Saturday, July 22, 2006

Forced Chemotherapy?

Click on the title above to be directed to a story about a young man with Hodgkin's disease who has been ordered to undergo chemotherapy. The gist, as I understand it, is that his parents wanted him to try 'alternative therapies' as his first experience with chemotherapy was not curative and was highly unpleasant.

Chemotherapy is simple in concept. Most cancer cells reproduce much more rapidly than normal cells. Chemotherapy agents kill all cells, but since cancer cells metabolic rate is very high they are killed much more rapidly than normal cells. Therefore chemotherapeutic agents tend to work well. They all cause all manner of unpleasant side effects however. Most patients experience hair loss, nausea, and vomiting. There are many other side effects, but to continue the explanation, the GI tract and hair follicles are normal cells which divide rapidly and are therefore killed preferentially along with fast dividing cancer cells.

We were told in medical school that the first chemo agent was a form of nitrogen mustard, and it was discovered when army physicians noted that soldiers with certain forms of cancer who were exposed to mustard gas in WWI had partial or complete remissions of their cancers. This is a neat story and it makes sense but I am not vouching for its veracity... That should be easy enough to do with google.

So back to the case at hand. I gotta tell you, this is a tough one for me only because of the age of the patient. Obviously with a name like Starchild Abraham Cherrix one can make some assumptions about the parents. Then when one notes that they want to pursue "alternative treatment of a sugar-free, organic diet and herbal supplements supervised by a clinic in Mexico" then it is hard keep the image of an LSD munching, Jerry Garcia loving, laissez-faire 'child raising unit' out of one's head. But so what?

So Starchild's parents are patchouli-wearing, tree-hugging, 'free thinkers' who have chosen to put their faith in some charlatan in Mexico. Is this the United States? Well, yeah, but it's a bit tougher than that. Starchild himself can not, by law, make his own health care decisions. Therefore, the court can assess his parent's capability to make reasonable decisions for him. These days I'm surprised that the parent's aren't being awarded a medal. Reminds me of the cases in which Jehovah's Witness parents denied their children life saving transfusions only to have the transfusions enforced by emergency court edict.

From a medical perspective, Hodgkin's disease, especially in the young, is very curable with chemotherapy. I personally witnessed the demise of a 23 year old from the disease who had made the exact same decision as Starchild's parents... He refused referral to an oncologist when he was first diagnosed. A year later he was back in the ED with a huge tumor burden and without options. He died three weeks later. He could have been cured. In his case it was simply a severe lesson. In this case I kinda don't know how to feel.

I will say, however, that it is ironic that if Starchild were a female, and were pregnant, that she could abort her living human fetus in most states without a second look from a court and without her parents knowing about it. Or, if she were merely infected with syphilis or gonorhea that she could receive secret treatment.

Finally, I must ask, what is it that makes the court sure that the alternative treatment will not work? As a physician and a father there is no way in hell I would go to some 'holistic' doctor in Mexico with my child who had Hodgkin's, but I'm not a gorp-eating, hankie-head, tree-hugging freak either. That being said, I like the fact that in America we leave freaks alone.

I know I can be sued for wrongful death. Can someone be sued for "wrongful life"? What I mean is what if the chemo works as it should... What then? Do this kid's parents continue to be his parents? What if he dies? Can the government be sued? No. It can't. Everyone has faith in something, eh?

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