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January 12, 2015 at 8:54 AMComments: 0 Faves: 0

Jackie Fortin Refuses Cancer Treatment for Her Daughter: Should Parents Have that Right?

By Jeffrey VanWingen M.D. More Blogs by This Author

This week I turned on the news and I'm still processing the emotions that it stirred.

Topping the broadcast were the accounts of a man who intentionally dropped his daughter to her death off a bridge in Florida, and a woman in Connecticut who is refusing chemotherapy for her daughter's Hodgkins Lymphoma.

After hearing these heart-wrenching stories, I couldn't help but contemplate the common threads that tied these two tragic tales together.

Where do we draw the lines as a society as to how much autonomy we have over our children?

What autonomy do children have in such matters?

Have I just opened Pandora's Box?

Parenting Perspective

I am convinced that parenting is the absolute toughest job we will ever have. It involves meeting a countless stream of evolving, varied, urgent and non-negotiable needs. Parents give up a life for themselves. They wake in the wee hours to feed their infants or to calm nightmares. They bank hour upon hour sitting in bleachers and meeting the logistics of increasingly active lives. They endure teenage ambivalence. They worry and fret about safety and wellness until their hair turns grey.

Yes, parenting is not for sissies.

And it goes well beyond the limited law of the land which caps the responsibility at 18.0 years. We rationally want the best for our children. Some say that it's because they are our genetic or chosen legacy. None would argue that we have a tremendous bond of love. But in an imperfect world, imperfections exist. This week's news was proof.

The Stories

According to witnesses, John Jonchuck, Jr. pulled his car over on the Dick Misener Bridge in Tampa, Florida after a police pursuit for speeding. He emerged from his car with his five year old daughter, threw her off the bridge, 60 feet above Tampa Bay, and then calmly returned to his car and drove away. Few additional details have been reported as to his mental state or motive.

Jackie Fortin does not feel that her daughter Cassandra should undergo chemotherapy for Stage IV Hodgkin's Lymphoma. When healthcare providers observed missed appointments and refusal to undergo therapy, they filed a report with the Connecticut Department of Children and Families (DCF). DCF made the determination to remove Cassandra from the care of her mother and force her to undergo therapy. The Connecticut Supreme Court upheld this decision.

Doctors say that with treatment she has an 85% chance of survival and without treatment she will die. Cassandra's mother does not want the treatment and neither does Cassandra, who is 17. Jackie feels that Cassandra can make her own decision. According to Jackie, "My daughter is not going to die. This is about, 'This is my body, my choice, and let me decide.' "

Black, White, and Gray Area

Obviously, the case of John Jonchuck is completely outside the bounds of parental behavior. He is likely psychotic and deranged. The case of Jackie Fortin is more debatable. Both, however, hit the same root regarding acceptable exertion of autonomy.

I face similar questions with parents every day with issues such as car seats, infants sleeping in bed with parents, spanking and immunizations. We all have opinions on what constitutes right and wrong in parenting. But, where is the line of interpretation drawn?

I believe that in parenting around gray areas, a system of checks and balances can be helpful:

  • Is the parent acting out of love? In other words, is the parent acting with positive intentions without any negative emotion such as selfish ambition, lack of motivation or anger.
  • Does the parent fully understand all sides and implications?
  • Is the parent of sound mind to weigh the implications of all possible actions?
  • Can they contend with all possible outcomes?
  • Is the parent's action or behavior going to harm the child physically or emotionally? This goes beyond the transient discomfort of a rendered punishment but considers the sum ramifications.
  • Is the parent's behavior going to harm others beyond their child?
  • Can the parent understand implications beyond the possible effects on their own child?

While even the fine points of these guidelines can be argued, I feel it sets a reasonable framework for reasonable people. I am presently wrestling with the Fortin case as I also wrestle with many more common parenting behaviors.

Jackie Fortin obviously loves her daughter. The press has played on her struggle raising Cassandra as a single parent and the two being inseparable. Jackie is not out to harm Cassandra, but the cancer is. I can't help but play out the sound byte I heard on NPR where Jackie says, "My daughter is not going to die."

Hodgkin's Lymphoma, is in fact fatal if not treated. Present treatment, while not a holy grail solution without perfect odds and no potential side effects, offers a bona fide fighting chance.

And finally is the issue that Cassandra herself, in line with her mother, does not want the therapy. This opens a whole different can of worms with the determination of autonomy in children and adolescents.

It's easy to stand outside of autonomy issues in parenting and cast judgment. Most of these issues are not black and white, but a hazy shade of gray. In keeping opinions outside of objective reasoning, I have wrestled with such ethical issues my fair share as a family doctor. I've found the reasoning shared in this blog to be helpful and hope it can help you put things in a bit clearer perspective.

Live, and live well.

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