## Facts

- Nancy Curran had sole custody of 3½-year-old twins, Allison and James, under a parentage order requiring her to consult the father on important health matters.
- Tamas Bosze, the twins’ biological father, also had a 12-year-old son, Jean Pierre, who had a rare, difficult-to-treat leukemia.
- Jean Pierre’s immediate family members were tested and were not compatible bone-marrow donors; the twins were viewed as remaining realistic potential donors.
- The twins and Jean Pierre were half-siblings with no meaningful relationship, having met only twice for about two hours each time.
- Bosze sought to have the twins undergo blood testing for compatibility and, if compatible, undergo bone-marrow harvesting to treat Jean Pierre.
- Curran consulted medical professionals and others with donor experience and refused consent to both testing and donation as contrary to the twins’ interests.

## Issues

1. Whether a court may order minor children, over the custodial parent’s objection, to undergo blood testing and nontherapeutic bone-marrow harvesting to benefit a half-sibling.
2. Whether the substituted-judgment doctrine can authorize such procedures for never-competent minors.
3. What requirements the best-interests-of-the-child standard imposes before a court may authorize pediatric bone-marrow donation.

## Decision

- The Illinois Supreme Court affirmed denial of Bosze’s petition to compel testing and donation.
- The court held substituted judgment is inapplicable to never-competent minors because it depends on prior, competent preferences.
- Applying the best-interests standard, the court held nontherapeutic donation may be authorized only under stringent conditions not met here, including informed, supportive consent by the custodial parent and a close donor-recipient relationship.
- The parentage order’s consultation requirement did not give the father equal medical decision-making power or justify overriding the custodial parent’s refusal.

## Legal Principles

- Substituted judgment generally applies to formerly competent persons who later become incompetent; it does not fit never-competent young children.
- For never-competent minors, courts evaluate proposed nontherapeutic medical procedures under the child’s best interests, focusing on the donor child rather than the recipient.
- Nontherapeutic pediatric bone-marrow procedures may be authorized only when:
  - The custodial parent or primary caregiver gives informed consent and provides emotional support; and
  - The donor child has a close, positive relationship with the recipient such that meaningful psychological benefit to the donor is likely; and
  - The medical risks are sufficiently low and the expected benefits to the donor (often psychological) are sufficiently concrete to justify the intrusion.
- A healthy minor cannot be compelled to accept medical risk solely for another’s benefit when the asserted donor benefits are speculative and the primary caregiver opposes the procedure.

## Conclusion

The court refused to compel blood testing and bone-marrow harvesting from healthy 3½-year-old twins for a half-sibling with leukemia, holding that substituted judgment does not apply to never-competent minors and that the best-interests standard requires, at minimum, informed supportive consent from the custodial parent and a close sibling relationship likely to yield real donor benefits.


Curran v. Bosze, 566 N.E.2d 1319 (Ill. 1990)