August 16, 2006

"How can you really force a 16-year-old to take a tough treatment that he does not want?"

Medical ethicist Arthur Caplan strongly approves of the new Virginia state court decision that allows 16-year-old Starchild Abraham Cherrix to refuse to submit to chemotherapy. A previous round of chemotherapy for his Hodgkin’s disease had many harsh side effects, making him -- and his parents -- prefer "an alternative treatment method that they learned of in a clinic in Tijuana, Mexico [using] a brew of herbs including licorice and red clover [and] spiritual prayers." But Caplan also approves of the decision by the state to intervene and charge the parents with neglect. What Caplan likes is the compromise:
The answer is to find a doctor who believes in standard medical therapy, who has a good rapport with the boy and his family and is open to working with them to allow them to pursue their ideas about healing, in conjunction with standard medical treatment for cancer.

That is exactly what happened today in the courtroom. Judge Glen Tyler announced that the state and the family had reached an agreement to let Abraham be treated by an oncologist who will work with them and be as flexible as possible about Abraham’s care. The regimen won't include chemotherapy, but might involve radiation.
If the state had not intervened, the boy would have continued on herb tea and prayers, on to nearly certain death. Meanwhile, the boy is able to feel that he's won:
"I'm very happy about today. I'm very happy about this outcome. We won. We got our freedom back."


John Althouse Cohen said...

I sense a theme on the Althouse blog today.

Akiva said...

While it's a nice compromise, it's funny that news reports came out today stating that chemo has much worse side effects "than previously thought".

It's also funny that we start talking about 'quality of life' when discussing very ill old people, severely impared people, and very ill newborns, but we don't do it here.

Medical science is not an absolute. I think it's very dangerous for the State to be deciding how much is enough beyond basic levels of care. Further, in the case of a deadly disease with multiple but all horrible treatments, I'm horrified the State has a place to decide.

What is the State's compelling interest? Could they compel me to put braces on my daughter?

jult52 said...

Well, I've been through exactly what this young man is going through (unfortunately) and I have two comments:

1) Current therapies are extremely successful in treating Hodgkins' (in the 95% range) AND

2) People are still entitled to raise their children as they see fit.

So it's a conflict between what is absolutely the right therapy (akiva -- please note) and the right of parents to raise their children in the way they deem appropriate. Not an easy conflict to resolve.

Akiva: Those chemo treatments in the article which you link to are for breast cancer, which is more difficult to treat than Hodgkins. Cancer really refers to a cluster of diseases with different kinds of therapy. And breast cancer treatments sadly have harsh side effects which are different from the easier Hodgkins treatments.

AJ Lynch said...

And the theme is "Read about the parents who are screwing with the lives of their kids in the name of zealotry and medical fads"

ps. and watch the state stand by and allow it.

vnjagvet said...

Does the same constitution that protects the right of a sixteen year old female person to "choose" to consent or not to the death of her unborn child protect the right of a sixteen year old male person to "choose" to consent or not to the injection of poisonous chemicals or tissue destructive radiation for the purpose of saving his life?

If not, why not?

JorgXMcKie said...

vnjagvet, why do you persist in asking these difficult questions?

Anyway, I know Art Caplan a little and my wife and I have a running joke about how many paragraphs down in a story about medical ethics it will be before Art is quoted.

He really is a thoughtful guy, though, and I enjoy his presentations.

But, he's a go-to quote machine.


Mike said...

I actually have a post about this topic. My general thought is that if you believe that suicide should be criminal for minors then you should support compulsion of treatment.

tcd said...

The kid's name is Starchild? Good thing the court intervened, clearly his parents are cuckoo-bananas.

P. Froward said...

He's sixteen, his parents consent; let him die. Who cares?

Where's there a victim here?

Jim said...


Medical Science is not only not an absolute, it is a contradiction in terms. Medical workers resist science and don't even scrub correctly between patient visits. A reasonable person (read: science savvy) would see a physician only as a last resort and never enter a hospital, where he is likely to pick up staph and seal his death warrant.

If we were to deregulate medicine as we have auto mechanics, we might have a chance of getting our body and chassis fixed. Until then think: Thailand, Brazil, India and other places where you can get First Class medical care for one-tenth what the medical pretenders here charge. Of course, Medicare and Medicaid won't pay!

Maxine Weiss said...

They are making the assumption that foregoing conventional medicine will be more humane.

But NOT doing chemo can be just as painful.

Akiva said: "State to be deciding how much is enough beyond basic levels of care...."

That's not what the State is doing. The State is simply upholding basic Consent Laws which already exist.

Children/Minors have no consent in a lot of areas. It might be unfair, but that's how it is.

Peace, Maxine

David said...

Of course he should be forced to take the treatment. How not? The disease is deadly and the treatment is effective. What rational reason is there not to follow through?

The odd thing about this is the severity side-effects. New anti-nausea drugs, like Emend, and other palliatives, have made chemotherapy much less unpleasant, although the hair loss continues. It used to be that many, if not most, women with breast cancer could not finish the entire course of treatment. Now almost every woman does.

MadisonMan said...

I just yesterday read an article somewhere online about how some kind of cancer treatment for women has much more serious side-effects for young women than for old. So I don't doubt that the side-effects are taking a toll on this child. But I do wonder if he understands what a pyrrhic victory is.

jult52 said...

Once again -- breast cancer therapies are much more difficult and painful than Hodgkins' treatments. Don't conflate the two. This 16-year-old will probably die if he doesn't accept treatment.

Jim -- My experience in cancer treatment showed me that oncologists were highly scientific-minded and were very up-to-date on the latest studies, and that cancer nurses were very methodical and well-trained.

Jay said...

I hope the woman who writes the Darwin Awards books is on this.

Kim Voynar said...

I don't know, I think the court is treading on dangerous ground here with both individual and parental rights. Where's the line? Should parents of a baby born with hypoplastic left heart syndrome, which requires 3 major open-heart surgeries and even then has a high fatality rate, be forced to put their child through that? Are they negligent if they choose not to?

How about the parents of Alex Scott, who died two years ago at the age of 8 after enduring endless surgeries, chemotherapy, and radiation since shortly before her first birthday? Were they negligent for deciding, toward the end, to allow their daughter to have a say over whether she wanted to subject herself to yet another round of debilitating chemo, rather than just accept death? She was tired. She fought hard. It was time to let go.

Death is part of life, and so much of this issue is tied up in our own fear of death and what lies beyond. It's sad to lose a loved one, sure, but I question sometimes the sanity of forcing children to undergo extensive surgeries, radiation and chemo because the State (or even their parents) can't let go.

If my cat was diagnosed with cancer, chances are the vet would recommend that we put her to sleep rather than "let her suffer". But for some reason, it's okay to force a child to suffer? I don't get that, sorry.

DaveO said...

Wow, I'm glad somebody finally said that. The compulsory nature of modern medicine scares me. I can understand protecting children from abusive parents, and I can understand that a sixteen-year-old has somewhat limited legal rights in matters such as this, but it scares me that the state can force a medical procedure on anybody. "We'll prolong your life using whatever means necessary no matter what your desires are." Yikes.

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