Are teens old enough for life/death decisions?

When Skagit County Superior Court Judge John Meyer came to work he expected to be hearing a few small matters.

Instead, he made a decision in a case that he said has "perhaps more profound interest and implication than any matter I have ever heard on the bench."

Meyer decided Wednesday to allow 14-year-old Dennis Lindberg of Mount Vernon to refuse blood transfusions — based on his religious beliefs — in his fight against leukemia. Lindberg died later that evening.

It's a case that brings into sharp relief the tensions in laws and ethics over whether adolescents should be able to make such serious health-care decisions for themselves.

"Fourteen-year-olds have a certain degree of maturity but there's also a concern that their judgments may not be as well considered," said Dr. Ben Wilfond, director of the Treuman Katz Center for Pediatric Bioethics in Seattle.

And some experts say the judge's decision points to a general trend in the courts to give teens more say in such matters.

"What we're starting to see is more respect for teenagers and their views," said Arthur Caplan, chairman of the Department of Medical Ethics at the University of Pennsylvania.

Lindberg, who was a Jehovah's Witness, objected to receiving blood, which doctors said he needed to survive his cancer treatment. His aunt, who was his legal guardian and is also a Jehovah's Witness, supported his decision, though his parents, who live in Idaho, disagreed with them.

Jehovah's Witnesses believe that the Bible says blood is sacred, that it represents the soul and should not be reused.

For several ethicists, the most interesting issue was not religion but what it says about age.

Lisa Kelly, director of the Children and Youth Advocacy Clinic at the UW Law School, said that while courts are listening more to adolescents, there's also the understanding that teens "have a developmental trajectory that is not yet like an adult's."

That tension is reflected in state law as well. For instance, those under 18 generally cannot receive health care without a parent's consent, though there are exceptions, such as in cases concerning birth control and abortion.

"It's a gray area when you have a 14-year-old making the decision," said Thomas McCormick, senior lecturer emeritus at the UW School of Medicine.

Such instances need to be taken on a case-by-case basis, ethicists say, after conversations with the patient to assess his maturity, whether his beliefs are well grounded and arrived at without coercion, and whether he truly understands the consequences of his decision.

In essence, that's what Judge Meyer was assessing in his decision, when he concluded that Lindberg was mature and competent enough to refuse blood transfusions.

Caplan of the University of Pennsylvania said the judge's decision came down "in a somewhat unusual direction" since the treatment appeared to be standard and had a good success rate.

But he sees it as part of a larger shift from the 1980s and '90s, when judges leaned toward ordering treatment for adolescents who refused it.

And there are larger implications. "Do you want to err on the side of trying to treat the 14-year-old or not," Caplan said. "Because those precedents will be set."