Earlier this year we asked, “Who gets to decide if this teenage cancer patient is mature enough to die?” when we wrote about Cassandra C., a 17-year-old cancer patient in Connecticut who’s being forced to undergo chemotherapy treatment after a state Supreme Court decision.
The reaction to Cassandra's story differed from that of Brittany Maynard who, perhaps because she was married and nearly 30, seemed to inspire a more sympathetic public response. In the fall of 2014, the terminally ill 29-year-old made international news when she and her family relocated from their home state of California to Oregon so that Maynard could legally end her life when she chose to. (She died on the date of her own choosing, November 1, 2014.)
Cassandra C.’s case is a bit different than Maynard’s, since the 17-year-old wants to decline life-extending treatment rather than seek physician-assisted suicide. But the teen's story, plus the media’s focus on Brittany Maynard and the news about Canada's legislation made us wonder...
Should the growing Death With Dignity movement take terminally ill young people into consideration?
Currently there are only two places in the world where death with dignity laws apply to minors: Belgium and the Netherlands. In 2014, Belgium expanded their law to include terminally ill minors with no age limit. Supporters of the updated law in Belgium argued that it would probably affect very few people, most of whom would be in their teens.
The modified law states that a minor would have to be terminally ill, face "unbearable physical suffering" and make repeated requests to die before their requests are considered, and parents, doctors and psychiatrists all have to agree before a final decision is made. In the Netherlands, the law is not available to children under 12, and teens using it must have parental consent if they’re under 16. Laws that apply only to adults also exist in Luxembourg, Switzerland and, in the U.S., there are laws on the books in Oregon, Washington, Vermont, New Mexico and Montana.
In the U.S., where opponents of death with dignity laws have been very vocal, there has been little discussion around whether the laws should even apply to minors. But in a nation where juveniles who have committed serious crimes can be tried as adults in almost every state, and teenagers seeking to terminate a pregnancy require parental consent in most states, it’s a discussion worth having.
Is it fair that teenagers are treated as adults under the law for committing crimes, but not when it comes to decisions about their own lives and bodies?
Diane Coleman, President and CEO of Not Dead Yet, a disability rights group based in Rochester, New York, told MTV News that long-term illness isn't the only concern.
“One of the big concerns about assisted-suicide laws relating to young people involves newly injured people," Coleman said. "After a serious injury, there is often a length of time in which the person's survival and future condition are difficult to predict. ... Many disabled people I know wanted to die at first, but now they love their lives.”
On some level, this statement echoes traditional arguments for and against physician-assisted suicide for adult patients. Less than one month before she died, Brittany Maynard told People magazine:
“There is not a cell in my body that is suicidal or that wants to die. I want to live. I wish there was a cure for my disease but there's not. ... My glioblastoma is going to kill me, and that's out of my control. I've discussed with many experts how I would die from it, and it's a terrible, terrible way to die. Being able to choose to go with dignity is less terrifying ... Right now it's a choice that's only available to some Americans, which is really unethical."
Peg Sandeen, the Executive Director of the Death with Dignity National Center in Portland, Oregon, reiterated this point.
“Oregon’s groundbreaking Death with Dignity law requires participants to be over the age of 18 and living with a terminal disease to ensure with certainty that they are competent and not being coerced," she told us over email. "Cases involving terminally ill teenagers are never easy issues to grapple with. Legally, the age of consent for a host of life situations has always been 18, even though we know nothing magical happens to individuals on their 18th birthday to make them suddenly more capable of making decisions. Fortunately, these are rare cases.”
On the other side of the argument, organizations like the Disability Rights Education and Defense Fund generally argue that though physician-assisted suicide seems to make sense in cases like Brittany’s, legalizing it for everyone could create risks that outweigh the benefits.
They note that terminal diagnoses aren't always correct, and list concerns over what could happen once health insurance companies conclude that lethal medication is cheaper than life-sustaining medication. They also claim that prejudice against the disabled could lead to a disproportionate number of disabled patients seeking and receiving assisted suicide, and that legalizing assisted suicide could reduce pressure on society to provide advanced, affordable care for the disabled, terminally ill and elderly.
Teenage brains have a harder time considering how decisions they make now will affect them in the long run.
As far as teenagers are concerned, the arguments have the potential to become even more complicated. According to Dr. Terry Jensen, neuroscientist and author of the book The Teenage Brain, there’s a layer of a fat called myelin that develops over time to insulate the brain, starting at the back and moving toward the front. Our brains aren’t fully insulated, Dr. Jensen said, until we’re in our 20s, and a lack of full insulation in the frontal lobe causes decision-making signals to move more slowly than they do in fully developed brains.
Basically, the science suggests that teenage brains have a harder time considering how decisions they make now will affect them in the long run.
You could argue that a terminally ill teenager’s brain won’t have the chance to fully develop before they die anyway. But you could also argue that for patients with even a small chance of survival, they may not be fully equipped to decide whether it’s worth the effort to fight, or to disagree with their parents if they decide it isn’t worth the fight. Ultimately, that contradiction is at the heart of this debate -- for those who are suffering and elect to die, there are no second chances.
Discussions about this difficult and complex issue are rapidly expanding in the U.S. It’s important for young people to stay informed and proactively join the conversation. Otherwise, decisions that could affect our lives and bodies may be made without our consent.
What do you think? Should physician-assisted suicide be legal for terminally ill patients in the US? What about for minors? Let us know in the comments.