High court clarifies rights of minors to make medical decisions

A young Jehovah’s Witness who challenged a Manitoba law that forced a blood transfusion on her won a partial victory and hundreds of thousands of dollars in court costs at the Supreme Court of Canada on Friday.

OTTAWA — A young Jehovah’s Witness who challenged a Manitoba law that forced a blood transfusion on her won a partial victory and hundreds of thousands of dollars in court costs at the Supreme Court of Canada on Friday.

The court ruled that the law in question is constitutional, but said in cases of a dispute about medical treatment, judges must offer children under 16 a chance to demonstrate their competence to make medical choices.

The law gave minors under 16 no say in medical treatment, but the 6-1 decision said courts must take into account the maturity and decision-making capacity of such minors before ruling on enforced treatment.

“Given the significance we attach to bodily integrity, it would be arbitrary to assume that no one under the age of 16 has the capacity to make medical treatment decisions,” Justice Rosalie Abella wrote for the majority. “It is not, however, arbitrary to give them the opportunity to prove that they have sufficient maturity to do so.”

She added: “A young person is entitled to a degree of decisional autonomy commensurate with his or her maturity.”

The case involved a young Jehovah’s Witness, identified only as A.C., who received a court-ordered blood transfusion in 2006.

She was 14 when she was admitted to the Health Sciences Centre in Winnipeg with internal bleeding as a complication of Crohn’s Disease, an incurable condition which can be eased through surgery and drugs.

Doctors ordered a blood transfusion, but A.C. and her parents refused on religious grounds because they believe the Bible forbids ingesting blood.

Child-welfare officials moved to take her into care and a court ordered that she be given the transfusion. The judge said he was satisfied she was competent, but followed the letter of the law since she was under 16.

Abella said mature minors should be given a chance to show they are capable of making medical decisions, although the courts can still override them in life-or-death cases.

Lawyer David Day, who represented A.C., said she is elated by the ruling.

“For 38 months, my client, a remarkable young woman, has been looking for respect in the Canadian courts for her medical treatment wishes,” said Day, who has pleaded Jehovah’s Witness medical cases for more than 20 years.

“Today, she got respect.”

The decision says laws can’t set arbitrary ages as a cutoff in cases where minors object to medical treatment. But judges must weigh age and maturity on a sliding scale balanced against the imminence and gravity of the threat on a case-by-case basis.

Although A.C. lost her constitutional argument, she won her costs.

“While A.C. has technically lost her constitutional challenge, she successfully argued that the provisions should be interpreted in a way that allows an adolescent under the age of 16 to demonstrate sufficient maturity to have a particular medical treatment decision respected,” Abella wrote.

“In these circumstances, it seems to me appropriate that since this is the major impact of these reasons, she should be awarded her costs.”

Day said he didn’t know how much this case cost, but said a similar case 15 years ago racked up $450,000 in legal bills.

Chief Justice Beverley McLachlin wrote a concurring decision with different reasons, while Justice Ian Binnie dissented, saying the law is unconstitutional and that mature minors should be allowed to make medical decisions, period.

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