May 12, 2008

A malady with no treatment?

Tom Blackwell
National Post (Canada)
May 12, 2008

When a judge in Hamilton ordered a young cancer patient to undergo chemotherapy last week, she triggered a bitter confrontation between the child's parents and hospital staff.

By the end of it, the irate father was reportedly in handcuffs, and the Children's Aid Society, which requested the court order, criticized as draconian.

The dispute underlined a rare but emotional scenario confronted by child welfare authorities across the country: parents who clash with doctors over whether their children, often deathly ill, should receive medical treatment.

Some caregivers insist on home or natural remedies over those of medical science, while others turn down vaccinations they consider dangerous or decline blood transfusions on religious grounds.

At any moment throughout the country, there are probably eight to 10 such disputes underway, says Peter Dudding, executive director of the Child Welfare League of Canada.

And they present a unique challenge to everyone involved. Unlike the majority of child-welfare files, in which the parents are accused of blatant neglect or abuse, medical-treatment cases often involve loving, responsible guardians who believe they are acting in their children's best interests.

"It is one of those very difficult situations where a court-ordered intervention is going to be seen as a last resort," Mr. Dudding said. "In virtually every other respect," he said, "this is probably not a child in need of protection."

Earlier this year, a judge in the Toronto area ruled that a newborn must get a hepatitis-B vaccination, though his mother believed--contrary to most research -- that it might make him autistic.

Child-welfare officials obtained similar legal authority last year to allow sextuplets born to parents in Vancouver who are Jehovah's Witnesses to receive blood transfusions.

Last July, Quebec youth-protection officials were asked -- but refused -- to intervene in the case of a three-year-old cancer patient whose parents wanted him on a special diet of raw vegetables instead of chemotherapy.

The most celebrated case came in the late 1990s, when the family of a Saskatchewan 13-year-old, Tyrell Dueck, fought a long court battle for the right to seek alternative treatment in Mexico instead of chemotherapy for the boy's bone cancer.

In the recent Hamilton case, the Children's Aid Society was approached by the oncology department at Mc-Master Children's Hospital when a couple refused to let their 11-year-old son continue his chemotherapy. The side effects had been punishing, and the boy himself asked for the treatment to end.

Doctors, though, said he had a 40-50% chance of going into remission and leading a normal life if he kept receiving chemo, said Dominic Verticchio, the society's executive director. If he discontinued the therapy, he would die within six months, they believed.

The prognosis was confirmed by the head of oncology at Toronto's Hospital for Sick Children, Mr. Verticchio said. The society even had a psychiatrist determine if the boy was capable of deciding the matter on his own. He was not, the therapist concluded.

Unable to convince the parents, the organization went to court and obtained an order.

"It's a very difficult, emotionally trying situation for everyone involved," Mr. Verticchio said. "[But] there is a very good chance he can overcome this disease."

When the hospital tried to implement the order, though, the father objected, while the boy cried out repeatedly, "I don't want this." The father told local CHCH-TV that hospital security staff put him in handcuffs when he tried to call his lawyer.

Peter Kormos, an NDP MP, was quoted as calling the society's response "heavy-handed."

The father could not be reached for comment.

Mr. Dudding argued that child-welfare authorities have no choice but to intervene in such situations, since legislation requires them generally to act in the best interests of children -- and specifically to ensure they receive needed medical treatment.

Most common are cases involving Jehovah's Witnesses, who will often refuse blood transfusions on religious grounds.

Doctors also contact child welfare when parents insist on using natural health products or home remedies, while refusing medical treatment, said Jeanette Lewis of the Ontario Association of Children's Aid Societies. Emergency departments sometimes call when parents take their children home before they get needed treatment, she said.

Usually, the authorities can negotiate an agreement between parents and doctors, but when they cannot, they resort to the courts, Ms. Lewis said.

"Witholding treatment is a form of neglect," she said.

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