Ethical story on news

[laboholic]

Did anyone see that story on Fox news about the 16 year old that had lymphoma? He had a round of chemotherapy, went into remission, and then had a relapse. He then did some of his own online research on alternative medicine. He found out that homeopathic medicine was "the best chance to cure him" so he told his parents and they backed his decision. The state is now taking legal action and trying to take the kid away from the parents. Also they are also going to force him to get more chemo.
Of course fox news thought this was horrible and the government was taking over the world.

I think it is too bad that the general public knows so little about medicine and science that they make such a poorly informed about their family’s healthcare. I blame all the misleading information on the internet. I hope I am prepared for this when I become a physician because it is only going to get worse.

What does everyone else think about it?

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[docB]

I'm not a fan of naturopathic medicine and I would not back my kid going that route. However, I do think that in this case the state should back off. This is a 16 yo who has been through the chemo before and is backed by his parents. The pt has been through the chemo before, that's about the most informed consent you can have. The parents do not eschew all medical care (like say the Christian Scientists) they are just supporting their son's desire to refuse this particular modality. A 16 yo IS different than a younger child in terms of being able to understand what's going on. You can debate where that demarkation should be but it really should be on a case by case basis.

If one supports the negation of parental rights and that chemo be forcibly administered to this patient then it begs some difficult questions. If informed refusal will not be accepted in patients like this should we do away with the farce of informed consent since there would be no choice? If a 16 yo were pregnant she would be considered to be able to make decisions. Shouldn't a 16 yo with a grave disease have the same rights? If we intervene in a case like this would there ever be a case where we wouldn't intervene? Could a pediatric pt ever be made DNR even if the patient and family and doctors agreed? Is it only the doctors' opinions that matter? Do we trump the patient and parents? Does every case of pediatric refusal of care need to go to a judge?

 

[psychbender]

I haven't seen the story, but from what you say, the state should back off. I don't much care for homeopathy, but if it's what the pt and his parents want for him, then why should the state intervene (yeah, yeah, protecting the well-being of a child)? I'd try to educate the patient and his parents, to make sure that he and his parents are truly making an informed decision (begs the question: can the decision truly be informed when there is so little EBM for homeopathy?); then, we have to respect whatever decision they come to. If the kid and his parents want no further treatment, then no treatment should be given. If he wants homeopathic treatment, then he should be able to get that treatment without government interference. The state should not be able to force whatever it deems appropriate on those that do not wish said treatment. This is not merely a case about misinformation given to patients, but about patient autonomy and the right to choose their own care.

 

[psychbender]

The parents do not eschew all medical care (like say the Christian Scientists) they are just supporting their son's desire to refuse this particular modality.

If the pt and his parents decided that they wanted no further care, would you still support their decision (or, more appropriately, would you still oppose the state)?

You also bring up an interesting point regarding pregnancy allowing a minor to be treated as an adult. The same is also true with emancipation. Under what circumstances can a minor become emancipated from his parents (never looked in to it, so I don't know)? If the pt was an emancipated minor, would you support or oppose the state's interference?

For precedence, what have cases regarding teenage (minor) Jehovah's witnesses refusing blood products, with or without their parents' backing, revealed? This is slightly different, as the Jehovah's witnesses object on religious grounds, and this case seems to not involve religious objection; but it still comes down to pt autonomy.

 

[laboholic]

I agree that the state should back off, but only if the parents and their son have been properly informed on the possible dangers of homeopathic medicine. I just worry that they are most likely basing their decision on information obtained on some website. Homeopathy is not the same as Naturopathy. http://en.wikipedia.org/wiki/Homeopathic
If a kid reads online that taking arsenic will cure cancer and his parents dumbly back him should he be allowed to do it?
I think this kind of falls into the dilemma of assisted suicide. It’s a touchy area.

 

[docB]

If the pt and his parents decided that they wanted no further care, would you still support their decision (or, more appropriately, would you still oppose the state)?

In this case I would support the patient and parents if they wanted no furthur care. They have been through the chemo before. If they decide it is worse than death then I think they have the right to choose that.

As for emancipated minors I would argue that they do have the autonomy needed to decide to be DNR. That's what emancipation is supposed to be all about.

I disagree that this situation is similar to assisted suicide. That requires an active effort on the part of the patient and someone else to shorten life. This is an effort to avoid a certain treatment and risking death in the process. Consequently it is more like a right to die issue.

 

[laboholic]

I disagree that this situation is similar to assisted suicide. That requires an active effort on the part of the patient and someone else to shorten life. This is an effort to avoid a certain treatment and risking death in the process. Consequently it is more like a right to die issue.

good point

 

[typeB-md]

I agree that the state should back off, but only if the parents and their son have been properly informed on the possible dangers of homeopathic medicine. I just worry that they are most likely basing their decision on information obtained on some website. Homeopathy is not the same as Naturopathy. http://en.wikipedia.org/wiki/Homeopathic
If a kid reads online that taking arsenic will cure cancer and his parents dumbly back him should he be allowed to do it?
I think this kind of falls into the dilemma of assisted suicide. It’s a touchy area.

you're too naive. it's not your job to mandate that your patients do what you say.

i also love how religious or sexual reasons don't get a second thought, but as soon as it's something else, the people are up in arms. what a screwed up society we live in.

and assisted suicide is no dilemma at all; well, maybe for those who feel the need to interject in other people's affairs, but not sane people.

 

[laboholic]

you're too naive. it's not your job to mandate that your patients do what you say.

I never said they have to do what I say. It is a physician's fiduciary duty to do his/her best to ensure that the patient has the best care possible - or to ensure that they have been properly informed of the facts regarding specific treatments.

and assisted suicide is no dilemma at all; well, maybe for those who feel the need to interject in other people's affairs, but not sane people.

I never said I was against assisted suicide. I only said: "It is a touchy area". And yes it is a "dilemma" because there are two options: have someone help you die, or wait to die. This, in essence, is the definition of dilemma.


It seems obvious to me that this kid does not want to die. If he did want DNR, would he have spent days on the internet researching treatments that could make him better? I think he has been given a false sense of hope by grandiose internet testimonials, and his parents are non the wiser. I feel sorry for him.

 

[yaah]

Unfortunately, the only way this kid is going to learn that homeopathic remedies don't work is to try them and have his lymphoma kill him. Sad but true. The lay public's assumption of "conspiracy theory" on matters of import, particularly medical, is astounding. Do people really think that if there was a simple, painless, and effective treatment for lymphoma, that it would be held back just so someone could profit by selling and implementing toxic chemotherapy and other radical methods of cure? It's sad.

 

[Chinorean]

Also they are also going to force him to get more chemo.
Of course fox news thought this was horrible and the government was taking over the world.

Whoah can you force someone to get chemo? Like what, frog-march them there and tie them down whilst they get irradiated???

 

[Law2Doc]

Whoah can you force someone to get chemo? Like what, frog-march them there and tie them down whilst they get irradiated???

Chemo is not radiation, its drugs. And no, you cannot force them.

 

[RxnMan]

Concerning some poster's coments, a doctor's position in the healthcare system has shifted from DOC tells patient what to do (which, in in the DOC's view, in the patient's best interests,) from a physician telling the patient alternatives and letting the patient decide. Sometimes education is a part of the process. If a patient wants to do XYZ treatment, then they can have it, but their doc is not bound to provide XYZ treatment. Conversely, while the doc can reccomend treatment ABC, the patient does not have to endure ABC. This describes the health advocate part of the physican's job. While the patient is a minor, his parents, who currently occupy the highest priority in the medical decision-making heirarchy for this child, are speaking up for him. That is their choice. The government interfering is wrong, and it is taking power away from its citizens when doing so.

About the human side of this, once you have even seen what happens to the folks going through intense chemo, you understand why they may not want to go through it ever again, even at the risk of death. By condeming their choices, we're judging them incompetent without cause.

 

[odrade1]

There seem to me at least two main ways come to the choice that the child & his parents did; one way is based on incorrect information & faulty reasoning, and so does not justify the choice, while the other line of reasoning does justify the choice:

A) Homeopathic treatments are an equivalent (or nearly equivalent) medical treatment alternative to chemo. Chemo is pretty awful, so we should try homeopathy.

B) Chemo is so awful, I never want to endure it again, even if not doing so jeopardizes my life. Since I am not going to do chemo, I might as well try homeopathic treatment, since there could be a chance (however small or large) that it might work.

If parents are using (A) to justify the homeopathic treatment, then they are endangering their child's life (or at least risking the childs life) for a bad reason. Such a decision is a kind of neglect (or perhaps abuse) in my eyes. A doctor would have reason to have the courts take over medical decision making, if the family insists on using bad information to make a decision for a child, that will likely harm the child.

If parents (and the 16 year old child) are using (B) to justify discontinuing allopathic treatment, then they are making a measured and careful evaluation of the wishes of the child for his own quality of life. This decision to cease treatment is reasonable and is not based on false beliefs in the adequacy of homeopathic medicine. The fact that they will pursue homeopathic treatment is accidental to the situation, and not a reason that they are discontinuing legitimate care.

 

[Sundarban1]

I'm not sure I totally agree with this, but a judge today ordered that the boy report to the hospital for treatment. Read about ithere.

 

[Mr. McDuck]

The same story is on AOL news, but they have a poll in which you can vote whether you think the judge was wrong or not. 64% of the 128,233 votes said the judge was wrong.

 

[Law2Doc]

The same story is on AOL news, but they have a poll in which you can vote whether you think the judge was wrong or not. 64% of the 128,233 votes said the judge was wrong.

Nothing like folks sitting home second guessing a judge who has actually heard the evidence, met the people involved. Of that 128,233 probably 90% don't know the meaning of the words lymphoma, chemo, or remission, and would be just as happy voting on who is hotter, Paris or Nikki H. The other 10% probably thought they were voting on who was hotter.