Teenager who declined cancer treatment has capacity to make decisions on medical care, court rules

Tusla, the Child and Family Agency, withdrew its application for High Court orders in respect of a 17-year-old girl who had declined cancer treatment, after a psychiatrist determined she had capacity to make decisions in respect of her treatment.

Details of the “very difficult and sensitive” case were outlined in a judgment published this week by the president of the High Court, Judge David Barniville.

Tusla went to the High Court in May after concerns were raised regarding the welfare of the girl, diagnosed with stage 4 vaginal cancer. In its application, Tusla sought various court orders in respect of the teenager, including, if necessary, consent to administer medical treatment and care considered to be in her best interest.

Following the initiation of the proceedings, the HSE arranged for an independent psychiatric capacity assessment of the teenager.

Dr Karen Humphries, a consultant psychiatrist, concluded that the teenager had a detailed understanding of her diagnosis, her prognosis, her treatment options, and the likely consequences of accepting or declining such treatment.

Humphries reported that the teenager wanted to give her body “a break” after having multiple scans last year. The teenager expressed a lack of trust in her treating hospital, and “her perception that she was not listened to”.

Recalling her diagnosis, the teenager said that she had been experiencing “severe and prolonged” bleeding and cramps when she menstruated, Humphries stated. When the teenager outlined this to her GP, they said, “it’s normal”, the psychiatrist reported.

Her symptoms persisted and subsequent scans led to the cancer diagnosis.

Humphries said the teenager was using a “herbal option” to manage or treat her cancer. The psychiatrist said the teenager expressed feeling better since taking the herbal option.

Humphries said: “[The teenager] was quite aware that her diagnosis had a poor prognosis and that death was a probable outcome.

“Despite this, given how she is currently feeling, she is quite positive and wants to continue feeling well. She understands the side effects of traditional options and believes that these side effects are worse than any potential benefits,” Humphries said.

The psychiatrist concluded the teenager had capacity to make decisions relating to her treatment and care.

A guardian ad litem, or advocate, was appointed by the court to represent the teenager’s views. In a sworn statement filed to the court, advocate Seona Ní Mhurchú stated the teenager said she was “doing very well”.

The teenager wanted the court to be informed of her desire to have privacy and for the court proceedings to conclude, to facilitate her and her family getting on with their lives, Ní Mhurchú said.

When the case came before the court in early June, lawyers for Tusla proposed seeking no further orders in relation to the teenager’s care, due to Humphries’s reporting and conclusions regarding capacity. This approach was supported by all parties.

Barniville agreed with the proposed approach. The judge said he completely accepted the evidence of Humphries and Ní Mhurchú.

“[The teenager] is a remarkable young woman who has borne her serious illness with great dignity and fortitude with the support of her loving family,” the judge said.

He added Tusla was justified in bringing the initial application amid “understandable” concerns.

The judge struck out the proceedings. He thanked the teenager for her co-operation with professionals and the court process.

“I sincerely wish her and her family the very best in what no doubt will be very difficult times to come,” he said.