A court in Noord-Holland, the Netherlands, on May 12 presented its judgment on a case that was brought by the father of 12-year-old David against the Foundation De Jeugd- & Gezinsbeschermers (Protectors of Youth and Family).

The father sought substituted consent for chemotherapy for David, but his son did not want it and the Foundation, which has custody over the child, respects his position. The judge has now denied the father's request.

In November 2016, David was diagnosed with a brain tumor, which was surgically removed. After, David received radiotherapy and was declared cancer-free. According to the treatment plan of the doctors at the Academic Medical Center (AMC) in Amsterdam, chemotherapy would be next. However, David did not want any follow-up therapy or treatment from the conventional medical world, a position that was supported by his mother.

As this was in conflict with the treatment plan and possibly harmful to David's health, he was placed in protective custody of the Foundation on December 19, 2016.

On request of Child Protective Services, David was examined by a psychiatrist specializing in youths, who concluded that David was mentally incompetent at the moment of his decision to stop treatment (December 2016), based on the severity of possible consequences.

David finished his radiation therapy, but later informed his legal guardian and doctor on February 24, 2017, that he wanted to stop the treatment and any follow-up chemotherapy. He also wrote a letter to the judge with his explanation. This formed the basis for his doctor to initiate a new examination into David's mental competence.

David is competent

The report of the specialized psychiatrist was concluded on March 27, 2017, and stated that David was now further developed and fully able to explain what effects his disease and treatment could have, as well as the consequences if he were to refuse further medical treatment.

The report states that David remains especially concerned about side effects and a reduced quality of life, but that he is not depressed and maintains a strong will to live, although he is also capable of contemplating death. The report found David 100 percent mentally competent.

As a result, both his doctor andthe Foundation chose to respect David's choice. David's father then requested the judge to grant substitute consent, thereby forcing his son to undergo chemotherapy.

Right to physical integrity

This case is characterized by David's exercise of his constitutional right to physical integrity. His consent is needed for life-changing medical treatment, because of his right to self-determination. But he has to be mentally competent.

A minor of 12 years of age is in principle competent and able to "reasonably appreciate his interests in a concrete situation," the presiding judge reasoned. Therefore, he has his own right to deny consent for medical treatment.

According to the law, the assessment of whether a minor is able to reasonably appreciate his interest in the case of medical treatment is left to his doctor, who acts on a treatment agreement with the minor and his parents. However, as David was placed under protective custody, there was also the legal option to request a judge's opinion.

The judge considered the entire process and determined that there are enough arguments to find David mentally competent. He also judged that the doctor's decision to respect David's wishes to stop chemotherapy was in line with the AMC's code of conduct and legislation. The decision was made carefully and remains in place.

Judge respects child's decision

The judge understands that David's father questions the competence of his son because of the consequences of his assessment. However, the judge sees no reason to disrespect David's opinion.

The legislature has made the choice to grant competent patients of 12 years of age the right to decide on their medical treatment, also in life-threatening situations.Thus the child's decision should be respected.

It can be assumed that David is able to appreciate his interests and the consequences of his decision. David had made his decision based on the quality of his life in the present. The right to make that decision is based on the right to self-determination, although its exercise can be hard on the parents.