By the age of 14, a Winnipeg girl known as A.C. felt that she had the right to prevent doctors from running roughshod over her religious beliefs and forcing a blood transfusion on her.
“I will not violate Jehovah God’s command to abstain from blood,” she said at the time. “I have dedicated my life to Him. Turning my back on God, who made my life possible, is not a compromise I am willing to make.”
Her plea fell on deaf ears. A.C. was forcibly given a transfusion to replace blood she had lost through Crohn’s disease – on Easter Sunday of 2006, no less.
The medical contretemps reaches the Supreme Court of Canada today, obliging the court to delve into the issue of when a mature minor can refuse medical treatment based on religious views.
The case of A.C. v. Director of Child and Family Services focuses specifically on older minors who are forced to accept treatment, even though they have the mental capacity to make treatment decisions.
On the day the drama began, A.C. had admitted herself to a Winnipeg hospital to receive treatment for Crohn’s, a chronic inflammation of the gastrointestinal tract that can cause bleeding from the bowel. Doctors quickly obtained a treatment order from a judge.
In a brief to the Supreme Court, her lawyers – Allan Ludkiewicz and David C. Day – quote the child describing the experience as “painful spiritually, mentally, emotionally and even physically. Having someone else’s blood pumped through my veins, stressing my body, caused me to reflect on how my rights over my body could be taken away by a judge who did not care enough to talk with me. … That day, my tears flowed non-stop.”
The legal brief argues that a provision in the Manitoba Child and Family Services Act that authorizes involuntary medical intervention is out of step with generations of judge-made law and with Charter of Rights guarantees to equality, freedom of religion and life, liberty and security of the person.
In an opposing brief, Manitoba Crown counsel Deborah Carlson and Nathaniel Carnegie maintain that any Charter violation that might exist would be more than justified by the importance of protecting children.
“Age as a prerequisite for the ability to make important decisions is a pervasive feature of the law throughout Canada,” they said. “Legislation regulating marriage, voting, driving, drinking, contracting, will-making and many other areas establish minimum ages which, in turn, deny privileges or impose disabilities on those persons younger than a certain age.”
The Crown lawyers said a child’s capacity to make a treatment choice can also fluctuate, depending on the nature of the illness and the medication he or she might be taking.
“Moreover, there may be significant differences in the way adolescents make decisions, which may give rise to legitimate concerns about the outcome of these decisions,” they said.
Lawyers Cheryl Milne and Mary Birdsell – arguing for a legal intervenor, Justice for Children and Youth, a Toronto legal aid clinic serving low-income youth – maintain that international law puts emphasis on allowing children to make choices. “By placing too much weight on children as future citizens, the danger is that we ignore the present assaults on their dignity premised on a paternalistic, ‘it’s for your own good’ approach,” they say in a brief to the court.