Teen cannot refuse blood transfusion, top court rules

The Gazette, Canada/June 26, 2009

OTTAWA - The Supreme Court of Canada has upheld a Manitoba law that denied an ill teenager the right to refuse a blood transfusion, even though she said it violated her religious beliefs as a devout Jehovah's Witness.

By a 6-1 margin, the court concluded that the legal tenet of the "best interests of the child" must be the overriding principle in deciding whether mature children under 16 have the right to make their own medical decisions.

The ruling involves a Winnipeg girl, identified only as A.C., who was almost 15 years old when she was apprehended by child welfare authorities and forced to undergo a blood transfusion that she compared to "being raped and violated."

The procedure kicked off an intense legal dispute over the rights of "mature minors" when stacked against the competing interest of the state in protecting children.

Legal clashes over court-ordered blood transfusions and other medical treatments have played out nationwide and the Supreme Court's judgment set guidelines on when older children are capable of making their own calls.

"It is a sliding scale of scrutiny, with the adolescent's views becoming increasingly determinative depending on his or her ability to exercise mature, independent judgment," wrote Justice Rosalie Abella.

"The more serious the nature of the decision, and the more severe its potential impact on the life or health of the child, the greater the degree of scrutiny that will be required."

Unlike some provinces, Manitoba's child welfare laws do not make exceptions for "mature minors" - older children under age 16 who are deemed capable of understanding the nature and consequences of their medical decisions.

The majority judgment all but rules out the possibility of mature minors refusing life-saving treatment, regardless of their maturity. Judges, when making decisions in such cases, would be hard-pressed to side with a child's decision, said the ruling.

The decision no longer applies to A.C., who is now 18 years old. She has since moved to Ontario.

The court rejected A.C.'s argument that the forced transfusion, violated her charter rights to religious freedom, equality, and life, liberty and security of the person.

A.C. is described in a court document as a top, award-winning student who is bilingual, loves to read Jane Austen and John Grisham, and suffers from Crohn's disease, a chronic, incurable disease that inflames the intestinal tract.

Two years ago, A.C. was admitted to hospital to be treated for bleeding of her bowel.

After she refused a transfusion because it is forbidden in her religion, her doctor informed Winnipeg Child and Family Services, who immediately apprehended her from her parents, who are also Jehovah's Witnesses.

Child welfare authorities obtained a judge's approval for a transfusion after satisfying him that A.C. was in immediate danger of death or serious injury.

A.C. contends that children's services did not have the "right or obligation" to interfere, just as her parents did not have the right because she had the capacity to make her own decision.

"Having someone else's blood pumping through my veins, stressing my body, caused me to reflect on how my rights over my body had been taken away by a judge who did not care enough to talk with me," she wrote in a 2006 affidavit filed in the Supreme Court.

"That day, my tears flowed non-stop. Nothing can properly describe how I was feeling and still feel today. I could liken it to being raped and violated but even those words do not express my feelings strong enough."

A.C. says she had the right to pursue other medical treatment that respected her religious conscience, including iron pumped into her body intravenously to help it produce red blood cells.

A.C.'s lawyers say that Ontario, Nova Scotia, Prince Edward Island, Newfoundland and Labrador and the Yukon all permit capable persons of any age to decided their own medical treatment without state interference.

The teen brought the case to the Supreme Court after losing in the Manitoba Court of Appeal.

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