Nozick’s Entitlement Theory. as it is difficult to quantify the costs and benefits that Cassandra would incur. their action of forcing Cassandra into undergoing medical treatment should be considered as unethical. which is to preserve the life of Cassandra. and in both cases. the state would be deemed to be acting unethically in their action of denying Cassandra of her prerogative to act within her self-interest. and that her interest lies in refusing chemotherapy. I shall not be adopting the Kantian approach to determine the morality of the state’s decision. Nonetheless. the state would intervene and preserve the life of the individual. Cassandra would have to suffer the . should the state accept the individual’s decision to commit suicide? Both cases consist of life-threatening decisions. and thus would have to rectify the situation by returning Cassandra her autonomy. if we focus solely on the intention of the state. With a utilitarian approach however. It is however a positive that the state demonstrates ethical consistency in its decision making. each individual is free to pursue his/her own interests with minimum government intervention. Unfortunately. We have to compare the happiness that Cassandra might experience after the treatment. The state would not fulfill the principles of Just Original Acquisition and Transfer. Conversely. then the action of the state is ethical. she should be deemed to be acting ethically in her decision to refuse treatment. From the perspective of Rawl’s Justice as Fairness. In addition. In undergoing enforced treatment. against the pain that she incurs during the treatment. despite any potential negative consequences of the state’s action. Thus.autonomy or the freedom to act. the state has breached the principle of equal liberty by denying Cassandra her right to exercise free will. it is complicated.

However. when the physical pains of treatment come. In addition. the emotional trauma of lost autonomy. and having fought long and hard for the basic rights of free will. On the other hand. does the happiness of being alive necessarily outweighs the pain of the 8 months? Expert medical professionals have declared an 85% survival rate for Cassandra. If Cassandra was forced to receive chemotherapy. to bring about greatest happiness would be to allow Cassandra to refuse treatment. In comparison. would be limited by her remaining lifespan. if Cassandra was forcibly treated and survives. After the treatment. given a mindset that believes that the pain of treatment was brought upon her and not something that she has willed? It is probable that even though Cassandra would experience deteriorating health from her refusal of treatment.excruciating physical pains of chemotherapy. even if she perceives the entire process as a suffering. By allowing Cassandra to refuse treatment. she would still be experiencing less pain than if she were receiving treatment. she would continue to live with the emotional scars of the enforced treatment. On the other hand. in receiving treatment. given that the impact of the decision on their personal lives. the amount of happiness that she would incur. Conversely. Cassandra has an 85% chance of survival. she could also have to live with future implications on her health. it can be said. survival does not necessarily mean quality of life. In addition. from another perspective. by refusing treatment. Cassandra case is likely to be just one of the many cases that the state has to deal with. what can Cassandra use to motivate her to endure the pain? Would the pain of chemotherapy increase exponentially. and the pains of separation from Fortin. if Cassandra were to refuse treatment. Furthermore. Cassandra could still live a life that is of pain and suffering. Cassandra would receive the happiness of being the “author” of her own life. yet suffer the deterioration of her health. Amongst the 5 major stakeholders that would be most directly affected by the state’s decision. she could still seek out new pleasure through new experiences for the rest of her life. However. As the treatment would only last a maximum of 8 months (months remaining before Cassandra can legally refuse the treatment). only the state would not derive happiness. it is highly probable . This stems from her ability to justify to herself that she was the one who chose to be in this very situation.

that both Cassandra and Fortin would derive great amounts of happiness from a positive decision. utilitarianism does suggest that state’s action in forcibly administering treatment on Cassandra should be deemed unethical. and the improbable feat of making interpersonal comparisons. However. for the reasons of uncertainty and difficulty in quantifying and qualifying happiness. who has nurtured Cassandra since birth. and Fortin. the potential inaccuracy in making adequate predictions of the consequences of the intended actions. Thus. they are defeating the purpose of the initial law. . even more so than Cassandra herself. If rule utilitarianism were to be applied. under utilitarianism. the state can be said to be arrogantly assuming that it knows the true value of pain and happiness to Cassandra. For doctors. they would be able to rely on their professional opinion while respecting the decisions of their patients. it would mean that as a general rule. and in overruling the decisions of their parent/guardian. the public (parents of minors) would receive greater autonomy about making decisions for their child. a decision she willed. By overruling both Cassandra and Fortin’s decisions. The purpose of granting parents the authority to make medical decisions on the behalf of a minor is due to the state’s recognition of the maturity level of an individual at age 18 and beyond (adult). we notice that the employment of utilitarianism as a moral guideline is extremely subjective and thus ineffective in determining the morality of the state’s decision. Moreover. As parents are responsible for the well being of a child. based on the assumption that autonomy would bring about greatest happiness. merely on the basis that the adult has chosen to respect the decision of the minor. Thus by overruling the minor’s parent. it is only sensible for them to have the freedom and flexibility to make such related decisions. the difficulty in distinguishing between lower and higher pleasures. the state would be ethical in making the final decision for all minors. as long as it is deemed to be life threatening. to make lifechanging decisions. As such. The state would also be assuming that the representative adult is insufficiently mature. it would be considered unethical for the state to enforce treatment on Cassandra. A decision that though poses a threat to her survival. rule utilitarianism.

then the state should be prepared to take responsibility for the consequences that might entail. the individual should be the one making the final decision. unprofessional treatment. This statement clearly articulates the tremendous amount of distress that the state has placed upon Cassandra and Fortin. it is clear that Cassandra and her mother have been inflicted with the most pain. Overtime this could then lead to undesirable societal consequences such as the seeking out of untested. when illness befalls them. However. the state would be in a better position to achieve their well intention of life preservation. Instead of being viewed as people who bring hope and healing. The pain can be summarized by Fortin’s statement that “the state has ripped apart a normal family and turned their lives into a nightmare”. As it is the individual. they could now think twice about seeking diagnosis for fear that they too may be forced into receiving specific treatments against their will. should the state overrule the individual’s personal decision and get involved in the decision making process. Thus considering the relevant ethical theories. For the general public. the state’s decision could also negatively affect the reputation of doctors. In other words. it is unethical for the state to enforce medical treatment. doctors could now be viewed as complicit of an overbearing state. By assigning a social worker to Cassandra. .Assessing the impact of the state’s action on the stakeholders. who would have to live with the consequences of the decision. the state should advice. present its stand and allow the individual to make the final decision. and the public’s behaviour. An alternative action that the state could have taken would be to provide advise. education or counseling to Cassandra. instead of seeking treatment at clinics and hospitals. Similarly. In doing so. trust could be built and more could be understood of her decision making process.