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Law,	
  Religion,	
  and	
  Health	
  in	
  America	
  
Harvard	
  Law	
  School	
  
May	
  8,	
  2015	
  
	
  
Jonathan...
Cassandra	
  C	
  (2015)	
  
—  17-­‐year-­‐old	
  diagnosed	
  with	
  Hodgkin’s	
  lymphoma	
  
—  Refused	
  chemo	
 ...
Cassandra	
  C	
  (2015)	
  
—  17-­‐year-­‐old	
  diagnosed	
  with	
  Hodgkin’s	
  lymphoma	
  
—  Refused	
  chemo	
 ...
General	
  Aspects	
  of	
  Law	
  of	
  Medical	
  
Decision-­‐making	
  
—  Legal	
  presumption	
  that	
  those	
  ov...
General	
  Aspects	
  of	
  Law	
  of	
  Medical	
  
Decision-­‐making	
  
—  Legal	
  presumption	
  that	
  those	
  ov...
General	
  Aspects	
  of	
  Law	
  of	
  Medical	
  
Decision-­‐making	
  
—  Legal	
  presumption	
  that	
  those	
  ov...
General	
  Aspects	
  of	
  Law	
  of	
  Medical	
  
Decision-­‐making	
  
—  Legal	
  presumption	
  that	
  those	
  ov...
PresumpBons	
  
—  Adults:	
  presumed	
  competent	
  to	
  make	
  decisions	
  for	
  
themselves	
  
—  Minors:	
  p...
Who	
  Decides	
  for	
  Minors?	
  
—  Parents	
  have	
  a	
  fundamental	
  right	
  to	
  raise	
  their	
  
children...
Prince	
  v.	
  MassachuseHs,	
  321	
  US	
  
158	
  (1944)	
  
—  Custodial	
  Aunt	
  takes	
  her	
  niece	
  out	
  ...
Prince,	
  321	
  U.S.	
  at	
  170	
  	
  
—  Parents	
  may	
  be	
  free	
  to	
  become	
  martyrs	
  themselves.	
  ...
Medical	
  Context	
  
—  What	
  rises	
  to	
  level	
  of	
  Prince-­‐like	
  Martyrdom?	
  
—  Life	
  Threatening	
...
Statutory	
  ExcepBons	
  
—  Status:	
  a	
  minor	
  who	
  is	
  homeless,	
  married	
  or	
  divorced,	
  has	
  
bo...
Statutory	
  ExcepBons	
  
—  Status:	
  a	
  minor	
  who	
  is	
  homeless,	
  married	
  or	
  divorced,	
  has	
  
bo...
Statutory	
  ExcepBons	
  
—  Status:	
  a	
  minor	
  who	
  is	
  homeless,	
  married	
  or	
  divorced,	
  has	
  
bo...
AborBon	
  
—  Planned	
  Parenthood	
  v.	
  Danforth:	
  States	
  are	
  not	
  
permitted	
  to	
  require	
  pregnan...
BelloV,	
  443	
  U.S.	
  at	
  625.	
  
—  A	
  pregnant	
  minor	
  is	
  entitled	
  to	
  such	
  a	
  proceeding	
  ...
Mature	
  Minor	
  Doctrine	
  
—  Theory:	
  if	
  a	
  minor	
  has	
  sufficient	
  competence	
  to	
  make	
  
an	
  a...
Are	
  There	
  Such	
  Minors?	
  
—  Empirical	
  research	
  performed	
  shortly	
  after	
  pregnant	
  
minors	
  e...
Findings	
  from	
  Studies	
  
— Generally	
  support	
  early	
  work	
  performed	
  by	
  Jean	
  
Piaget	
  
— mino...
Cardwell	
  v.	
  Bechtol	
  (Tenn	
  1987)	
  
— Whether	
  a	
  minor	
  has	
  the	
  capacity	
  to	
  consent	
  to	...
Ethics	
  of	
  Medical	
  Decision-­‐Making	
  
— Rise	
  of	
  Autonomy:	
  Kantian	
  respect	
  for	
  self-­‐
determ...
Dennis	
  Lindberg	
  (2007)	
  
—  14	
  Years	
  Old	
  diagnosed	
  with	
  leukemia	
  
—  70-­‐75%	
  chance	
  of	...
Dennis	
  Lindberg	
  (2007)	
  
—  14	
  Years	
  Old	
  diagnosed	
  with	
  leukemia	
  
—  70-­‐75%	
  chance	
  of	...
Watch	
  Tower	
  Teachings	
  
—  avoid	
  independent	
  thinking;	
  	
  
—  abide	
  unquestioningly	
  to	
  the	
 ...
Lessens	
  from	
  Canada	
  
— “a careful and comprehensive evaluation of the
maturity of the adolescent will necessaril...
Jonathan	
  Will	
  
will@mc.edu	
  
SSRN:	
  http://ssrn.com/author=1298344	
  
Faculty	
  Bio:	
  http://law.mc.edu/facu...
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Jonathan F. Will, "Religion as a Controlling Interference in Medical Decision Making by Mature(?) Minors"

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Religion and medicine have historically gone hand in hand, but increasingly have come into conflict in the U.S. as health care has become both more secular and more heavily regulated. Law has a dual role here, simultaneously generating conflict between religion and health care, for example through new coverage mandates or legally permissible medical interventions that violate religious norms, while also acting as a tool for religious accommodation and protection of conscience.

This conference identified the various ways in which law intersects with religion and health care in the United States, examined the role of law in creating or mediating conflict between religion and health care, and explored potential legal solutions to allow religion and health care to simultaneously flourish in a culturally diverse nation.

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Jonathan F. Will, "Religion as a Controlling Interference in Medical Decision Making by Mature(?) Minors"

  1. 1.   Law,  Religion,  and  Health  in  America   Harvard  Law  School   May  8,  2015     Jonathan  F.  Will   Associate  Dean  for  Faculty  Development   Associate  Professor  of  Law   Director,  Bioethics  &  Health  Law  Center   Mississippi  College  School  Law   Affiliate  Faculty  –  UMC  Center  for  Bioethics  and  Medical  Humanities   ©  2015  Jonathan  F.  Will      
  2. 2. Cassandra  C  (2015)   —  17-­‐year-­‐old  diagnosed  with  Hodgkin’s  lymphoma   —  Refused  chemo  with  estimated  success  rate  of  80-­‐85%   —  Death  expected  within  2  years  without  treatment   —  Supreme  Court  of  CT  ordered  treatment  over  objection  of   Cassandra  and  her  mother.  
  3. 3. Cassandra  C  (2015)   —  17-­‐year-­‐old  diagnosed  with  Hodgkin’s  lymphoma   —  Refused  chemo  with  estimated  success  rate  of  80-­‐85%   —  Death  expected  within  2  years  without  treatment   —  Supreme  Court  of  CT  ordered  treatment  over  objection  of   Cassandra  and  her  mother.   —  As  of  April  2015,  treatment  successful;  disease  in   remission.  
  4. 4. General  Aspects  of  Law  of  Medical   Decision-­‐making   —  Legal  presumption  that  those  over  the  age  of  eighteen  may   make  decisions  for  themselves,  while  those  seventeen  and   under  may  not;  
  5. 5. General  Aspects  of  Law  of  Medical   Decision-­‐making   —  Legal  presumption  that  those  over  the  age  of  eighteen  may   make  decisions  for  themselves,  while  those  seventeen  and   under  may  not;   —  Parents  have  a  constitutional  right  to  make  decisions  on   behalf  of  their  minor  children;  
  6. 6. General  Aspects  of  Law  of  Medical   Decision-­‐making   —  Legal  presumption  that  those  over  the  age  of  eighteen  may   make  decisions  for  themselves,  while  those  seventeen  and   under  may  not;   —  Parents  have  a  constitutional  right  to  make  decisions  on   behalf  of  their  minor  children;   —  This  parental  right  is  not  unlimited;  parents  are  not   permitted  to  imperil  the  lives  of  their  children;  and  
  7. 7. General  Aspects  of  Law  of  Medical   Decision-­‐making   —  Legal  presumption  that  those  over  the  age  of  eighteen  may   make  decisions  for  themselves,  while  those  seventeen  and   under  may  not;   —  Parents  have  a  constitutional  right  to  make  decisions  on   behalf  of  their  minor  children;   —  This  parental  right  is  not  unlimited;  parents  are  not   permitted  to  imperil  the  lives  of  their  children;  and   —  When  confronted  with  the  situation  where  a  parent  may   not  refuse  life-­‐saving  medical  treatment  on  behalf  of  the   child,  families  have  asserted  that  the  decision  is  being   made  by  a  minor  who  is  mature  enough  to  have  her  own   decision  respected.  
  8. 8. PresumpBons   —  Adults:  presumed  competent  to  make  decisions  for   themselves   —  Minors:  presumed  to  lack  the  maturity,  experience,   and  capacity  for  judgment  necessary  to  make  life’s   difficult  decisions     —  Parham  v.  J.R.,  442  U.S.  584,  602  (1979).    
  9. 9. Who  Decides  for  Minors?   —  Parents  have  a  fundamental  right  to  raise  their   children  as  they  see  fit.  Troxel  v.  Granville,  530  U.S.  57,  65-­‐66  (2000)   —  This  includes  religious  upbringing.  Wisconsin  v.  Yoder,  406   U.S.  205  (1972)   —  Parents  have  what  children  lack  in  maturity  and   experience,  and  historically  it  has  been  recognized   that  natural  bonds  of  affection  lead  parents  to  act  in   their  best  interests.  Parham  v.  J.R.  442  U.S.  584,  602  (1979)    
  10. 10. Prince  v.  MassachuseHs,  321  US   158  (1944)   —  Custodial  Aunt  takes  her  niece  out  to  distribute   Jehovah’s  Witness  pamphlets     —  Charged  with  violating  State’s  child  labor  laws.   —  Aunt  claims  1st  and  14th  Amend.  Rights  in  challenging   the  statute   —  Supreme  Court  says  tough  luck  
  11. 11. Prince,  321  U.S.  at  170     —  Parents  may  be  free  to  become  martyrs  themselves.   But  it  does  not  follow  they  are  free,  in  identical   circumstances,  to  make  martyrs  of  their  children   before  they  have  reached  the  age  of  full  and  legal   discretion  when  they  can  make  that  choice  for   themselves    
  12. 12. Medical  Context   —  What  rises  to  level  of  Prince-­‐like  Martyrdom?   —  Life  Threatening  Exception:  State  will  intervene  as   parens  patriae  where  parents’  decision  puts  child’s  life   at  risk  
  13. 13. Statutory  ExcepBons   —  Status:  a  minor  who  is  homeless,  married  or  divorced,  has   borne  a  child,  is  pregnant  or  has  been  pregnant,  has   graduated  from  high  school,  is  living  separately  and   independently,  or  is  a  member  of  the  armed  forces  is   permitted  to  make  medical  decisions.    (like  emancipation)  
  14. 14. Statutory  ExcepBons   —  Status:  a  minor  who  is  homeless,  married  or  divorced,  has   borne  a  child,  is  pregnant  or  has  been  pregnant,  has   graduated  from  high  school,  is  living  separately  and   independently,  or  is  a  member  of  the  armed  forces  is   permitted  to  make  medical  decisions.    (like  emancipation)   —  Treatment:  venereal  disease,  drug  or  alcohol  dependency,   sexual  abuse,  mental  health  treatment,  seeking   contraception  
  15. 15. Statutory  ExcepBons   —  Status:  a  minor  who  is  homeless,  married  or  divorced,  has   borne  a  child,  is  pregnant  or  has  been  pregnant,  has   graduated  from  high  school,  is  living  separately  and   independently,  or  is  a  member  of  the  armed  forces  is   permitted  to  make  medical  decisions.    (like  emancipation)   —  Treatment:  venereal  disease,  drug  or  alcohol  dependency,   sexual  abuse,  mental  health  treatment,  seeking   contraception   —  Nothing  to  do  with  maturity  
  16. 16. AborBon   —  Planned  Parenthood  v.  Danforth:  States  are  not   permitted  to  require  pregnant  minors  to  obtain   parental  consent   —  Bellotti  v.  Baird:  If  States  wish  to  require  parental   consent  or  notification,  must  also  provide  judicial   bypass  
  17. 17. BelloV,  443  U.S.  at  625.   —  A  pregnant  minor  is  entitled  to  such  a  proceeding  to   show  either:  (1)  that  she  is  mature  enough  and  well   enough  informed  to  make  her  abortion  decision,  in   consultation  with  her  physician,  independently  of  her   parents’  wishes;  or  (2)  that  even  if  she  is  not  able  to   make  this  decision  independently,  the  desired   abortion  would  be  in  her  best  interests.  
  18. 18. Mature  Minor  Doctrine   —  Theory:  if  a  minor  has  sufficient  competence  to  make   an  autonomous  decision,  that  decision  should  be   respected  as  such.    In  other  words,  mature  minors  are   no  longer  in  need  of  protection  from  their  parents  or   the  State.  
  19. 19. Are  There  Such  Minors?   —  Empirical  research  performed  shortly  after  pregnant   minors  extended  decision-­‐making  authority  in   abortion  context   —  Grisso  &  Vierling  (1978);  Weithorn  &  Campbell  (1982);   Scherer  &  Reppucci  (1988)  
  20. 20. Findings  from  Studies   — Generally  support  early  work  performed  by  Jean   Piaget   — minors  aged  fourteen  and  older  demonstrate  a   level  of  competency  equivalent  to  that  of  adults     — possess  the  cognitive  capability  to  reason,   understand,  appreciate,  and  articulate  decisions   comparable  to  young  adults     — Studies  have  been  critiqued  based  on  white   middle-­‐class  subjects;  narrow  definition  of   competency;  psychosocial  aspects  of  adolescence  
  21. 21. Cardwell  v.  Bechtol  (Tenn  1987)   — Whether  a  minor  has  the  capacity  to  consent  to   medical  treatment  depends  upon  the  age,  ability,   experience,  education,  training,  and  degree  of   maturity  or  judgment  obtained  by  the  minor,  as   well  as  upon  the  conduct  and  demeanor  of  the   minor  at  the  time  of  the  incident  involved.     Moreover,  the  totality  of  the  circumstances,  the   nature  of  the  treatment  and  its  risks  or  probable   consequences,  and  the  minor’s  ability  to   appreciate  the  risks  and  consequences  are  to  be   considered    
  22. 22. Ethics  of  Medical  Decision-­‐Making   — Rise  of  Autonomy:  Kantian  respect  for  self-­‐ determination   — Autonomous  Authorization:  personal  self-­‐ governance;  personal  rule  of  the  self  by  adequate   understanding  while  remaining  free  from   controlling  interferences  by  others  and  from   personal  limitations  that  prevent  choice              
  23. 23. Dennis  Lindberg  (2007)   —  14  Years  Old  diagnosed  with  leukemia   —  70-­‐75%  chance  of  success  with  chemo  +  transfusions   —  Agreed,  and  began  chemo,  but  without  transfusions.   —  Became  severely  anemic;  persisted  in  refusals   —  Religious  leaders/aunt  prevented  him  from  seeing   nonbelievers.  
  24. 24. Dennis  Lindberg  (2007)   —  14  Years  Old  diagnosed  with  leukemia   —  70-­‐75%  chance  of  success  with  chemo  +  transfusions   —  Agreed,  and  began  chemo,  but  without  transfusions.   —  Became  severely  anemic;  persisted  in  refusals   —  Religious  leaders/aunt  prevented  him  from  seeing   nonbelievers.   —  Judge  held  Dennis  to  be  mature  enough  to  make  decision.   —  Dennis  died  three  weeks  after  initial  diagnosis.  
  25. 25. Watch  Tower  Teachings   —  avoid  independent  thinking;     —  abide  unquestioningly  to  the  tenets  of  the  faith   prescribed  by  the  governing  body;   —  independent  thinking  viewed  as  sinful  –  evidence  of   disloyalty  to  God  
  26. 26. Lessens  from  Canada   — “a careful and comprehensive evaluation of the maturity of the adolescent will necessarily have to be undertaken to determine whether his or her decision is a genuinely independent one.”     —  Judges  ought  to  consider:  “whether the adolescent’s views are stable and a true reflection of his or her core values and beliefs” as well as “the potential impact of the adolescent’s lifestyle, family relationships and broader social affiliations on his or her ability to exercise independent judgment.” A.C.  v.  Manitoba  (Director  of  Child  and  Family),  [2009]  2  S.C.R.  181,  at   par.  95-­‐96  (Can.  2009).    
  27. 27. Jonathan  Will   will@mc.edu   SSRN:  http://ssrn.com/author=1298344   Faculty  Bio:  http://law.mc.edu/faculty-­‐staff/faculty/will/   601.925.7195   151  East  Griffith  St   Jackson,  MS  39201  

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