Here's a story about a father who rejected chemotherapy for his minor child, Daniel Hauser, resulting in a court intervention and forced therapy.
Daniel Hauser, a minor, has Hodgkin's lymphoma. Hodgkin's lymphoma is a highly curable cancer. This family does not want him to have standard western medical therapies, which include chemotherapy and radiation. Instead they have chosen natural remedies, such as herbs and vitamins, against the recommendations of his doctors.
Their county attorney in Minnesota has accused the parents of child neglect and endangerment and is asking the judge to order the boy into treatment. The parent's defense? Treatment would violate their religious beliefs.
What do you think, catholic hospital religion or otherwise? Does a court have a right to order treatment of a disease for a minor against the wishes of their guardian parents? There are lots of things that parents do that endanger their children. They smoke in front of them. They don't make them wear seat belts. They feed them McDonalds. They let them light firecrackers. They let them watch R rated movies. They let them stay up late at night. They fight in front of them.
Perhaps the belief that the Hodgkin's lymphoma represents a life threatening endangerment makes the county attorney feel obliged to get involved in this case. However, if you're going to force a family to give chemotherapy to a child, you also must force them to stop feeding them McDonald's. Or to force their obese children to exercise on a strict government regimen as both conditions are killing their children as well. Or to make them go to bed on time. Or not to fight in front of them.
One can also reverse the situation and discuss elderly family members who are unable to make their own medical decisions, but rather rely on the decisions of their guardians. My existence as a hospitalist is one where every day family members are making wrong informed decisions. They demand that we do things to their grandma and grandpa that you wouldn't do to a pet therapy dog. Placing futile feeding tubes in patients with end of life disease burden. Forcing intensive therapy cares on end stage disease processes with the hope of squeezing one last week of survival. Sticking tubes, catheters, knives and cameras in every orifice with the hopes of extending for another week or another month the painful existence many elderly live.
Should we not also call the county attorney every time we are forced to provide care which we as physicians deem inappropriate or abusive?
What do you think? Should parents be forced into making their child get chemo+ radiation?
Happy, you show good examples of how it seems to depend on "what". I have thought about this one much as a student. We medical folks have to sort things out, understand where we stand, and then be able to put that aside when we deal with our patient final decisions to be able to function psychologically. Right now, I lean towards doing my best to connect with the family and help them to get all the information they need to make a well informed decision. That means being kind and firm and frank. If I were to be dealing with this family that has decided a different direction, I would then wish them well, but also give them information about the downward spiral they might encounter, and what will signal this so that they might seek some sort of palliative care... My point is, I would do all I could to keep the channels open. I am aware of many medical people who would just close that door. But, how can you do that knowing the future? Not that I would keep in touch personally, but hopefully when things get bad, there might be a hope for less suffering for patient and family, if they feel that help is available.
ReplyDelete-Second career nursing student
The Supremes have decided that the state has a protective function in the welfare of kids. They have also decided that the kid can not be made a martyr to the parent's religion. You did not include the age of the kid who is arguing, as the courts also suggest that there is a time when the kid can make the decision for themselves (although last I looked it wasn't as clear--to me anyway-- as to what is the magic age is).
ReplyDeleteI don't see this opening up the slippery slope to felony child neglect-McDonalds. That is coming from another side.
I don't see how you can honestly compare essentially sentencing this kid to death (and probably not a very pleasant one) to merely bad parenting skills (which, yes, I agree are not good for his health). But they are not similar. One will directly result in his death while the others are just "merely" harmful to his health. A line has to be drawn somewhere, and I think this falls well within that line of doing something to help the child. Anyone that uses religion to justify the death of a child should not have custody of one.
ReplyDeleteI have no comment on this scenario but a related issue was well presented in "my sister's keeper". The novel's premise is that a family is essentially harvesting bone marrow from one child to keep the other child alive who has leukemia. The donating child hires an attorney to stop her parents signing the consents for all the donating procedures. It has a great ending. Just something to think about.
ReplyDeleteMidwest woman
As I said, a line has to be drawn somewhere, and no doubt it is subjective. And the fact that death would occur relatively soon (I assume) is very relevant. If child protective laws or systems aren't in place to prevent this sort of thing, then we shouldn't have them at all, as I think this is worse than living with a crack whore.
ReplyDeleteIf it was some experimental treatment, then sure, but if it's highly curable then it should be pursued, despite the parents' objections.
As for the weight related diabetes, I think part of the solution is for schools to actually teach physical education. I'm not a doctor so I can't really comment further, as I don't know how reversible or deadly it can be. But I doubt it is nearly as immediate as cancer, so I think this case would fall on the other side of the 'line'.
This isn't Russia Danny... is this Russia??
ReplyDeleteAll the kid has to do is not pay... just try and find an Oncologist to give Chemo free of charge, and when you do, let me know, I've got some business for him.
And I don't mean those crooks who dilute the Interferon or whatever they're usin now a days...
This issue has been looked at in many iterations in the courts, but most prominately with Jehovah's Witnesses and the issue of blood transfusions. Clearly in terms of child abuse there are acts of commision and acts of omission. We have just as many arguments about what constitutes child abuse as an act of commision as we do omission. In the end though, we have all decided (rightly) that we have a responsibility to protect the powerless through laws. Those laws may change over time and the point of debate is to decide where we draw the lines. There is no "slippery slope," but rather we as a society have decided through law what constitutes the boundaries of parental control -some may disagree, but they are still subject to the boundries. If you don't like the boundries then voice your opinion and vote for different judges and politicians who have the power of appoinment. The practical challenge inthis cse is the age of the child (17?) and their willingness to have treatment. Most of us would not place a 17 year old in leathers and infuse chemo agsint their will while they struggle and fight. Practically, you can't by force make a 17 year old to comply with a court order to receive chemo.
ReplyDeleteFrank - btw many oncologists will give chemo in this situation in a patient who has no insurance.
Ohio... that makes me crazy. I just hate the "in this situation with no insurance" I have a REAL hard time with the picking and the choosing because of media coverage.
ReplyDelete-Second career nursing student
Second career nursing student:
ReplyDelete"in this situation" is NOT referencing media coverage or any other stipulation EXCEPT that the patient has a curative disease and has no insurance. Don't let things make you crazy.
However, the dollar amount of the drugs DOES matter (Hodgkin's is treated with ABVD - relatively cheap as all the drugs are generic). If you are planning to give single source drugs (some courses of which can cost $100,000 or more) then you cannot give these drugs to patients who have poor or no insurance. Your practice will go broke. In 2009 there is effectively no margin in chemotherapy as there was 6 years ago - so you cannot cost shift from the paying patients to the non-paying patients.
You might be interested to see a long thread over at allnurses.com entitled "Stupid Ignorant Patients" Good discussion of the complexities of penalizing patients for lifestyle issues and how near impossible it is to discern a direct causal relationship to base your sanctions upon. Big Macs don't kill children. My logic professor would love to take that one apart.
ReplyDeleteOhio, thank you for clarifying.
ReplyDeleteI am well aware of what goes into who gets what. I have a business background. It's just the surreal mix of business and medicine. The conversations that go on in care coordination. There have been one or two that hit me like a ton of bricks recently that were ICU related. And I thought I was a tough business woman. I guess I will also get numb to it, if I want to get a paycheck.
-Second career nursing student
so as I want to understand everything I read, you CANNOT deny chemo based on religious belief but it CAN be denied if you have no or bad insurance. No fault to you, ohio oncologist..I understand you would go broke. I just find this highly ironic. So if the court would mandate chemo, as they should, whose to pay if they're underinsured?
ReplyDelete"In a 58-page ruling Friday, Brown County District Judge John Rodenberg found that Daniel Hauser has been "medically neglected" and is in need of child protection services.
ReplyDeleteRodenberg said Daniel will stay in the custody of his parents, but Colleen and Anthony Hauser have until May 19 to get an updated chest X-ray for their son and select an oncologist"
http://news.yahoo.com/s/ap/20090515/ap_on_he_me/us_med_forced_chemo
In our society, the patients' autonomy or right to self determination usually reigns as the most important aspect of medical ethics. Daniel is a minor, but that does not necessarily mean that his parents must make the decision for him. The age of intellectual discretion cannot be measured in months and years. If medical professionals, including child psychologists have determined that Daniel understands his choices and probable outcomes and alternatives to treatment, and is considered as able to make an intelligent decision, then his choice, especially if it matches his parents', should be honored. However, in a case that is overwhelmingly treatable and the alternatives are extremely ineffective, this may constitute an enigmatic refusal of treatment. Further, as I understand, Daniel doesn't really understand that he is dying. If this is the case, Daniel's decision should be overruled.
ReplyDeleteDr. WJD, Consultant in Medical Ethics