Abraham Cherrix's Fight for Life

July 21, 2006 7:22 PM

Teen cancer patient, Starchild Abraham Cherrix, in a custody battle between his parents and and the Accomack County (Virginia) Social Services Department, has lost his battle to choose his own treatment for Hodgkin's disease. A judge has ruled that the 16-year-old must report to a hospital by Tuesday and accept treatment that doctors deem necessary.
posted by ericb (81 comments total)

this is so wrong. i feel bad for the kid. the state doesn't own him.
posted by brandz at 7:35 PM on July 21, 2006

did somebody page Dr. Nanny-state?
posted by i_am_a_Jedi at 7:37 PM on July 21, 2006 [1 favorite]

Of course, if he decided to kill someone, he'd be entirely responsible for the decisions he'd made.
posted by rxrfrx at 7:38 PM on July 21, 2006

Errr, who's paying for all of this?
posted by rough ashlar at 7:39 PM on July 21, 2006

I think it's more accurate to say that he's fighting to refuse treatment, since there's no evidence that the "treatment" he's chosen works. What if it were his parents forcing him to accept treatment? I don't think we'd be hearing about this.
posted by transona5 at 7:53 PM on July 21, 2006

Abraham and his family are treating his cancer with an herbal remedy four times a day and an organic diet under the guidance of a clinic in Mexico.
Don't get me wrong, I like organic food as muchas, often more than, the next guy, but I'm guessing that if the judge didn't give the rulng he did that this would all sort itself out. Permanently.
posted by lekvar at 7:57 PM on July 21, 2006

Children's Healthcare Is a Legal Duty is a group that works to "protect children from abusive religious and cultural practices, especially religion-based medical neglect." The group's short FAQ has a list of religions that object to medical care of children. And here's a reprint of a 1995 Atlantic Monthly article by Caroline Fraser, "Suffering Children and the Christian Science Church," that explores these issues pretty thoroughly (I know, this was a case of Jehovah's Witnesses, but it's still worth a read).

From this post's first link:

"I don't think any family in the commonwealth would be comfortable with the fact that a social worker with no medical training could make a medical decision for their child," Taylor said. "It's an assault on the American family."

I'm so torn on this kind of thing. On the one hand, the above is difficult to disagree with on its face, particularly for someone who's generally libertarian on social issues. And the fact that it's a relatively aware kid making the decision tilts in his favor, too. But I can't stop thinking about other cases I've seen, like the Twitchell case, where a two-year-old with an intestinal blockage that could have been surgically remedied died because his Christian Scientist parents refused to call a doctor. Or cases where children die from a ruptured appendix for the same reason. I find it hard to see how even the most dedicated anti-big-government libertarian wouldn't pause at those.
posted by mediareport at 7:59 PM on July 21, 2006 [1 favorite]

The Twitchell case. i_am_a_Jedi, I'm particularly curious to hear your response to that episode, given your rather glib "nanny state" comment.
posted by mediareport at 8:05 PM on July 21, 2006

mediareport, is this case religion-based like the twitchell case?
posted by brandz at 8:10 PM on July 21, 2006

Nice to see a red state resisting faith-based unmedicine.
posted by flabdablet at 8:12 PM on July 21, 2006 [1 favorite]

The state is invoking the common law legal doctrine of in loco parentis.

This is tough, not only because the child seems self aware enough to choose for himself, and because the states actions are directly contrary to much of the American libertarian tradition, but it is clear that if he was the age of majority, he would be within his rights to refuse treatment.

Starchild is a victim of the bright line, as it were.
posted by thewittyname at 8:13 PM on July 21, 2006

um, mediareport, Jehovah's Witnesses weren't mentioned in your linked article by Fraser and neither are they the same as Christian Scientists.
posted by Tacodog at 8:17 PM on July 21, 2006

That Twitchell case makes me want to scream. The sheer arrogant horror of it is disgusting.

But I also firmly believe that an adult has a right to chose any course of treatment or non treatment he or she desires, even if they pick a "therapy" that is patently idiotic. Call it natural selection against stupidity.

The thorny issue here is that Starchild Cherrix (and I can't help raising an eyebrow at his name and wondering if he shouldn't have been born in 1969) is not legally an adult... and yet he is clearly not in the same position as an infant like Robyn Twitchell. At the age of 16, he is capable of understanding what he is facing and making his own desires known, and as alluded to in a post above, the law has had little problem holding 16 year olds liable as adults for criminal acts.

It isn't really a cut and dried choice here, but, with reservations, because we really know very little about Cherrix and how maturely he is able to consider his choices, I think most 16 year olds should not be forced into treatment against their desires.
posted by John Smallberries at 8:20 PM on July 21, 2006

mediareport, is this case religion-based like the twitchell case?

Well, it isn't clear this is a religion-based case; I was thrown off by the reference to Jehovah's witnesses in that second link. But I do think the same dilemmas apply in the case of alternative and/or New Age treatments, which are often centered on spiritual issues, and many of the points raised in Fraser's piece are directly relevant here.

[Tacodog, I know JW and CS are different; in fact, I mentioned it.]
posted by mediareport at 8:31 PM on July 21, 2006

I agree with transona5. Assuming the Mexican alternative is ineffective, it amounts to a forced treatment vs. no real treatment.

I wonder whether the case would have come out differently if the boy with parental support had just refused treatment.

Chemotherapy inflicts terrible suffering on the patients, and the claims about its effectiveness are based on the grossly fraudulent definition of "cure" as "surviving for 5 years". In essence, the kid is being coerced into being an experimental subject.

An honest evaluation of any cancer treatment would have to consider how many would survive for five years anyway; the quality of life in the 5 years; the rate of real cures in terms of the correct use of words; and how many patients would still see the cost/benefit ratio as favorable in the absence of the linguistic deceit. But in view of the deception already involved in selling mainstream cancer treatments, I doubt that any honest evaluation can be expected from anyone involved in the lucrative business.
posted by jam_pony at 8:46 PM on July 21, 2006

Warning: anecdotal

The hospital ward I work on recently had a faith healer patient, who through using his faith healing to control his diabetes had necrotic (dead) feet. He insisted on using his special healing powers to bring his feet back to life, and resisted the prognosis of 3 different doctors that his right foot would need full amputation and his left foot partial.

As he was 44, there wasn't much anyone could do but eventually discharge him into a hostel (he couldn't support his own weight so couldn't take care of himself at home) and await news of his death from sepsis or gangrene or the various complications brought about by having a dead limb still attached to you.

It was so *frustrating* knowing that he was going to die, and that not only was there something we could do about it but the only thing stopping us was his stubborn belief that he could bring his feet back to life.
posted by Silentgoldfish at 8:51 PM on July 21, 2006

Last time I checked, i dont recall anyone in the field of oncology claiming 'cures' for cancer. Doing so would be unethical.
posted by MrLint at 8:52 PM on July 21, 2006

This case reminds me of the book The Spirit Catches You and You Fall Down, which is an exploration of the journey of the Hmong people from pre-industrial Laos to refugee communities in Central California told through the experience of a small Hmong girl with epilepsy.

The Hmong have little understanding of Western medicine, preferring to treat their sick through herbal dermal remedies and elaborate sacrfices to the malevolent spirits they believe cause illness. The little faith this particular family had in US medicine was reduced to nil when their daughter's condition worsened despite several years of intense treatment through an ever-changing cocktail of powerful drugs.

When the parents proved both unable and unwilling to continue to follow the very complex drug regimen prescribed by her American doctor, that doctor had her removed from her home and placed in foster care. It was devastating for the girl's parents. They couldn't understand why they were not allowed, in the country which they were told was "free", to treat their child as they saw fit, and especially as it was clear to them that the Western treatment was ineffective.
While in foster care the girl was given her medicine, and still her condition didn't improve. I don't want to reveal the end of the story for those who might want to read it, but ultimately her Western doctors failed her, and indeed they may have actually made the girl's condition worse.

I can understand both sides of the issue, but I think at this point I would support the family and their decisions. Ultimately the parents should have the right to determine how their child is treated, or not treated if that is the case. I don't believe the state should be able to prescribe a medical treatment over one preferred by the parents. Western medicine isn't always the only way to cure every illness.
posted by Kraftmatic Adjustable Cheese at 8:52 PM on July 21, 2006

This is an outrageous decision. I read about this a day or two ago and thought that the judge would let the teenager do as he wished. Boy was I wrong.

The kid is old enough to decide if he wants to put himself through chemo again. I'm sure he's capable of comprehending the risks associated with various treatment options.

IMHO a number of medical treatments are nothing short of barbaric -- and I'd tend to put chemotherapy in this category. From my viewpoint, it's akin to drinking drano and hoping that you survive.

While I fortunately have never had cancer, we all worry about what we would do if faced with various choices for treating cancer. I honestly don't think that I'd put myself through chemotherapy.
posted by bim at 8:57 PM on July 21, 2006

Hoxsey hoax
posted by hortense at 9:07 PM on July 21, 2006

@MrLint: This is only the first link I found on the notorious "five year" thing and it is clearly a mainstream source.

Maybe it is not always the word "cure" - I know use of this word is restricted by law. The point is that the MD uses expressions implying "cure" and the patient or parents interpret the statements in the ordinary sense while the doctors have in mind the special definitions.

Anyway it is a huge business for drug companies and a very questionable deal for patients.
posted by jam_pony at 9:09 PM on July 21, 2006

"Hoax" or not, it's still should be the teenager's choice.

Putting himself through hell for an alleged five year survival rate might not be a particularly attractive option for some people.

The insistence on prolonging life at all costs is very scary.
posted by bim at 9:18 PM on July 21, 2006

mediareport, Thank you for posting your ambivalence. I wish to agree with you. I too am also torn about this case.

Having just endured half a year of chemotherapy myself for advanced cancer (uterine and fallopian), I can say it was an awful experience and the doctor administering the chemo was an ignorant ass, who didn't inform me how to deal with the pain of chemo, knew almost nothing about pain management period, nor was he honest or informed about the side effects of either the chemo or pain meds. He was adamant that I not take antioxidants or vitamins during chemo. And he didn't tell me honestly that chemo takes a person near death, in order to live. He was everything awful that would have caused me to go the way this kid is trying, via Hoxsey.

Bottom line is that I don't think Hoxsey works well enough for certain cancers, like Hodgkin's, and chemo has a proven track record for certain cancers.

My dad had Hodgkin's, did chemo and radiation and if he hadn't smoked and boozed, I think he would have had a greater chance of living the 10 years he did after he was diagnosed and treated.

I'm glad I did the chemo. I think it works better than a lot of other things. But I never would have said that prior to the cancer diagnosis. Once I had cancer I did a lot of research and I haven't heard such good reports about dealing with cancer by alternative methods. I think alternative treatment is excellent for preventing cancer, for detoxing after cancer treatment but, knowing what I do, I think in the case of this boy, the right thing is being done, to oblige him to take chemo until he is legally able to be responsible for his decisions.
posted by nickyskye at 9:18 PM on July 21, 2006

"to treat their child as they saw fit"

Because they don't own the damn child. The sooner we move away from this sense of a parent's ownership of a child, the better. In my opinion, a parent, any parent, should be considered to be allowed limited custody of a child as the presumptive agent of the child's best interests. Any evidence to the contrary, the state should then take over that role. That's radical, but I have good reasons for believing it.

In that context, then, this particular case should be decided firstly, upon the truthfulness of the claim that the chemotherapy has a strong medical utility especially compared against quality of life issues. If so, then the secondary consideration might be whether this 16-year old is mature enough to make life-decisions that, in effect, release him from anyone's custody, his parents or the state. If so, then he should be allowed the threatment he prefers. If not, then the state should force this treatment.

And if the chemo doesn't have much medical utility in comparison to the quality of life issues, then the decision should then be left to the parents, who are presumed to be competent in acting in the child's best interests.

So, for me, it all boils down to whether or not what his mother says is actually true:

"But if he doesn't have a very good chance of coming through this chemo, which he doesn't, I'd much rather him have quality of life."

It seems there is some disagreement about this claim.
posted by Ethereal Bligh at 9:26 PM on July 21, 2006

I hope you are feeling better, Nicky. As one who has been on estrogen for many years, the issue of breast cancer and what to do if it should ever occur is an ever present fear. I appreciate your insights into the issue.

I also am angered by the never ending and always contradictory medical studies on this subject too -- all in the name of a publish or perish environment, in my opinion. Take care. :)
posted by bim at 9:32 PM on July 21, 2006

Wow. I'm astonished that anyone would side with the family on this. The state has the reponsibility to protect its underage citizens from life-threatening errors committed by their parents. Whether the kid is mature enough to make his own decisions is, to me, not relevant. He's a minor.
posted by solid-one-love at 9:37 PM on July 21, 2006

Ethereal Bligh : "Because they don't own the damn child."

Neither does the state.
posted by Gyan at 9:39 PM on July 21, 2006

Because they don't own the damn child. The sooner we move away from this sense of a parent's ownership of a child, the better.

well the state doesn't own the child either. i'll go out on a limb here and clearly state the parents have more say (rights) with their own children than the state.
posted by brandz at 9:46 PM on July 21, 2006

Good. He can kill himself when he turns 18 if he wants.
posted by delmoi at 9:49 PM on July 21, 2006

In my opinion, a parent, any parent, should be considered to be allowed limited custody of a child as the presumptive agent of the child's best interests. Any evidence to the contrary, the state should then take over that role.

So we would get even more intrusion and oversight of family life as we move towards child rearing via litigation. Hmmmm.

I'm wondering how the courts and meddling doctors will feel if the teenager decides to off himself soon rather than be forced to undergo treatment. Or maybe he'll have to permanently flee the country -- a stressful option that surely won't help his health.
posted by bim at 9:52 PM on July 21, 2006

well the state doesn't own the child either. i'll go out on a limb here and clearly state the parents have more say (rights) with their own children than the state.

Except in this case where the parents, by making a choice which will most likely result in a preventable death of their child, have shown themselves to be incompetent.

I don't think many people have a problem removing a child from a physically abusive family, and this is a case where the parents are causing at least as much harm as that.
posted by scodger at 9:52 PM on July 21, 2006

Will the state be paying his medical bills, too, I wonder?
posted by eegphalanges at 9:57 PM on July 21, 2006

He can kill himself when he turns 18 if he wants.

I hope and pray that he doesn't decide to do so sooner, since he's about to subjected to a bout of medically-authorized poisoning against his will.
posted by Dreama at 10:00 PM on July 21, 2006

Whether the kid is mature enough to make his own decisions is, to me, not relevant. He's a minor.

Well, in the state of Viriginia a child of sixteen can petition the court to be emancipated at age 16. So we have a bit of a contradiction here if we claim maturity doesn't matter and it's only a numbers game.

A 16 year old "minor" COULD be considered mature enough to be emancipated. Surely then a sixteen year old could be considered mature enough to decide how to prolong his life...or not via medical treatment.
posted by bim at 10:07 PM on July 21, 2006

Except in this case where the parents, by making a choice which will most likely result in a preventable death of their child, have shown themselves to be incompetent

you do not know what the outcome of treatment vs no treatment will be. nobody does. for all we know, treatment (chemo) could be worse. your statement is arrogant, scodger.
posted by brandz at 10:10 PM on July 21, 2006

"Neither does the state."

When I use the word "ownership" with regard to "parental rights", what I mean is the idea that parents rights are absolute, specifically that it's the parents' right to determine what is in the child's best interests.

If it is not, and I don't think it should be the case, that parents have some absolute right to determine their children's best interests, then who else does that leave but the state to determine them? Other family? Why, unless using the same reasoning that asserts a parents unquestioned right?

If we look at the example of the mentally incompetent adult, then we can see that the assumption that the state is the entity most responsible for the person's welfare, with the exception of the responsibilities recognized as belonging to the individual, no one asserts that in embracing this policy the state "owns" the incompetent individual.

My argument is that even in the case of parents, there is no rationally supportable argument for the primacy of the parents ability to determine what's best for their children except with regard to proximity and familiarity. But, at birth, neither is particularly relevant—the assumption of a parent's primacy in determining what's best for the child is questionable.

That being the case, then I'm arguing that at the outset the state be seen as the entity, in general, responsible for the best interests of the child and for a variety of reasons, some theoretical, some practical, some based upon tradition, it provisionally assigns that responsibility to the parents until the parents demonstrate reasons that assignation be revoked. In all of this, I'm not claiming that in any way the child belongs to the state. I believe that only the individual can be rightly thought to "own" oneself.
posted by Ethereal Bligh at 10:10 PM on July 21, 2006

I bet this kid would be gung ho about chemotherapy if he could get a prescription for medical marijuana to help deal with the chemo.

In that case, I bet a bunch of his classmates would undergo chemo too, as a 'show of solidarity'.
posted by Davenhill at 10:12 PM on July 21, 2006

I think he would have had a greater chance of living the 10 years he did after he was diagnosed and treated.

Meant to write: a greater chance of living more than the 10 years he did after he was diagnosed and treated.

bim, Thanks for your kind good wishes. I encourage you to go off the estrogen as soon as possible; stay fit, muscular and trim, do detoxing stuff, it does help, take anti-oxidants. There is a standard blood test, which can indicate either inflammation or cancer, CA-125. If I'd known about this prior to getting cancer I would have had one every six months after the age of 40.
posted by nickyskye at 10:14 PM on July 21, 2006

Ethereal Bligh : "I'm arguing that at the outset the state be seen as the entity, in general, responsible for the best interests of the child"

Ethereal Bligh : "I believe that only the individual can be rightly thought to 'own' oneself."

If the state can mandate a subject to undertake some conduct that affects only the subject, then the state "owns" that subject. Put another way, what does it mean for an individual to own himself? In this particular case, does the individual own himself?
posted by Gyan at 10:17 PM on July 21, 2006

Well, all I can say about modern cancer treatments is that I have a mother, diagnosed with lupus, and a stepfather who has survived both hairy cell leukemia and testicular cancer, both of whom I love very much, that are still here, far past the time they were given.

They both work, socialize and travel, so I don't think quality of life is an issue.

I'm not saying cancer treatment works for everyone, and the right doctor is invaluable, but it seems too many people just have a knee jerk reaction to the medical industry.

Although, I must admit fixing a syringe of interferon for my quasi-straight edge stepfather got a little surreal...
posted by Samizdata at 10:23 PM on July 21, 2006

He has an awesome-yet-horrible-at-the-same-time name.

I think he might want to actually get the chemotherapy. It's not nearly as scary as it was in the mid-and-early 90s, and the rates are fairly good now. I'm sure he'll live. With a name like that, I'm hoping that he's actually the next saviour of mankind. Mostly so I have the excuse to say STARCHILD CHERRIX out loud a bit.
posted by blacklite at 10:27 PM on July 21, 2006

"If the state can mandate a subject to undertake some conduct that affects only the subject, then the state "owns" that subject."

No, that's simply not true. Why do you think it's true? Sure, this particular language in this context is very imprecise and more emotive than anything else; but it seems to me that my imprecise and emotive usage implies something very close to no restrictions on use and not at all the existence of even a single restriction on use.
posted by Ethereal Bligh at 10:29 PM on July 21, 2006

Ethereal Bligh : "No, that's simply not true. Why do you think it's true?"

Because sovereignty has been overriden.
posted by Gyan at 10:36 PM on July 21, 2006

"If the state can mandate a subject to undertake some conduct that affects only the subject, then the state "owns" that subject."

No, that's simply not true. Why do you think it's true? Sure, this particular language in this context is very imprecise and more emotive than anything else; but it seems to me that my imprecise and emotive usage implies something very close to no restrictions on use and not at all the existence of even a single restriction on use.
posted by Ethereal Bligh at 10:36 PM on July 21, 2006

First Point - The state (government) does not have the best interests of the child at heart. The state is a bureacracy and will apply bureacratic rules in lieu of any real care or consideration of a child's needs.
Second Point - Is years of forced unwanted medical treatments worth peace of mind and living how one chooses, even if in doing the latter one's life is shorter? And how can one make that decision for another?
posted by forforf at 10:40 PM on July 21, 2006

1)I'm not saying cancer treatment works for everyone, and the right doctor is invaluable, but it seems too many people just have a knee jerk reaction to the medical industry.

2)I think he might want to actually get the chemotherapy. It's not nearly as scary as it was in the mid-and-early 90s, and the rates are fairly good now.

Um...I think folks are overlooking the fact that the teenager in question already went through chemo and radiation once (see the newspaer article). So I think we should give him credit for understanding what chemo entails. It seems like an "informed decision" to me.
posted by bim at 10:44 PM on July 21, 2006

Sorry about the double.

Anyway, "because sovereignity has been overridden" is not an answer. It's a slogan, not a rational answer. While sovereignity might imply ownership (arguable), an "overriding" of sovereignity does not imply that "ownership" has been transferred to the overriding agent. It is possible, after all, for no sovereignity to exist. Maybe not in the land of slogans, though.
posted by Ethereal Bligh at 10:45 PM on July 21, 2006

EB, you should define ownership of a person before we go any further.
posted by Gyan at 10:48 PM on July 21, 2006

Well, I dont quite know where you got the idea that no one knows the outcome of treatment brandz.

If we have a look here and here you can see that there is a 80-90% chance of surviving treated hodgkin lypmphoma, which is what Starchild has.

On the other hand the hoxsey treatment he is going to use has no known efficacy.

I would say removing a 80-90% chance of a child surviving for an unproven and likely bunk cure is clear evidence of incompetence.
posted by scodger at 10:51 PM on July 21, 2006

in the state of Viriginia a child of sixteen can petition the court to be emancipated at age 16.

Huh. That is something of a contradiction. Presumably he could make his own medical decisions at that point? If so, I'd bet that's the family's next legal move.
posted by mediareport at 10:54 PM on July 21, 2006

"The state (government) does not have the best interests of the child at heart. The state is a bureacracy and will apply bureacratic rules in lieu of any real care or consideration of a child's needs."

Perhaps in practice. But then the same criticism could be applied to most parents^*. So this isn't a very convincing counter-argument to mine.

I'd argue that in a democracy with good government and education the state is the best agent, in general, to determine a child's best interests. Perhaps a particular state fails these tests, but whether that's an argument for better government or an argument for parental rights depends, ultimately, on a comparison between that given government's particular history in protecting childrens best interests versus that same society's particular history of protecting children's best interests. In my opinion, our particular cultural history favors government, not parents. It is government that has to mandate education for all children to teenage years, it is government that has to mandate against physical violence against children, it is government that has had to require professionals report incidents of sexual abuse when they discover them. Parents in the US, left to their own devices, don't have a stellar history in looking after their children's best interests.

In fact, this is true of most cultures. Traditionally, because of high child-mortality rates, children have, in fact, been owned commodities to be exploited for the benefit of the parents, foremost, and the rest of the family, second-most. It is the state which, historically, has taken the longer, broader view.

On preview: the best example we have for "ownership" is literal ownership and which my use is probably intended to evoke. That's chattel slavery, where ownership implies absolute sovereignity over another individual, including their life. Parental "responsibility" has, in the past, actually included such an extreme—but even in the present US context, when we look at caes such as choosing to withhold medical treatment or such, we find something very close. Indeed, when you look at things like the death penalty or conscription, you find governments coming similarly close.

* Not that parents are a bureaucracy, but that parents may substitute procedural rules governed by, say, tradition, indoctrination, laziness, self-interest, or other factors not directly related to the child's best interets.
posted by Ethereal Bligh at 11:08 PM on July 21, 2006

Important correction (that might be unnecessary because it's implicit in context). I wrote:

"versus that same society's particular history of protecting children's best interests. "

...which should have been

"versus that same society's parents particular history of protecting children's best interests. "
posted by Ethereal Bligh at 11:11 PM on July 21, 2006

"I don't think many people have a problem removing a child from a physically abusive family, and this is a case where the parents are causing at least as much harm as that."

Yup. That's pretty much it.

I'm also comfortable with the child's opinion being disregarded. Most 16 year olds are still immortal - with remnants of the childhood mentality that death is far far away, if it even applies at all. Give a 16 year-old a 40% chance of survival, and most will give insufficient weight to it, assuming at a deeper level that they'll be ok - that they'll be in that 40%.

Give a 16 year-old a lifetime osmosis of his parents "knowledge" of how effective alternative medicine is or how the big bad medical establishment just refuses to listen, and chances are the kid's worldview will have been shaped by this. Maybe that's not how it played out, but mere possibilities like that show why a minor is treated as such.

It's horrible. But it's right.
posted by -harlequin- at 11:30 PM on July 21, 2006

WRT absolute parent ownership rights overriding society's rights, is now a good time to trot out that "it takes a village to raise a child"?

/runs and hides

:-)
posted by -harlequin- at 11:33 PM on July 21, 2006

(Actually, it's not about societies rights, it's about the child's rights. The child has the right to live. When the child won't do this (eg won't eat because he doesn't like vegies), the parents make him. When the parents won't do this, the wider family does. When the family won't do this, the state does. When the state won't do this, the child is screwed.
posted by -harlequin- at 11:37 PM on July 21, 2006

The child has the right to live. When the child won't do this...

This isn't describing a RIGHT. This is describing a STATE MANDATE. Rights don't require coercion.

Furthermore, all actions have both a gain and a cost attached to them. You're only looking at an somewhat uncertain gain (given chemo plus radiation didn't do much the first time). What about the cost of all this? That has to be considered too. Aside from any financial costs which aren't the issue here, at what physical and mental cost will this teenager's "survival" occur? There's a quaility of life issue involved here.
posted by bim at 11:54 PM on July 21, 2006

solid-one-love said 'The state has the reponsibility to protect its underage citizens from life-threatening errors committed by their parents.'

I'd agree with that wholeheartedly, but I think it does become a grey area when we're talking about a 16 year old.

On the more general issue, having known someone who died, leaving two small children fatherless, because he pig-headedly persisted with 'alternative' therapies for a form of treatable cancer with excellent recovery rates with chemo, I wish I could send this kid a copy of the late John Diamond's Snake Oil and Other Preoccupations.
posted by jack_mo at 3:30 AM on July 22, 2006

We'll have to agree to disagree EB, I fundamentally do not agree with a state overriding a competent individual or a competent family's choice. Shades of Schiavo to me.

I don't understand why forcing someone to live is so important to our society. I can absolutely understand the government taking an active and forceful role in preventing people from actively taking a life, but our society seems to have taken that to an extreme. This case, the doctors and nurses in New Orleans, the Schiavo case, all point to a government that says living miserably is better than dying. I wouldn't mind so much if the state would actually take real responsibility for those lives it wants to save. Instead you have a foster care system with no mechanism to protect the quality of life of the foster kids, ya government that will dictate methods and procedures after the fact, but abdicates the responsibility for dealing with those repurcussions. Who will pay for the treatments? Who will provide emotional assistance to the kid and family to help them deal with this? Instead, what you will have is a court ordering treatment and the family and kid left to sort out the rest themselves. Sorry, I don't see how that approach benefits our society overall.
posted by forforf at 6:43 AM on July 22, 2006

At 16 in some states, you have the right to refuse medical treatment, or choose your own course of care. Nanny state, indeed.
posted by moonbird at 6:44 AM on July 22, 2006

Last time I checked, i dont recall anyone in the field of oncology claiming 'cures' for cancer. Doing so would be unethical.

According to the ACS,"About 90% of newly diagnosed patients [with Hodgkin's Disease] are cured with chemotherapy and/or radiation therapy." That might not be a "cure", but the odds look pretty good to me
posted by bluefrog at 7:07 AM on July 22, 2006

Perhaps the state should sterilize teens whose parents recognize that they will have sex regardless of what they are told?

Yes, then the state can review all children's diets and intervene in the case of those parents who refuse to feed their kids milk and meat.

Wait, perhaps the state can intervene and tell you that the chiropractor you are choosing to effectively treat your lower back pain is ineffective and you MUST have the surgery that has been proven effective in eliminating it!

Why the possibilities are endless!

The State of Virginia cannot even manage to fix its potholes. It just executed a man with an IQ of 76. It housed the most impoverished black plantation remnants I have ever seen on the eastern shore when I was a kid. It has no moral capital, no demonstrated ethical superiority, no particular keys to the kingdom of knowledge, as it were.

And its mindless bureaucrats should be involved in the life and death decisions of each and every family in the state?

My nephew, Abraham, is going to die. Either at 17 or at 100. I'd obviously prefer the latter, and as a scientist, would certainly recommend chemo IF I WERE ASKED, which I was not. It is a sad case, not made any better by the publicity. But it's not my decision. It is properly Abraham's and his parents'. My agreement or disagreement is irrelevant. So is yours. So is the state's.

I buried my first wife 8 years ago after watching her do chemo and alternative therapy for colon cancer. Chemo sucked... and it didn't work. It doesn't always. Sometimes, one opts for quality of life. I desparately wanted her to continue chemo, she did not. Her choice.

None of this is academic for me. It's not speculative. It's not an interesting little discussion.

It is how life plays out. Not pretty. Not always nice. Not always predictable. The ONLY guarantee is eventual death.

There may be some Darwinian aspects to it, but be careful of encouraging the state to make these decisions on YOUR behalf. Remember Terri Schiavo and Karen Quinlan.
posted by FauxScot at 7:22 AM on July 22, 2006 [1 favorite]

I guess I don't expect people on Metafilter to be medical experts or anything, but damn, rarely have I seen so much overheated rhetoric based on so little information. I'm not a doctor, but I am currently undergoing chemo for Hodgkin's, so I have some firsthand experience.

Hodkin's is one of the few cancers that is considered "curable," in that many (85%-90%) of patients experience a permanent remission from chemo. However, if you do relapse after chemo (like I assume Abraham did), your odds with salvage therapy are much worse — 50% at best — and the treatment extremely unpleasant; it involves doses of chemo large enough to kill all your bone marrow, which then needs to be regenerated via a stem cell transplant.

If I were in Abraham's position, I would take the chemo, but I totally understand his decision not to, and I think it's unconscionable that the state would seek to compel him to accept an extremely unpleasant and not especially effective treatment.
posted by myeviltwin at 8:10 AM on July 22, 2006

i'd say forforf, moonbird and FauxScot pretty much have it right. i still don't understand why the state feels it can intervene and force treatment on somebody who clearly doesn't want that treatment. it's not like the kid is contagious. in my view it's all about self-determination.
posted by brandz at 8:51 AM on July 22, 2006

I'd say that forforf, moonbird, and FauxScot would pretty much have it right if Cherrix were an adult, which he isn't.

And, as I've repeatedly said, if there's little hope for recovery for Cherrix, then I completely agree with the quality of life objection, and in this way his case is (marginally) comparable to the Schiavo case. But, so far, the only person who's made the claim that this round of chemo will not "cure" Cherrix's cancer is his mother. Otherwise all I've seen is that Hodgkin's is very successfully treatable by chemo and that there are all indications that this is months of horror as the price for many, many years of normal and happy life. In that context, the comparison to Schiavo is just, well, stupid.

And FauxScott's argument, if taken seriously, applies to any state overrule of a parent's decision concerning their child, including sexual abuse, starvation, and execution. We've already agreed that the state can overrule a parent's decision about their child—the question is what decisions a parent makes should be overruled. Medical decisions that threaten a child's life should be one of those.
posted by Ethereal Bligh at 9:09 AM on July 22, 2006

Otherwise all I've seen is that Hodgkin's is very successfully treatable by chemo and that there are all indications that this is months of horror as the price for many, many years of normal and happy life.

How many times do we have to point out that the kid already had chemo once and the cancer returned? And that the odds of a "cure" are therefore significantly lowered? This even straight from the mouth of a Hodgkin's patient.

Give it up, E.B. It's OK to change your mind. Geesh.
posted by bim at 9:34 AM on July 22, 2006

I live in Tidewater and have followed this case on the local news since it started.

One thing I can say, without a doubt, is Cherrix is an intelligent, articulate, thoughtful kid (beyond his years, IMHO) who has come to his own decision. He tried chemo once, and decided he didn't want to go throught it again.

If I were in his shoes, I would try the emancipation route.

PS- Hard and fast rules that apply to legal cases without taking into account the specifics of the individual case, are always wrong.
posted by Benny Andajetz at 9:44 AM on July 22, 2006

benny -- Is the right to life crowd busy meddling in this case? I'm curious.
posted by bim at 9:55 AM on July 22, 2006

"How many times do we have to point out that the kid already had chemo once and the cancer returned? And that the odds of a "cure" are therefore significantly lowered? This even straight from the mouth of a Hodgkin's patient."

Yes, which I missed. And perhaps I've similarly missed others making that point, but I didn't see them. Anyway, I said in my first comment that if this were true and the mother is right, then I agree with her. Myeviltwin says that Cherrix's chances are 50% at best. My ultimate judgment, then, would still depend upon where in that range Cherrix's case is. Especially with such a young person, it seems to me that anything closer to 50% is easily high enough to justify the chemo.

Remember that while we give adults reponsible for themselves great leeway in weighing QOL against treatment, as a general rule in the case of children all our laws are weighted heavily toward protecting the life of a child against the various inconveniences that result. Culturally, we value the lives of children highly, and rightly so, I think—I value a child's life higher than mine, that of a middle-aged man. For similar reasons, I valued Terry Schiavo's life at nil. That's why I think comparisons to the Schiavo case are strained, perhaps absurd.
posted by Ethereal Bligh at 10:07 AM on July 22, 2006

I think that we may finally have concensus, E.B. :>

I would wholeheartedly agree that if this were the first time chemo and such were being considered, the state would be right in requiring chemo over parents' objections.

But a second time after the first round of chemo failed...no way.

Personally I think this all started as a "cover your ass" situation for the doctor and then the social worker. And then religious politics may have taken over in Virginia and the courts decided to cover its ass. All at the expense of Starchild.
posted by bim at 10:31 AM on July 22, 2006

FauxScot, Thank you for your powerful post. My heart goes out to you, your family and to Abraham.

This is an organisation that helped me, Cancer Hope Network. They provide free counseling and experienced support. Perhaps it would be of use and support to Abraham?

Dr. A. Hoffer is a doctor who has done extensive research on treating cancer naturally: Orthomolecular
Vitamin Information Centre, tel: [phone], clients by appointment only. Calls for appointment will be made to Fran at the above number for information. He will not provide any information to any one he has not seen personally. For more information [e-mail]

Info re Vitamin C and chemo.

Alternative cancer treatment centers outside the USA.

He referred me to Dr Jeanne Drisko. "She is
Professor of the new chair in Orthomolecular Oncology at U of Kansas, Medical School, and is the worlds expert on treating ovarian cancer with intravenous vitamin C. But she lives in Kansas" [e-mail]

This info may be of help to Abraham. Perhaps Dr. Jeanne Drisko knows of previous legal precedents in treating cancer alternatively in America?

Jeanne Drisko, MD
Associate Professor
Program Director
Program in Integrative Medicine
Functional Medicine and Complementary and Alternative Therapies
University of Kansas Medical Center
Kansas City, KS 66160
913-588-6208

Or the American College for the Advancement in Medicine may know?
http://www.acam.org/

Sloan Kettering has a site with information about what herbs, supplements have had clinical trials, what has been shown to work so far. It's incomplete but it has some useful info.

PubMed returns on searching "Hoxsey".

The problem appears to be a legal one but, of course, it has many ramifications.

There are Americans with religious or cultural preferences, who have previously put their children in harm's way by not allowing them to have appropriate medical care. So the State has already set a precedent to force medicine on those children.

Maybe the State not allowing those children the medicine they need would be like being accessory to murder, legally?

In the hospitals here in the USA there is a law to sustain life and unless one signs a Living Will, allowing life-sustaining machinery and medication to end, one's life is prolonged artificially, even against the will of the family unless there is a Living Will that says otherwise. The Living Will lets the hospital off the hook, legally. If the hospital 'let people die' in the hospital they might be considered accessory to murder, legally.

A huge problem, in my opinion, is that the traditional, pharmaceutical/insurance companies' medical biz is staggeringly corrupt and has not allowed alternative treatments more clinical trials, so that better tests can be done to see what actually works in terms of treating cancer, rather than letting the pharmaceutical companies hold people's health in a stranglehold, in order to make more money off certain medicines.

The only place I know which seems to include both traditional medicine and alternative treatments is Cancer Treatment Centers of America, holistically, and I've heard nothing but good reports about them and the success of their approach.

It seems that people have become very litigious in the last 40 years. The upside of this is that people can get legal recourse when there is a screw up. The downside is traditional/pharmaceutical/surgery driven doctors do less for patients, will not answer many questions or give opinions, because they are frightened of being sued. My older half brother, who is a doctor, told me this. It puts the docs at yet one more remove from being caring, personally connected physicians.

It's a quandary. The State might be sued for reckless endangerment of a child's life if they do nothing and are reviled if they do something.

myeviltwin, As one surviving cancer to another, I'm glad you sound feisty. It would seem there are a bunch of us MeFites surviving one form of cancer or another. Every chemo for each different cancer is different and each patient responds specifically, although there are some typical effects. May I ask you what chemo is like for you in treating Hodgkin's?

Are you familiar with this site? I found it very helpful as I've gone through cancer treatment and they have free research oncologists who can advise what supplements have been clinically proven to help with certain cancers. This is an excellent site. There are other useful links here too.

Going through chemo can be really weakening. If I can offer you any research you need in regard to your treatment, please feel free to contact me at my email address.
posted by nickyskye at 10:42 AM on July 22, 2006

benny -- Is the right to life crowd busy meddling in this case? I'm curious.

Not overtly.

Virginia is depressingly conservative on these kind of issues. We are the home of Jerry Falwell and Pat Robertson, and groups like theirs have always held a lot of sway at the governmental level. The Commonwealth of Virginia is always more than willing to pick these kind of fights on its own.
posted by Benny Andajetz at 10:57 AM on July 22, 2006

In 1994 Billy Best ran away from his home near Boston, so that he would not have to undergo chemotherapy treatments for Hodgkin's disease.

"Billy's running away after deciding not to continue chemotherapy, against the advice of doctors, raised new questions about the right of a teen-ager to refuse medical care.

Billy's parents said today that the decision was up to him. His mother, Susan Best, said at the news conference that she wished she had handled his disease and treatments differently.

...His decision to stop chemotherapy recalls the case of Benito Agrelo, a 15-year-old from Coral Springs, Fla., who decided last summer to stop taking medication to help his body accept a transplanted liver. Benito also suffered from his drug's painful side effects. A judge ruled that even though Benito was only 15, he had the right to refuse treatment. He died on Aug. 20."

[New York Times | November 24, 1994]

Billy's website: Billy Best -- The Boy Who Ran Away from Chemotherapy (Cancer Free Since March 1995)
posted by ericb at 11:49 AM on July 22, 2006

Nickskye, I suppose this could be considered a derail, but since part of the issue in Abraham's case is that he had bad side effects from chemo, I think it's fair game. The standard treatment for Hodgkin's is called ABVD; it's a combination of adriamycin, bleomycin, vinblastine, and dacarbazine, which have a whole bevy of delightful side effects. Adriamycin causes hair loss and can cause congestive heart failure, bleomycin can severely reduce lung function, vinblastine causes neuropathy (nerve damage in your hands and feet), and dacarbazine makes you very nauseous. They all are bad for your bone marrow, energy level, and digestion.

Which particular side effects you get varies, of course; I got bad nausea (treatable with medication, though it's expensive), hair loss, fatigue, and low white blood cell counts (dangerous, but also treatable). These days the side effects are mostly under control, so I usually just feel sort of crappy for a few days after each treatment.

Can I ask what kind of cancer you had?
posted by myeviltwin at 11:59 AM on July 22, 2006

"So I think we should give him credit for understanding what chemo entails. It seems like an "informed decision" to me."

I'm with bim on that. And I believe the state should never have a right to interfere with a family's medical decisions, period, end of story, no exceptions. After the Schiavo mess, I started work on my living will and discovered that -- should I be in some horrific car crash, let's say -- if I am even the SLIGHTEST bit pregnant (we're talking whatever the earliest a pregnancy can be detected), the State of Ohio can intervene and keep my family and boyfriend from pulling the plug.

Which is, bluntly put, so fucked up there's no other words to describe it. Say hello to bitter-girl the blastocyst incubator extraordinaire.

I'm writing in a clause that specifically directs them to take me out of state if need be in order to kill me. And barring that, I have more than enough relatives who'd be willing to risk jail time to do it for me.
posted by bitter-girl.com at 12:32 PM on July 22, 2006

myeviltwin, Glad your symptoms are mostly under control. :)

Thanks for the info about Hodgkin's. Once one gets one type of cancer, usually, after treatment, the cancer comes back, in one form or another, some time or another in another part of the body, so it's useful to know how other cancers are treated.

"One in three people will be affected by cancer at some stage in their lives."

It's never what cancer you "had" because it's not curable, yet. Cancer goes into remission and is an illness one survives and tries to live beyond, as many years as possible before it, or the effects of the treatment for cancer come back.

I'm surviving 2 primary cancers: Fallopian Tube (a rare type, treated as Ovarian Cancer)
Cancer, Stage 1, Grade 3.

That was treated with 6 months Carboplatin and Paclitaxel.

And Uterine Cancer Stage 3, Grade 1.

That was treated with: 5 weeks 3D Conformal external radiation, plus 3 weeks brachytherapy (internal radiation) with Iridium 192.

Those are standard protocol treatments for those specific cancers, as you stated ABVD is the standard for Hodgkin's.

When I got chemo it was 2 days after I felt ok, then the wallop of 1 week of agony and 1 week crawling back to life after suicide-inducing pain. Each round got progressively worse.

I think pain for kids, like the experience of time, is much more intense. So I can imagine for Abraham, that the pain of chemo is intolerable.

Here is a site for teens living with cancer.

As a grown-up I am more comfortable with pain, can endure it better than I could when I was younger. As a Buddhist, I can accept the reality of death more easily now after decades of contemplating the impermanent nature of life. That's another thing, docs don't want to talk about facing death or the feelings that come up having cancer. All my oncologists put support groups down, saying patients just went to them to complain about their doctors. Hmmm, I wonder why?

I actually liked the alopecia (hair loss) that came with the chemo, thought it was kind of fun to look like a lightbulb, lol. Most of my adult life I've had a yard of long blond hair and it was an interesting exercise in non-attachment to look like a Buddhist nun or a shaved-head jazz musician. Kind of space age looking. I didn't enjoy the chemo hat thing, went bare-headed when possible. But it was not that easy for other people to accept my having been hairless. I was afraid I'd lose my medical insurance job because I looked funny to others without hair.

Nausea sucks. Cold mandarin orange slices helped. Altoids Tangerine Sours helped.

For the neuropathy one thing can make a radical difference: Mega-Glutamine, 1 teaspoon of powder taken 3 times a day in water. It's cheap and it works to prevent nerve damage from chemo. One report on its efficacy. Another. Clinical trial result. Search results on glutamine in The American Society of Clinical Oncology. The sooner it is taken while undergoing chemo the less nerve damage.

It's energising too. Hope that info is useful to you and to Abraham if he does go through with the chemo.
posted by nickyskye at 1:13 PM on July 22, 2006

I haven't read through all of the posts here, but here is my opinion regarding this boy making his own decisons....

A few years ago, a co-worker's daughter, at 16, was suffering from colitis. She required surgery because it was so bad. Her prospects were good, but there was a risk of a colostomy bag, at least for a month or two. On the upside, the surgery (I'm sorry, I can't remember the nature of the surgery) would help her tremendously, and she would no longer have pain or problems.

Being 16, and thinking, as all teens do, that she was somehow invincible, she fought her parents against the surgery. Why? Because she would have a scar. Her parents won out, the surgery was performed, and she has been right as rain ever since.

Moral? Teenagers don't know what's best for them. They may seem adult, but they truly don't have a clue about their consequences. They believe nothing will happen to them, that they are indestructible, that they will be fine. I'm sorry that he is being forced to undergo chemo, but ask him in a year or two how he feels then.
posted by annieb at 4:58 PM on July 23, 2006

annieb : "Teenagers don't know what's best for them."

You do realize that his 'adult' parents are on his side?

Ethereal Bligh : "the best example we have for 'ownership' is literal ownership and which my use is probably intended to evoke. That's chattel slavery, where ownership implies absolute sovereignity over another individual, including their life."

Well, you brought up the word 'ownership' and said that parents don't own the child. I don't think that anyone has "absolute sovereignty" so this turns out to be an irrelevant point (that parents don't "own" the child). Guardianship does confer sovereignty, and the parents/family are the natural guardians. The state is just bureaucrats composed of people from other families. I don't see why they ought to have a greater claim to decide a child's best interests.
posted by Gyan at 6:18 PM on July 23, 2006

Judge Says Teen Won't Have to Undergo Chemo Treatment for Now

"An Eastern Shore teenager with cancer does not have to report to a Norfolk hospital today for treatment.

That's the ruling this afternoon by an Accomack County Circuit Court judge, after a lawyer for 16-year-old Starchild Abraham Cherrix appealed an earlier ruling by a juvenile court judge.

Judge Glen Tyler said Abraham and his parents will get a new trial in Circuit Court as soon as possible. A trial date was to be set.

The judge also returned full custody of Abraham to his parents.

That ruling suspends an order by the juvenile court judge that required Abraham's parents to share custody with the county's Department of Social Services."

[Associated Press | July 25, 2005]

posted by ericb at 2:58 PM on July 25, 2006

Thanks for the update ericb.
posted by nickyskye at 6:18 PM on July 25, 2006

Oh, how this story all of a sudden has hit home.

I just learned tonight that one of my friend's 20-year-old son has been diagnosed with Desmoplastic Small Round Blue Cell Tumor (in his liver, spleen, lungs and spine) -- and has started a bout of aggressive chemotherapy (which he obviously abhors).
posted by ericb at 7:19 PM on July 25, 2006

They reached a final settlement.
posted by cass at 10:32 AM on August 16, 2006