Solomon's Wisdom

Art Caplan claims in MSNBC that the Virginia courts' ruling on the case of Abraham Cherrix is a good one:

Very good news emerged from a Virginia courtroom this morning. Starchild Abraham Cherrix, who has been through more hell than any 16-year-old ever ought to have to face, will be spared from the chemotherapy he dreads but still receive cancer care that could save his life.

gThe tall and articulate young man, who lives with his four younger brothers and sisters in rural Chincoteague, Va., was diagnosed with cancer last year. Doctors at the Children’s Hospital of the King’s Daughters in Norfolk recommended chemotherapy to treat his Hodgkin’s disease. The treatment left him bald, feverish, nauseated and so weak he could not walk. After two months the cancer came back.

His doctors said he needed to go through the treatment again. This time, he said no. The state of Virginia took him and his family to court with the idea of forcing chemotherapy on him.

Instead of chemo, the teen, who goes by Abraham, and his parents wanted to pursue an alternative treatment method that they learned of in a clinic in Tijuana, Mexico. Abraham's dad stews up a brew of herbs including licorice and red clover, which he gives to his son four times a day. The parents offer up spiritual prayers while their son drinks the potion.

The case for the Virginia courts to leave Abraham and his parents alone was very strong. At 16, Abraham is smart and thoughtful. He has already been through a round of treatment which did not work and left him sick as a dog. His parents, who obviously love him, agree with him and support him in his decision to pursue alternative medicine. So why should the state have insisted on a trial?

The answer became clear this morning. Standard medical treatment for the kind of cancer he has usually works. And Abraham, for all his apparent sophistication and thoughtfulness, is still a kid.

Cancer doctors at my medical school, the University of Pennsylvania, tell me that, supplemented with radiation, the cure rate for Abraham’s cancer is between 85 and 90 percent after three rounds of chemo. This is one of the most curable of cancers.

True, the young man has been through a round of treatment and hated it. He and his parents have talked themselves into believing that a screwball regimen from a Tijuana clinic is just as likely to save his life. It isn’t.
Still, how can you really force a 16-year-old to take a tough treatment that he does not want? 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. The court will keep an eye on Abraham to make sure that his treatment is reasonable and within the standard of care that young people with Hodgkin’s ought to receive.

That is absolutely the right resolution for this difficult case.

Keep in mind that none of this would have happened if the state had not intervened and demanded that Abraham and his parents go to court. There would have been no settlement.

Instead, Abraham would have only been pursuing a treatment that is nothing short of quackery. By intervening, social services and the courts of Virginia forced an accommodation that respects the family’s values but also ensures that standard, proven medical care will be used as well.

While it is hard for some who say the only thing to do is to leave families alone when it comes to medical care decisions, sometimes a bit of a push from government officials and courts can help doctors do the right thing.

posted Aug 17, 2006 | link | jump to the comments (10)

comments

Placing the resolution compromise at the end of the article was unfairly nerve-wracking; I was afraid I might have found myself on the opposite side of Art, which doesn't strike me as a pleasent place to be.
Moderative compromise sounds like not only the ideal in this case, but the ideal in every case - to reach an accord that both sides find acceptable.

- by Kelly on Aug 17, 2006 at 10:54 AM | link

[I]t is hard for some who say the only thing to do is to leave families alone when it comes to medical care decisions, sometimes a bit of a push from government officials and courts can help doctors do the right thing.
I'm surprised to see "doing the right thing" equated so easily with "imposing the standard treatment", especially on a bioethics blog. Even granted that the standard treatment is statistically vastly more clinically effective than the quack treatment they prefer, how did patient values drop out of the equation?
I have always viewed the increasing acceptance of the idea that people have differing values, and differing healthcare goals and interests, and thus that different people will find that different treatments are right for them in similar cases, as one of the great victories of bioethics. If patient autonomy means anything, it has to mean the ability to make choices "the authorities" do not agree with. The resolution in this case seems to me to be a throwback to the days when "patient autonomy" merely meant doctors allowing patients control over whatever aspects of treatment the doctors felt were negligible, while demanding compliance with any decision the doctors chose to enforce. I am skeptical that the compromise reached in this case is one the patient really feels comfortable with; likely it was simply the greatest degree of flexibility he could pry out of the authorities without them incarcerating him for forcible treatment, as had been threatened.
It would be a tragedy if this young man were to die through his own false expectations and aversion to painful therapy, but it would at least be an outcome in keeping with his values and his choices, as the result of a risk he chose to run. As things stand, he may be getting a clinically effective treatment, but I see no evidence it is the "right" treatment for him, or that this imposed "compromise" is much better, in that respect, than the threats that preceded it.

- by Kevin T. Keith on Aug 17, 2006 at 3:51 PM | link

"Keep in mind that none of this would have happened if the state had not intervened and demanded that Abraham and his parents go to court. There would have been no settlement."
The state would not have had to intervene if Abraham's original doctors had been more reasonable and had not told him that the chemo he rejected was his only option.

- by Laura(southernxyl) on Aug 18, 2006 at 12:27 AM | link

If patient autonomy means anything, it has to mean the ability to make choices "the authorities" do not agree with.
But this isn't just an issue of patient autonomy, is it? The patient is 16, so while he can assent to his treatment (or not), he can't consent. If the patient had been 18, would we have seen it in courts at all? I doubt it - doc's would have rolled their eyes and allowed him his false expectations and beliefs.
This seems much more in line with cases of parents choosing bad medical choices for their parents based on religious beliefs; they simply removed the religion from the belief in the argument.
For better or worse, we don't give under-18 patients the right to choose their treatment (aside from some issues of sexual health care).

- by Kelly on Aug 18, 2006 at 3:33 PM | link

"Andrew's" actual first name is "Starchild."

- by Beverly on Aug 19, 2006 at 4:57 AM | link

I am responding to Kevin T. Keith's excellent posting above. While I agree wholeheartedly with most of it, there is one part I would like to take exception to.
Kevin says:
"I'm surprised to see 'doing the right thing' equated so easily with 'imposing the standard treatment,' especially on a bioethics blog. Even granted that the standard treatment is statistically vastly more clinically effective than the quack treatment they prefer, how did patient values drop out of the equation?"
In my opinion, there is really very little chance of knowing for sure that the standard treatment is statistically more or less clinically effective than an alternative treatment.
Why do I say this? As we have seen so much in recent months and years, there is a great deal of "cheating" going on in many of the clinical trials that are done -- especially those that are paid for by pharmaceutical companies.
Pharmaceutical companies pay for so many of these so-called trials, and it has been shown that, when they do pay for a trial, the drug they are "studying," is usually "proven" to be effective.
Even the highly respected Journal of the American Medical Association (JAMA) was recently caught (by Wall Street Journal writer David Armstrong) publishing study/articles where the author/physicians were on the payroll of pharmaceutical companies! (I have written a 2-part article on this topic on my website at http://honestmedicine.typepad.com/medical_watch/new_series/index.html.)
If you look into this problem, you will find that the financial ties involved in many of these "studies" are prevalent -- and astounding.
Also, Kevin (and so many people who have written about the Abraham Cherrix case) have referred to the Hoxsey treatment in Mexico as "quackery." To the contrary, this treatment has a long history of working for many (but not all) patients. Unfortunately, for political reasons, Harry Hoxsey was hounded out of this country. As most of us now know from following the case of Abraham Cherrix, medicine in this country is an extremely political affair.
There are a book and documentary, both entitled "When Healing Becomes a Crime," that are mentioned elsewhere on this site. In both the film and book, author Kenny Ausubel details the sad story of Harry Hoxsey and his controversial treatment. I will also be writing about this treatment (and about the Cherrix case) within the near future on my site. (www.honestmedicine.com)
Alternative treatments may -- or may not -- be more, or less, effective than conventional treatments. The real answer would be to have totally INTEGRATIVE medicine, with physicians who would help their patients to utilize the most appropriate treatments from both worlds.
It shouldn't be an either/or situation, nor should there be any political agendas involved in doctors recommending one particular treatment over another one.
The Cherrixes are really extremely wise and gutsy people. It is my hope that the press surrounding this case will actually change how medicine is practiced in this country.
I am very grateful to the Cherrixes.
Julia Schopick
www.honestmedicine.com

- by Julia Schopick on Aug 20, 2006 at 3:36 PM | link

It is up to government to make sure parents let their children have adequate medical care. No religious or other opinion should have negative influence .Freedom of religion most cerainly does not mean freedom to get quack treatment for children!The Cherrixes are wrong.

- by griggs1947 on Aug 25, 2006 at 3:20 PM | link

The observation that the chemo left Abraham "sick as a dog" is inappropriate. Healthy dogs aren't sick although those with parvo virus are fatally ill without Tamiflu. No connection exists between an ill human and the health of a canine.

- by william morrison on Aug 25, 2006 at 3:29 PM | link

The child's welfare is what is important, not the relgious or other beliefs of the parensts .

- by griggs1947 on Aug 25, 2006 at 4:55 PM | link

griggs1947, did you read the article at all? The family did not reject chemo because of religion. They rejected it because Abraham went through a round, it nearly killed him and didn't kill the cancer, and the doctors insisted that he go though another round of even stronger chemo.

- by Laura(southernxyl) on Aug 28, 2006 at 1:13 AM | link