THE Connecticut Supreme Court has denied a young woman suffering from Hodgkin Lymphoma the right to refuse chemotherapy on the grounds that the 17-year-old lacks the maturity to make such a grave decision. The woman, identified in court documents as "Cassandra C" (pictured), has sought to avoid treatment due to a belief that the chemotherapy will poison her body and leave her permanently damaged. Doctors familiar with her case say that without chemotherapy Cassandra will likely die within two years. Her lawyers argued that Cassandra's refusal of consent ought to fall under the "mature minor doctrine", a widely recognised legal principle that instructs medical providers to honour the consent, or the withholding of consent, of unemancipated minors bright enough to grasp the consequences of their considered decisions about medical treatment. After all, in Connecticut, 17 is considered old enough to donate blood, acquire birth control, seek psychiatric treatment, or terminate a pregnancy—all without parental consent. Nevertheless, the Connecticut high court determined that there was insufficient evidence of Cassandra's maturity to allow her wishes to prevail. She is now in state custody receiving forced treatments. At first blush, this appears to be a case about the age of consent, and that is largely how the story is being reported. When are young people old enough to make potentially life or death decisions? We allow 17-year-olds to enlist in the army. Teens as young as 15 are regularly tried as adults in murder cases. So why shouldn't a 17-year-old have the right to decide what medical treatments she will undergo? It's an interesting question. However, on closer inspection, this case raises even bigger questions. For one, where are Cassandra's parents in this? As it happens, Cassandra's mother, Jackie Fortin, supports her daughter's decision to forgo chemotherapy treatments. Is Cassandra's middle-aged mother too immature to make decisions on her daughter's behalf? Presumably not. So what gives?

This part of the story is oddly buried in coverage by the New York Times, CNN, NPR and other major outlets. Cassandra's eligibility to make medical decisions on her own behalf as a "mature minor" arose only because Ms Fortin had been stripped of her custody of Cassandra after doctors reported her for neglect for "not attending to Cassandra’s medical needs in a timely basis". There is an insidious circularity here.

Ms Fortin's standing as legal guardian with the authority to make decisions on her daughter's behalf was, in effect, conditional upon her agreement with the prescriptions of the doctors. That is to say, she never really had any meaningful authority in the matter. Her refusal to submit with sufficient alacrity to the will of the doctors was taken as evidence that she was unfit to be entrusted with this authority. So Cassandra was taken from her mother, from whom she had never been separated, and placed into state custody. She was kidnapped, for her own good. "DCF and nearly the entire Windsor Locks police department arrived when I was home alone and surrounded my house, banging on doors and windows", Cassandra wrote in her moving personal account of her trials. "I hid in my closet crying on the phone with Mom and my friends until Mom came home." And then she was taken away.

After two weeks, she was allowed to return home to her mother, on the condition that she agree to undergo chemotherapy. Frightened after having been wrenched from her home by police, she agreed. But after two days of treatment, she couldn't take it anymore and ran away. "Two days was enough", she wrote. "[M]entally and emotionally, I could not go through with chemotherapy." She returned home after about a week, quite reasonably afraid that her flight could land her mother in legal hot water. She was then restored to state custody, taken to the hospital, tied to the bed, sedated, implanted with a port in her chest, and filled with chemicals. "I was outraged and felt completely violated", Cassandra wrote. "My phone was taken away, the hospital phone was removed from my room and even the scissors I used for art were taken."

This is what the court has decided to allow to continue, and it was Cassandra's broken promise to seek treatment after being allowed to return home that was the linchpin of the state's case for her immaturity. "The choices that this child was making were irrational and not in her best interests," argued the state's lawyers before the court.

It's simply maddening. Let's recap. Cassandra's mother does not force her to submit to an unwanted treatment, so she is an unfit mother. Cassandra is therefore held hostage by the state and allowed to return home only if she pays a ransom: submission to the unwanted treatment. Held against her will, and very afraid, so she agrees under duress. But she hasn't really changed her mind about the treatment, so she reneges. This is then used as evidence that she was insufficiently mature to be allowed to make her own decisions about the treatment in the first place. Dizzy yet? It seems that the only thing that would have counted as dispositive evidence of Cassandra's maturity, of her capacity to withhold consent, was a willingness to grant it.

I suspect Cassandra has some dotty ideas about chemotherapy. Perhaps she inherited them from her mom. It may be that if she were allowed to act on her dotty ideas, she would die, while chemotherapy may save her (Hodgkin Lymphoma is one of the more treatable cancers). But liberty is a completely empty ideal if we are free to act only when our conception of our interests coincides with those of experts, medical and otherwise. If we are entitled to choose on our own behalf—or on our children's behalf—only when we are deemed rational, and rationality is defined to mean a consensus with the authorities, then autonomy is a bad joke. Cassandra's case illustrates the technocratic tendency of American culture and politics to nibble away at the edges of our autonomy, to deprive us of the right to make anything but the medically correct choice.

"How long is a person actually supposed to live, and why?" Cassandra was mature enough to ask. "Who determines that?" If it wasn't clear to her when she asked, it's outrageously clear now.