Cathy Young asks what rights a minor has to refuse treatment.
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Comments to "New at Reason":
Warren | August 1, 2006, 3:08am | #
Shame on you Cathy. This is an agonizing decision true, but the agony is not yours. The principals at stake here are all but cut and dried. The question of whether a 16-year-old should be allowed to make this decision is moot, as his parents have come to the same decision. Everybody dies, and chemotherapy will not change that. I'm not trying to trivialize, only to draw attention to the crucial question of quality vs quantity of life. I am left with the impression that you think this family reached its decision without agonizing over it. I would be very surprised if that was the case, and you've given no reason to believe that it is.The libertarian principal is that government should not interfere with the medical decisions people make for themselves. A child's rights are vested in his parents. Only in extreme cases when it can be shown that a parents decision rises to the level of abuse or neglect can we as libertarians condone state interference. While the consequences here are grave, the price that must paid in pain and suffering no matter what they decide, is more than sufficient to insulate this family from a meddlesome government.
twotunes | August 1, 2006, 3:45am | #
If the facts in this case are as stated by Ms. Young (no evidence for the efficacy of the alternative treatment, high likelihood of recovery under traditional chemo) then it seems to me the state does have a compelling case when it comes to minors. Yet, the fact that he had a relapse would suggest to me that the case for chemo was not as strong as supposed.Generally, I think the state should only intervene when it's been demonstrated that traditional medicines are mostly effective for whatever the condition we are talking about and the condition is a life threatening one (some cancers and some chronic conditions are not so effectively treated by traditional medicine) yet, the parents are opting for an alternative treatment for their offspring. Otherwise, the state should butt out.
In the free speech case involving the Phelps, the best remedies would be not to allow the Phelps on private property, to protest in front of their churches and homes until they desist, and/or to not publicize where the funerals will be held.
Based on Cathy's article, it appears that Abraham's choices are effective treatment (with a good chance of recovery) or ineffective treatment (essentially suicide). Seemingly, Abraham wants to live, but is making an irrational choice towards that end. I'm not sure that we're obliged to respect patently irrational choices when the stakes are this high (age * chance of survival).
Jadagul | August 1, 2006, 6:43am | #
You say that, Eric, but who defines "patently irrational" and who defines "stakes"? My grandmother could tell me that denying God is patently irrational, and the stakes are eternal damnation (for that matter, isn't that basically Pascal's Wager?). Even though it really, really sucks in this instance, I think we basically have to keep the government out of this kind of decision.I wrote about this in more detail on my blog.
Again | August 1, 2006, 7:00am | #
"A child's rights are vested in his parents. Only in extreme cases when it can be shown that a parents decision rises to the level of abuse or neglect can we as libertarians condone state interference."Couldn't you argue this is essentially one of those cases?
The first hit I get for Hoxsey treatment is this:
http://www.bccancer.bc.ca/PPI/UnconventionalTherapies/HoxseysHerbalTonicHoxseyHerbalTreatment.htm
Mr. F. Le Mur | August 1, 2006, 7:17am | #
The first hit I get for Hoxsey treatment is this: says:"Review by the NCI of the 'cures' from these treatments failed to reveal any evidence of effectiveness for these patients with cancer."
IOW, for him it works just as well as, if not better than, his already-failed 'conventional' treatment.
But it shouldn't make any difference unless your rights are dependent upon statistics about other people.
thoreau | August 1, 2006, 8:03am | #
Only in extreme cases when it can be shown that a parents decision rises to the level of abuse or neglect can we as libertarians condone state interference.And the question is whether this is one of those extreme cases. I think a good argument can be made that it is.
Now I'm going to give a cruel answer to a question that Cathy Young posed:
But what happens when the result of a principle is a dead child?
Natural selection.
He Who Shall Remain Nameless | August 1, 2006, 8:33am | #
Starchild? The only thing the state should be forcing the kid to do is change his name.thoreau | August 1, 2006, 8:36am | #
Good catch, You Who Shall Remain Nameless. (Judging by your email address, I'm guessing your name is a reference to Enoch Root?)The fact that his name is "Starchild" explains quite nicely why he and his parents prefer some sort of quack remedy.
Come on, you know I'm right.
I think you have to let the kid and his parents decide this. I can imagine a terrifying slippery slope if the right to refuse medical care is not available. Lord know the Terri Schiavo nuts would keep people alive in horribly degrading ways just to satsify their extreme "pro-life" ideas. Life without freedom is hardly a life.
Jennifer | August 1, 2006, 8:39am | #
Personally, I've always opposed the religious exemption to the rule that parents must provide medical care. If a Christian Scientist's child dies of appendicitis because her parents opted for prayer rather than an appendectomy, how is this death any less permanent than that of a child who dies of appendicitis because her parents were too lazy or stingy to get the treatment?A few years ago I read an article in Newsweek about a loathsome man who belonged to one of those no-medicine Christian fringe cults. He didn't lose his faith in God or the cult while he watched his two kids die in diabetic comas, but later he developed back problems and left the cult to enjoy the benefits of secular pain meds. Personally, I thought life in prison with no chance of parole or medical care would have been a fitting end to his story.
He Who Shall Remain Nameless | August 1, 2006, 8:57am | #
I'm guessing your name is a reference to Enoch Root?NERRRRRRRRRRRRRRRRRRRRRRD!
Cab | August 1, 2006, 9:06am | #
The fact that his name is "Starchild" explains quite nicely why he and his parents prefer some sort of quack remedy.I'm going to assume you are just being silly. I think the fact that Starchild has already undergone chemo (prior to the alternative method), makes that statement false.
Anyway, on another note, I don't see anything 'anti-libertarian' about the State stepping in to protect a child from neglectful parents. In fact, just the opposite, one of the few legitimate roles the government has is protecting people from those that will do harm.
I wish I knew more about the alternative treatment. To me, this decision boils down to the efficacy of the two competing treatments.
So the original judge ordered him to undergo treatment. What happens if he refuses? Is he strapped down like a prisoner to have poison pumped into him? Phrased that way, I would side with the family. This is government sanctioned assault and battery. Additionally, if the judge is forcing him to undergo treatment that he does not want and will presumably have to pay for, that seems like a taking to me. I do not see why he could not sue to have the government cover his medical bills.
My question is this. What's the difference between a teen and his parents agreeing on a medical decision, and an adult making a decision for himself?
P Brooks | August 1, 2006, 10:12am | #
"And yet the fact is that without conventional treatment, Abraham is virtually certain to die."Young Mr Cherrix is unquestionably certain to die, with or without conventional treatment. It's best not to lose sight of that fact.
___________
Remember: "There's nothing wrong with you that an expensive operation can't prolong."
John DeWitt | August 1, 2006, 10:18am | #
The argument for a principled opposition to state infringements on liberty is a compelling one. And yet at what point does such opposition turn into upholding ideology over common sense?Not at all, Cathy. I can condemn someone's foolishness, but still defend his right to be a fool as long as he's only hurting himself. To whom does he belong? To himself? To me and you? To the state? Who gets to decide such things for him? You either believe that we own ourselves, or you don't. There is no middle ground.
In any case, as others have already pointed out, the kid already went through a full round of chemo, with all the agonies that entails. I've seen that, and I'm in full sympathy with anyone who decides that death might be preferable.
Reformed Republican | August 1, 2006, 10:19am | #
I could understand state intervention if the teen wanted treatment, but parents refused. This is not the case. The teen is making a choice to refuse treatment, and his parents support it. There is no abuse or neglect here. Regardless of the effectiveness of the alternative treatment, it is his choice. For the state to take custody and force treatment is intrusive and a bit frightening.JMoore | August 1, 2006, 10:21am | #
Here's a question: What if the kid was not taking, or even interested in, "alternative therapy"? What if he were just refusing chemo?We can easily fault a belief in quackery, but can we fault an apparently intelligent, well-spoken young man's (and in TV interviews, he does seem remarkably clear-headed) refusal of chemotherapy?
I think not.
One big problem is that he is BOTH a child and a young man. For a six-year-old, I'd say screw the parents' bizarre desires and use the best medicine has to offer. But for a 16-year-old? Perhaps the best solution is to let him make his case in front of a judge--with no parents or public officials present. If he can convince said judge (whose responsibility would be highly UNenviable) that he has given enough thought to the matter, and that he is literally risking his own life, then let him choose. However, if the judge believes that he is still too much of a child to know better, then let the state take over.
It's not perfect, but laws and customs regarding children never are.
Cab | August 1, 2006, 10:58am | #
There is no middle ground.Of course there is middle ground. As stated earlier, If the kid was 8 years old and diabetic, and his parents refused insulin, the State should step in. We've chosen 18 as the arbitrary cut off point for being mature enough to make decisions such as this.
If the parents don't offer insulin to an 8 year old, that is considered a crime. People ( even people 'that own themselves') are entitled to protection form crimes when possible.
Frankly, I think the kid should seek emancipation from his parents. The court would have to then consider him an adult, therefore leaving no reason to interfere.
Robert | August 1, 2006, 10:58am | #
Do any of you think the judges in these cases face any different considerations from what any of us are considering? Or that they consider them any differently? I doubt that any of these judges are thinking, for instance, of the sovereign's ownership of the kid as catapult fodder.A big and usually unspoken factor in such decisions is whether there's an after-life, and if so whether after-life is common or uncommon, lasting or ephemeral, and how the quality or duration of after-life compares to that of regular life. Unfortunately there's very little evidence one way or another on any of those questions, so persons make tacit assumptions about the answers. I suggest that "survival" research (evidence concerning after-life) could help with such situations and others, but currently it is vexingly linked to religious beliefs. If it's been difficult to disentangle regular biology (e.g. regarding evolution) from religion, how hard will it be to conduct "after-biology" objectively?
I don’t have a constructive opinion about the afterlife stuff, but I have thought about what the judge in this instance is thinking. I came to the conclusion that if it were me, I would have to put aside the question of why I was put in a position to make the decision. Once I realized that, for whatever reason, it were up to me to decide what is best for the kid, I would base my decision on science. If chemo gave the kid a significantly higher chance of surviving, I would choose it. If it didn’t, I wouldn’t. Fuck his parents, fuck libertarianism, fuck me. Of course, from afar, we will all just spout on about how noble to ‘the cause of freedom’ we would have been. I call bullshit.
Warren | August 1, 2006, 11:25am | #
I think there are a couple of key points that need to be made regarding chemotherapy. First of all, it is quite literally, gut wrenching agony. JKoerner's description, "strapped down like a prisoner to have poison pumped into him", is not figurative, it is literally what we are talking about. Mandatory treatment would be torture for the boy, and his parents would have to watch their child suffer (I'm not suggesting that they would be compelled to watch by the state). Second, since he has already undergone one round of chemo and his cancer has returned, it is more likely (than the first time) that the cancer will return after this round. (Ms. Young claims that "despite the evidence of his relapse, has very good prospects of recovery with conventional treatment". However, she supports this assertion with a link to the National Cancer Institute's clinical trials database. Perhaps there is validation for Ms Young's claim there, but anyone not intimate with medical research documentation would be hard pressed to find it. I suspect even a trained professional would require the better part of a day for sifting before rendering a conclusion. At any rate even if we accept that Starchild has very good prospects of recovery, that also means he has moderate prospects of relapse).Jennifer's example of parents praying over their child while his appendix bursts, is a much better case for state intervention. Better because; The prospect for recovery with treatment is outstanding. Without treatment, death is not only near certain, but imminent. And especially because treatment will put an end to the child's suffering, and forgoing treatment will prolong it.
In the Cherrix's case, I just don't think it's a close call.
Jennifer | August 1, 2006, 11:28am | #
If the parents don't offer insulin to an 8 year old, that is considered a crime.Unless the parents claim they withheld the insulin because they thought that's what God wanted them to do.
gaijin | August 1, 2006, 11:49am | #
The simple (minded?) answer here is to ask yourself......any decision you'd like to make for yourself...do you think someone else should make it for you?
bubba | August 1, 2006, 12:01pm | #
Our ability to conjure examples where we would want the state to intervene (there's a bomb on the subway) is moot. This is a young adult who has come to a decision, with the support of his parents, after having experienced first hand the recommended treatment.What grounds are there for State intervention?
There will be one less Starchild voting in 2008 and one more datapoint against whacko therapy, OR the kid will recover. Either way the State lets us keep our rights for another day.
There is no downside.
John DeWitt | August 1, 2006, 12:01pm | #
Of course there is middle ground. As stated earlier, If the kid was 8 years old and diabetic, and his parents refused insulin, the State should step in.To keep its property from being damaged? I can certainly see a case for someone stepping in - someone who's actually involved. Grandparents, uncles, siblings. But who died and made the State Big Brother?
We've chosen 18 as the arbitrary cut off point for being mature enough to make decisions such as this.
Who's this "we" I keep hearing about? I don't remember the questionnaire that asked me at what arbitrary age it's okay to stop needing a nanny with SWAT teams and snipers.
Given that this kid has been raised by people who named him "starchild" (maybe death doesn't seem so bad compared with another year of high school for him?), he may very well lack the ability to make a rational decision until atleast his 2nd year of college (in a different town). If he continues to choose alternative therapies after that age then it's another one for natural selection.
thoreau | August 1, 2006, 12:14pm | #
I can certainly see a case for someone stepping in - someone who's actually involved. Grandparents, uncles, siblings. But who died and made the State Big Brother?Fair enough. So what happens when Grandma takes the kid to a hospital and the parents call the doctors and tell them to ignore Grandma and not treat the kid? If you want Grandma to intervene rather than the State, then Grandma should have some way of prevailing when her case is reasonable. That seems to be the sort of situation that courts were designed for, when there are conflicting claims.
paleosnuffed | August 1, 2006, 12:35pm | #
Those who say the state has no right to intervene at all and for any reason I'd like to ask this question. You walk by the neighbor's house and happen to see the father beating the crap out of their son. Do you think at any point the police should be called? Or can parents do whatever they want with their child because the child belongs to the parents?paleosnuffed | August 1, 2006, 12:36pm | #
Those who say the state has no right to intervene at all and for any reason I'd like to ask this question. You walk by the neighbor's house and happen to see the father beating the crap out of his son. Do you think at any point the police should be called? Or can parents do whatever they want with their child because the child belongs to the parents?We have quickly moved our society from a need for healthcare, to a right to healthcare, to, we are socially responsible to keep ourselves healthy. State intervention is required because you did not make the right decision. The only difference between this and smoking or fast food bans is this has a name and face attached to it.
John DeWitt | August 1, 2006, 1:47pm | #
You walk by the neighbor's house and happen to see the father beating the crap out of his son. Do you think at any point the police should be called? Or can parents do whatever they want with their child because the child belongs to the parents?If you feel justified in intervening, intervene and deal with the consequences. Why call somebody else to do it for you?
And given the frequency with which this hypothetical is trotted out, I've a counter-question: Has this ever actually happened you you? Or to anyone you know? Because it's never happened to me.
paleosnuffed | August 1, 2006, 2:35pm | #
Okay, John, I take that to be a 'no, there is no limit to what someone could do to their kid that would ever justify any employee of the state to intervene.'Sorry to tell you that it's not that uncommon for people to abuse their kids. They have even murdered them. But I guess according to your way of thinking that would be interfering with the parent's right to do what they want with the kid. Outside parties could intervene...unless of course they are employees of the state, like the police. Then suddenly, outside parties are verboten.
Robert | August 1, 2006, 2:50pm | #
"I would base my decision on science. If chemo gave the kid a significantly higher chance of surviving, I would choose it. If it didn’t, I wouldn’t."With no consideration as to quality of life?
And now imagine how your decision might change if you had evidence you thought to be, say, 50% reliable, that 90% of vertebrates on dying would be immediately reincarnated randomly (in proportion to their numbers) as vertebrates.
CrackerBarrel | August 1, 2006, 3:06pm | #
I don't know a lot about the ethics and legalities that are involved here.I believe that we each own ourselves. When sufficiently young people are involved, authority should devolve to parents/guardians by default. This should also be the case for older persons who have diminished capacity to decide for themselves. If no parents/guardians exist, then I guess the state should step in.
While trying to figure out where I stand on this case, I wondered what the difference is between what young Cherrix and his parents decided and a "Do Not Resuscitate (DNR)" order. Both involve decisions about the course and nature of medical care. Apparently, a DNR and the Cherrix's decision to use alternative treatment both result in decreased likelihood of long-term survival. Why is the one accepted by the state, but the other controversial? "I choose to use a DNR for myself. I acknowledge that my life might thereby be shorter than if the latest technology were to be used instead." Substitute "the Hoxsey Method" for "a DNR" above. How does that change anything?
I agree with Warren: At least with today's technology, we all die eventually.
CrackerBarrel.
I really sympathize with everyone who wants to force Starchild to take a chemo course. His parents seem to be complete kooks, and we want to protect them from him. But first, he seems basically old enough that we need to let him make some decisions for himself. And second, medical decisions are the absolute worst place (excepting perhaps psychologyical treatments, if we count them as a separate category) for the state to involve itself in private family decisions. I worry about the day when governments make all treatments for children either mandatory or forbidden, so that we don't get any choice (and with the FDA's track record, we might be better off if those lists switched). Or even worse, when the government edges from medicine into psychiatry, and forbids parents to teach religion because it's psychologically damaging to the child.
Kent_Geek | August 1, 2006, 3:47pm | #
I think its a little unfair for Cathy to characterize people who agree with the judge's decision as "cheering" for it. It's a wrenchingly difficult decision for everyone concerned. In the end, even though I disagree with this young man's thinking, I feel we should allow him (and his parents) the freedom to live and die on his own terms.It's sad that our educational system doesn't make life more difficult for quacks, but a committment to freedom means you have to accept some pretty ugly realities now and then.
John Rhoads | August 1, 2006, 3:52pm | #
Most of the analogies used to justify the state's case in this are grossly misrepresentative of the situation. The person in question is 16, not 6, and perfectly capable of making his own decisions in this matter. Chemotherapy, for those of you who have not seen it first hand, literally is poison. It is an extremely painful form of treatment that is sometimes successful at treating cancer and sometimes is not. Rational people make the decision not to get chemo all the time. In the case of a relapse, chemotherapy is not very likely to permanently solve the issue. This 16 year old would most likely live longer with the chemo, but his chances of reaching his 70s are virtually 0. There certainly are a lot of interesting issues that childhood brings up with respect to libertarianism, but the intervention of the state in this particular case is so hard to justify that it is only the (completely not-analogous) analogies that people mention on this thread that addresses these issues.I'd be willing to bet that the 16 year old in question is fully aware of the choice that he is making. It's not comparable to child abuse, unless you want to argue that the hypothetical beaten child I keep seeing mentioned on this thread *wants* to be beaten by his parents. He has made a choice that is perfectly reasonable, his parents agree, and still the state wants to force him to undergo an extremely painful (lasting pain too) procedure that is still unlikely to result in him living into adulthood. (even though he will probably live longer if he gets it) This just seems absurd to me.
Lost_In_Translation | August 1, 2006, 5:43pm | #
I think the real question is,"Why do we care if this kid lives or dies?"
No coercion seems to be in play and the parents have managed to raise him almost to adulthood before any controversial decisions seem to have been made. If they choose a path for their child that may result in his death and he agrees, why do we care?
downstater | August 1, 2006, 5:55pm | #
i'm not so sure that it's even fair to characterize the kid's parents as kooks.if you view 18 as an arbitrary age to be an adult (and the kid comes across as much more mature than most people over 18 that i have ever met) then what is so kooky about treating your son who thinks and behaves like an adult, as an adult and consequently respecting his decision?
it's not as if the parents didn't consent to chemotherapy in the first place.
i'd cut them some slack. i wish more REAL adults could learn to treat young adults as they are.
mr. anderson | August 2, 2006, 3:44am | #
"Most of the analogies used to justify the state's case in this are grossly misrepresentative of the situation. The person in question is 16, not 6, and perfectly capable of making his own decisions in this matter."I agree that in this situation an outside legal authority intervening is not justified. Yet, one view on this thread is based on a principle that parents are the sole or final authorities on any treatment of any kind for a minor. I think that principle is way too powerfully applied if applied as an axiom.
16 is definitely not 6 but the line does need to be drawn somewhere, however arbitrary it might be, at what age people can make all decisions for themselves.
John Rhoads | August 2, 2006, 11:41am | #
I agree that the line for adulthood needs to be drawn somewhere, but comparing a 16 year old deciding not to get chemo to a parent beating or not feeding a 6 year old is just absurd. I know you don't disagree, but just thought I should reiterate that point.