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State forcing teenager to undergo chemotherapy

PostPosted: 08 Jan 2015, 11:45
by brandtrn

The girl in question is nine months away from her 18th birthday, when she'll be "legally" capable of making her own health decisions and refusing treatment, if that's what she wants to do. What difference will those nine months REALLY make as far as thinking and decision-making skills go? Yes, I realize that life is a learning process and our thinking and decision-making skills DO improve over time, but at age 17 years and three months, she's either got the basics down or she doesn't. Yes, Hodgkins lymphoma, if caught early, IS highly treatable, and the sufferer can reasonably, with treatment, expect to look forward to a healthy life. Still, I think it's highly unethical to *force* this girl against her will to undergo anything as uncomfortable and as full of potential complications as chemotherapy. It IS her body, after all, and I think that a "child" of that age SHOULD be able to participate in decisions made regarding her own health care. Thoughts, please?

Re: State forcing teenager to undergo chemotherapy

PostPosted: 08 Jan 2015, 16:10
by Ice.Maiden
Individual cases can all be different. I'd like to see at what stage of the disease the girl was in when she received her diagnosis, and have to ask why she's been in hospital for a month?

When my son was 11, he was diagnosed with the same disease. He was very ill, and we could've lost him. After 2 operations within a week, he was then put on a strong cycle of chemo, which undoubtedly saved him. His torso was riddled in tumours which were physically impossible to operate on, but the drugs thankfully shrank them, and after months of treatment, he's now been in remission for over 3 years.

I refused to let him be a hospital in-patient, believing that he'd recover more quickly in the surroundings of his own home, where we could watch over him 24/7. He remarkably did, and this word was used by the consultants and doctors.

I don't dispute that this girl's mature for her age, but I wonder if she fully understands her illness and the treatment? My feeling is, that she was probably terrified by stories of how gruelling the treatment can be - and it certainly is - but there are several ways of administering the drugs, so as not to cause pain if the veins in the back of the hand refuse to accept the cannulas. My son had a Hickman Line inserted, and developed continuous infections when it was cleaned at hospital. I learnt how to do it, and was allowed to do this at home. He never had an infection after that!

I feel that this poor girl's very frightened - hence running away and not wishing to have her treatment. I don't know if she's received kind and understanding medical advice, with proper explanations and alternatives, but if not, that's what she needs.

This particular illness can reoccur later in life, but when young people develop it, there's a good chance of recovery, albeit having to go through the drug treatment first. Left, the girl could well die or go on to develop leukaemia or metastasis of the said cancer.

I wish I could sit down with the girl and listen to her, to find out what her real objections to the treatment are. I agree that she should have some say in what happens to her, but she, and her family, should be guided by what the medics feel's best for her. I don't agree with forcing someone into treatment they'd rather not have (it's optional in the UK, but if a person refuses to have it, that's their prerogative - with the understanding that if complications arise, the hosptals can, in theory, refuse to treat that patient).

I truly think that fear, physical discomfort and mental stress can put people off, but if things were put to her in such a manner as to try and alleviate these fears, the girl could (and most likely would) go into remission and thereafter lead a normal life again.

Re: State forcing teenager to undergo chemotherapy

PostPosted: 08 Jan 2015, 16:44
by Yogi
Chemo therapy is potentially lethal. Before each dose is administered two witnesses must verify that you are the person you say you are and agree to take the treatment. Additionally, you must sign papers stating explicitly that you accept this treatment willingly. All of these precautions are necessary when dealing with such a powerful drug, and I know Cindy must have experience in this procedure given her nursing background.

Cassandra's parents must do the signing and consenting in this instance because Cassandra is not legally of age to do it herself. The question here is not whether the girl is mature enough to make up her own mind. It's a legal issue that lawyers and insurance companies have established and clearly defined with help from state and federal lawmakers. Apparently the Connecticut Department of Children and Families has taken charge because they deemed Cassandra's parents were negligent by not providing properly for Cassandra's needs and allowing treatment for her illness.

Everyone but Cassandra's parents is adhering to the law, and, unfortunately, Cassandra is being portrayed as the victim of said laws. I think not.

Re: State forcing teenager to undergo chemotherapy

PostPosted: 08 Jan 2015, 17:09
by Ice.Maiden
Yes, the mother/parents aren't helping at all, but because: "Cassandra had to be restrained by hospital staff and “put up a fight,” according to her mother, when she had preparatory surgery for her chemo .." it shows that the girl herself didn't want to undergo the treatment.

Perhaps the girl's picked up on her mother's fears, and believes that the treatment's going to be so hideous that she'd rather go without. I think she has a right to voice those fears, although the law says she's a minor so it falls upon the parents or guardians to consent.

All things considered, Cassandra's parents ARE being negligent, but I think there's an emotional issue to it. The mother won't want to see her daughter go through the tortuous process. I know how I felt myself, and watching my son being prepared for the chemotherapy was nothing short of heartbreaking, but I knew it had to be done or we'd lose him anyway.

I hope that Cassandra and her parents've been counselled, leaving them in no doubt of what can be done and what might happen - but in such a way that it doesn't increase fear. I'm sure the girl's parents'd rather have her there than not, and despite the poisons that'll be going into their daughter, the majority of patients (especially young ones) now survive the ordeal.

The mother seems adamant that it's her daughter who's made the choice (whether she's listened to or not), but I personally don't think so. I think the mother's fear, coupled with what the girl's already been through've made an impact on their stance.

I'm of the opinion that Cassandra should be made to have the treatment, although I wouldn't say that, if she was classed as an adult, because it's up to the individual. The court ruling could save her.

Re: State forcing teenager to undergo chemotherapy

PostPosted: 08 Jan 2015, 19:41
by brandtrn
Dennis is right re: chemotherapy. I was an oncology nurse for a little over two years, when I finally burned out on watching my patients slowly die from their diseases, anyway. Not only do two nurses have to identify the patient and verify his/her consent to the procedure...but, after the Doc has ordered the chemo and the pharmacist has figured out the dose and compounded the mixture, TWO chemotherapy-certified RNs have to verify the dose, based on patient age, weight, etc. prior to administering the dose. Make no mistake about it, this stuff is POISON, and has been known to lead to renal failure in the short-term and secondary cancers, infertility, and a host of other problems in the long term. Re: Cassandra's parents -- initially, her Mom DID force her to undergo treatment, leading to the girl running away from home. Honestly, given the high success rate of treatment for Hodgkin's, as a mother, I'd strongly encourage my child to take the treatment. Still, I think it's highly unethical to *force* treatment upon anyone. Honestly? As a nurse, I'd have a great deal of difficulty administering such treatment to someone who so obviously was against receiving it. I think the girl should have a thorough psychiatric evaluation in order to determine WHY she is so against receiving the treatment.

Re: State forcing teenager to undergo chemotherapy

PostPosted: 08 Jan 2015, 21:24
by Ice.Maiden
In other words, you're saying what myself and Yogi have. It's wrong to force treatment upon someone, but as the girl's not classed as an adult, then obviously they require parental consent - which the mother initially gave.

I know from my own experiences that chemo drugs're highly toxic, but despite that, they DO often work to shrink tumours and kill off cancerous cells. Followed by radiotherapy, this frequently helps enough for the patient to go into remission, and sometimes for a good number of years.

I don't know about putting Cassandra through a thorough psychiatric evaluation. Sometimes, simple questions from an understanding nurse, another current patient or from a calm family member who can talk honestly and knowledgeably can give the simple answers required.

I was given the task of trying to calm down two very frightened women who were waiting to go in for their first chemo sessions. They didn't want to go, and in frustration, one of the nurses whispered: "Please do. We have to get on." I persuaded both women to have a bash, and afterwards, they said it wasn't half as bad as they'd feared - but of course, many of the side effects can build up as the cycles progress - e.g. hair loss, sickness and other unpleasant things.

I'm still in contact with one of those women, over 4 years on, and she still thanks me for making her feel confident enough to go through with the treatment, but I don't want thanking. I'd seen it all before, and just put myself in their shoes, knowing how awful the prospect was for them.

As you know, many of these side effects can be alleviated or removed altogether. The damage done to the body can take a very long time to repair, but not everyone realises what's happening anyway. The point is to educate patients in an understanding manner, find out why they don't feel as though they can undergo or continue with their treatment, and then reassure them, if only with facts and figures. At one of our hospitals, where I volunteered to work with cancer patients, the day that one lady sat there crying her eyes out in fear, a nurse told her that they hadn't lost a single patient on that oncology treatment ward in 5 years. That was enough to cheer her up slightly, but it was the truth. Cancer's a killer, and nobody's "cured" of it, but various treatments can now prolong life beyond what was even possible 12 months ago. New combinations of drugs're coming out all the time, and new treatments're being tried constantly. My nephew's a doctor in genetics, working on cancer cells, and he tells me that the future's more exciting now than it's ever been.

Patients need to have facts presented to them, along with the pros and cons. If someone's given confidence, their attitude becomes more positive, and that's one of the keys to survival.

Cassandra and her mother need a friendly face; someone who'll listen to their fears and answer them in a way they can understand. Perhaps the girl's already had this, but still fears certain aspects of the treatment. This can be put right, in much the same way as someone who has an abject fear of undergoing an operation.

I can only say that I hope whatever decision's made, it benefits the girl, and if she agrees to the chemotherapy asap, then her chances look fairly good.