When your child claims the right to refuse treatment

As a therapist working with children and adolescents I am often confronted with a demand from parents to help their child.  It is typically not the child herself that picks up the phone and reaches out. Sometimes, when the parent calls the children themselves have asked their parents to talk to someone, but more often the parents call because they are concerned, and it is not sure whether the child wants to come in for himself or herself. And if they do, they might have quite different concerns. In cases where children do not want to come, or are hesitant I like them to commit to 6 sessions to give it a try, so that they can see whether it would work for them. Because, indeed, it is not because the child says he or she does not want to come, that she really does not want to come.  It could just mean that the child does not want to do what the parent thinks is best for the child. There is nothing wrong with that. Indeed, the child will have to see for herself whether she wants the therapy for herself. 

Parents often become confused when I put it that way, as they feel their child 'needs' the therapy, and it should not be left to them. My response is that therapy only works when a person can get engaged in it, and not when it is imposed by someone else. 

I came across an interesting article by R. Muller about a 17-year old girl 'who refused to undergo chemotherapy after being diagnosed with Hodgkin Lymphoma, a cancer of the lymphatic system.  The Connecticut Superior Court ruled that as a minor, Cassandra did not understand the severity of her condition. She was taken to Connecticut Children’s Medical Center in Hartford, where she was forced to undergo chemotherapy.'

In an essay that recently got published the girl states:

“I should have had the right to say no, but I didn’t. I was strapped to a bed by my wrists and ankles and sedated. I woke up in the recovery room with a port surgically placed in my chest. I was outraged and felt completely violated.”

As her mother did not comply with the court ruling, and did not bring C. to her appointments, she was removed from her mother and placed in foster care.  C. argued that she cared more about the quality of her life than the duration. Yet she was told that undergoing chemotherapy would increase her chance of survival by 85 percent. Without it, doctors said there would be a near certainty of death within two years. C. acknowledged this risk, but maintained that she had the right to make decisions about her own life and body.

The mother supported her daughter's decision: 

“She knows the long-term effects of having chemo, what it does to your organs, what it does to your body. She may not be able to have children after this because it affects everything in your body, it not only kills cancer, it kills everything in your body.”

There is some concern that C's opinion on medical treatment could have been influenced by her parents. This issue is especially important given the far greater chance of survival offered by treatment.

At this age the right to independent decision making at this age is an important factor. In her essay, Cassandra writes:

“I am a human—I should be able to decide if I do or don’t want chemotherapy, whether I live 17 years or 100 years should not be anyone’s choice but mine.”

And it is important that this desire for independence should be heard.  Does this mean that any demand has to be immediately satisfied, because it is the demand of the adolescent wanting to be independent? Of course not.  It is important to hear and and worked through. 

A refusal to see treatment, whether it is chemotherapy or psychotherapy does not necessarily have to be considered an obstacle to the treatment.  It is an important message that needs to be heard, and that can be worked on.  And it is an essential first step in having a successful psychotherapeutic treatment with an adolescent. 

C. was discharged from hospital last April, after completing treatment. Prior to being released, she wrote on Facebook: “I have less than 48 hours left in this hospital and I couldn’t be happier!”

She reported that she was grateful that she responded positively to the drugs and was predicted to survive cancer-free. But she also added:

“I stood up and fought for my rights, and I don’t regret it.'