Cassandra Callender is a woman who refused chemotherapy and ended up being held in custody and forced to complete her treatment. It’s horrible but it was the right thing to do.

Ms Callender was diagnosed with Hodgkin’s Lymphoma and due to concerns about potential organ damage and infertility in the future refused the only effective treatment available, chemotherapy. Treatment with chemotherapy has a very high success rate, with an 85% chance of recovery or better in most cases. However, she wanted to be able to try alternative medicines, which would not have worked and would have ensured that her cancer killed her. Her mother supported her decision to reject chemotherapy so only after a court ruled that she would be forced to undergo treatment was Ms Callender taken into custody and treated. Her treatment included the use of sedatives to ensure that the cancer treatment could be administered if she resisted. This was only possible because she was 17 at the time and, as she was under 18, not considered to be responsible for her own medical decisions.

There are two objections which I have seen given by people opposed to her forced treatment. The first, is that it is arbitrary to say that a person cannot make decisions about their own treatment before the age of 18 but that they can immediately on turning 18. There is nothing special about turning any particular age that means that a person is any more qualified to make any sort of decision than she was a few seconds, or hours, or months before turning that age. There is nothing wrong with this objection, at most we may be able to identify a number of features which are more likely to be present at a particular age than not and which would make a person more qualified to make some sorts of decisions and use this to determine the age of majority. However, there will be a large number of people who have these features much earlier or much later than the average. In terms of defining a usable rule it is necessary to pick a specific age, or something else which is easy to identify as we do with driving licences, rather than a set of characteristics but this objection does show that there should be some provision to appeal against a person being treated as if they lacked these characteristics when in fact they have already developed them.

The more interesting objection is that everyone has an inviolable right to bodily autonomy and, as such, forcing someone to do something or have something done to them can never be justified. This objection is interesting because, when you look at the cases where you might usually encounter people who want to take this right away, such as in discussions about voluntary euthanasia or abortion, an inviolable right to bodily autonomy does exactly the job we need it to. However, when we consider other cases we can see that an unconditional and inviolable right to bodily autonomy does a great deal of harm.

I want to describe one potential case in the hope that you will agree with my intuition that in some cases we are at the very least permitted, if not morally required, to override another person’s right to bodily autonomy.

Imagine that you come across a person standing on a bridge in obvious distress. Being a kind and helpful person you approach them carefully and ask if there’s anything you can do to help, or if there’s anyone they’d like you to call. In response they tell you that there is nothing you can do to help, they have made up their mind that they are going to jump from the bridge in order to kill themselves. They explain that they have just lost their job and, although there was nothing special about their job, they believe that life without a job is not worth living. In their distress they cannot see any way in which they will ever get a job again. So, they have decided to kill themselves. Assuming that you can prevent them from jumping without putting yourself in danger – should you? Even without knowing for sure that this particular person will be able to get a new job soon you do know that people get new jobs all the time. In fact, you are almost certain that if this person survives just a short while longer they will get another job and consider that their life is worth living. Here you face a choice about whether to intervene and override another person’s bodily autonomy. Refusing to intervene ensures that they die immediately, while intervening extends their period of distress but also makes it almost certain that they will soon be back to living a life which they think is worth living. In the moment the person will resist your intervention but, in the long run they will be glad that you intervened. They will even be glad to be alive later even if they resent the way in which you saved their life.

In this situation an intervention is the only course of action which can be supported. You must stop them from jumping. From the person’s own point of view, still having a life that is worth living is a better outcome than not having a life at all. Intervention requires kindness, even if it is in the form of tough love, while allowing the person to kill themselves requires callousness which may even extend to cruelty even though it may appear to be based on kindness. So, the best outcome in the long run and the action based on kindness is in direct opposition to the respect for an inviolable right to bodily autonomy.

Cassandra Callender’s case was essentially a more complicated version of the choice I just described. People who were responsible for ensuring that she had the best possible outcome were faced with a choice over whether to intervene or not. Refusing to intervene would definitely result in an extremely unpleasant death. Intervention would result in a period of extremely unpleasant treatment followed by an extremely good chance of recovery and Ms Callender living a long and worthwhile life. It certainly isn’t a case where any bystander could just choose to intervene as the necessary skills and equipment required for the intervention are not available to everyone. The special knowledge and responsibilities which come with, for example, being a doctor are relevant here. Also, the probability of the treatment being successful is lower than the probability that someone will find a job in the forseeable future. However, given the high chance of success despite the unpleasantness of the treatment and the certainty of an unpleasant death without any intervention the choice to intervene was, in this case, the right one.

If she had been near the end of her life anyway or if the treatment had a much lower chance of success or if any number of other issues had been different then the right decision may also have been different.

This does not mean that any intervention is justified if we believe that it is for a person’s own good. The key consideration is whether a person is going to live a worthwhile life by their own standards, not by ours. If the consequences of non-intervention were less severe or less certain then intervention may not be justified. Every person has different inclinations, different tastes, and different capabilities which all combine into a different picture of what a worthwhile life is for them. It is certainly possible for a person to be wrong about what would count as being a worthwhile life from their point of view but, the difficulty in discerning this means that intervention must be reserved for only the most clear cut cases. While I believe that Cassandra Callender’s case was just such a case, that doesn’t mean that I believe that anyone faced with similar cases in the future should just go ahead and intervene without reviewing the specifics of the actual case they are faced with.  There will be individual distinguishing features in every case and these can make all the difference. An action is only right if it both originates from virtuous intentions and succeeds in hitting the target of that virtue.

 

 

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