(CP)
Tuesday, May 13, 2008

TORONTO—A decision to forcibly impose chemotherapy on an 11-year-old Hamilton boy who didn’t want to go through another round of painful treatment was “heavy-handed” and “worrisome” considering how often similar conflicts arise, several bioethicists said yesterday.
The boy, who cannot be named because he is now in the care of the Children’s Aid Society, has been thrust into the thorny debate over the right to seek alternative therapies and ignore conventional wisdom.

He was diagnosed with acute lymphoblastic leukemia when he was seven. After enduring the tough experience of chemotherapy, his cancer went into remission, but returned earlier this year.
After being told last week he needed more chemo, he refused to go through the ordeal again.
He took that position even though doctors said he’d have only six months to live without the therapy while treatment would give him a 50 percent of fighting off the cancer.
The boy’s family supported his decision and was ready to try some alternative therapies at home, but doctors insisted he go through chemotherapy again.
A judge ruled the boy cannot make an informed decision and he was put into CAS care to ensure he get chemo.
Yesterday, some bioethicists said they were concerned about the decision and worried that other parents’ wishes might be superseded by health care practitioners who assume they know best.
“If a doctor says [therapy] is in your best interest and you say you don’t want it, within our laws, ethically and legally, that’s fully acceptable,” said Kerry Bowman of the University of Toronto’s Joint Centre for Bioethics.
“And in this case, that’s kind of turned upside down,” he added. “Best interests have taken over as opposed to what the family believes and I think there’s a lot of ethical tension here, and I think it’s pretty worrisome.”
There may be factors in the case that haven’t been publicized and that could have impacted the decision to ignore the boy’s wishes, but Bowman said he was a bit surprised by the decision.
“It looks very heavy-handed to me and it’s got a lot of implications because we have lots of children throughout the country in institutions and parents often have a different view of what treatment should be than physicians do,” he said.
The Hamilton case is not particularly rare or unusual, and is “the kind of thing that we struggle with in health care all the time,” said Brendan Leier, a clinical ethicist with the University of Alberta and the Stollery Children’s Hospital in Edmonton.
Although officials had decided the boy wasn’t capable of making his own decisions, and that his parents essentially were making the wrong choice for their son, the patient arguably was the best-equipped to predict how chemotherapy would affect his body given that he’d been through it before, Leier said.
“This kid is now an expert on what going through chemo entails and this is where it becomes, for me, ethically problematic,” he remarked.
Although it’s a complicating factor that the boy has fetal alcohol syndrome and takes special education classes, Leier said the boy still is capable of understanding what more chemotherapy would do to him.