Thursday, July 7, 2016

Government, Parental Rights, and medical treatment

A few weeks ago in Brantford, Ontario, Canada, a judge made an amazing ruling in favor of a child of First Nation (also called aboriginal Canadian – what we used to call Indian) parents. “Amazing,” because Justice G.B. Edward decided that the family’s aboriginal rights trumped the wishes of McMasters Children's Hospital.
The hospital had petitioned that custody of the little girl be transferred from her mom to the child-welfare authorities so they could force chemotherapy on her. The judge’s decree stated:
“This is not an 11th-hour epiphany employed to take her daughter out of the rigours of chemotherapy. Rather, it is a decision made by a mother, on behalf of a daughter she truly loves, steeped in a practice that has been rooted in their culture from its beginnings.”
Editorializing on this, Raymond Critch of The Independent said that “settler Canadians” (what the rest of us would call “Canadians” – this whole political correctness thing has gotten out of hand, hasn’t it?) were “outraged at the double standard. The courts have forced medical treatment on other Canadians, so why not aboriginals?”
Critch then went on to explain to these outraged settlers why it’s okay to force medical treatment on them, but not okay to force medical treatment on Indians – I mean aboriginals.
“Aboriginal status is like a second citizenship. So the better comparison is not with Jehovah’s Witnesses rejecting blood transfusions for themselves or their children. The right comparison is with the child of a diplomat, living in an embassy. Would it be acceptable for the government of Canada to invade an embassy in Ottawa to force medical treatment on the child of a foreign diplomat? The honest answer to that question is, I’m not sure. Maybe it would be justified to spark an international incident to save a child from their well-intentioned but ignorant parents. Maybe it wouldn’t.”
I agree with Critch’s sovereignty example: invading the Chinese embassy to force medical treatment on anyone, even a child, would be an act of war. But he seems to be saying that, all other things being equal, it’s okay to overrule other “well-intentioned but ignorant parents.” So much for the principle of "A man's home is his castle."
The hubris of calling a parent “ignorant” is astounding. Ignorant compared to whom? What does Critch know of aboriginal Canadian medical treatments? I'll give him the benefit of the doubt here and assume he knows more than I do, but does he know enough to call aboriginal parents 'well meaning but ignorant'? Does what he THINKS he knows come from aboriginal Canadians or from the mainstream medical intelligentsia?
A few months ago I did a series of columns on advances in blood medicine. As part of that series I had occasion to educate myself about the stance taken by Jehovah’s Witnesses. They are probably more knowledgeable about blood medicine than any other patient a doctor will ever work with. They have to be: having decided they won’t take blood, they need to know everything they can about alternatives available to them. In some cases, they have to educate doctors and hospital staff about alternatives.
For example, in my research I learned about a chemical I'd never heard of, called tranexamic acid, TXA for short. It is practically a wonder drug at controlling bleeding. Yet the comments about that column on my Facebook page suggested that few individuals in the medical profession were even aware that TXA could be lifesaving in ER, Post-Op, and post-natal scenarios... they only knew it as a hemophilia treatment. And some hadn’t heard of it at all.
Mr. Critch’s assumption, that any parent who disagrees with the medical establishment is ‘well-intentioned but ignorant,’ betrays a common bias. Who knows a child’s needs better: her mother, or Child Welfare? And there is another flaw in his logic: Neither he nor the medical community would ever have heard of this patient unless her parents had shown up at a medical facility in the first place! They came to find out why the child was sick. How can a case be made that these are unfit parents? The case resulted, not from bad parenting but from an egotistical doctor whose pride was hurt that his treatment protocol wasn’t accepted as gospel.
It is the doctor’s opinion that chemotherapy is the only way to defeat her leukemia. Okay, he’s entitled to his opinion. But are there other treatments, even treatments he doesn’t think are as good, perhaps even treatments he thinks are malarkey or voodoo? The simple answer is, yes there are. The leukemia cure rate for chemotherapy is 40%, not 100%, or even 90%. I think calling it "lifesaving" is a bit of a stretch. What's the cure rate for alternative therapies? I don't know. Does the doctor?
So: his job is to educate these parents. Give them all the information they need to make an informed decision. Once he has done that, he has discharged his responsibility. If their informed decision after that point doesn’t agree with his, too bad. Accept that they disagree. Or admit you did a poor job of educating the parents. Or try explaining it again a different way. Or try researching alternative treatments that might win the parent’s approval. But in the end it is their decision, not his. How can he know for certain that the treatments they opt for won’t work? Is he an expert on that particular mode of treatment? As the saying goes, ‘To the person who is good with a hammer, every problem is a nail.’ (Incidentally, if you click on the three links in these paragraphs with the word "treatments", you'll find three different approaches to treating leukemia without chemotherapy.)
Does this mean a judge should never interfere, that parents are always right? Of course not. But if this trend continues, schools will be petitioning courts to have parents declared unfit for packing their kids' lunches rather than agreeing to the cafeteria's menu. Don't laugh - it has already happenedMore than once.
Imagine you are the judge being asked to rule parents unfit because they had the audacity to disagree with the treatment outlined by a doctor. Would that be enough for you? Wouldn’t you look at the child’s whole environment? Wouldn’t you ask: Is this child being properly fed, clothed, housed, and disciplined? Are his parents seeing to it that he is being taught, not just schoolwork but values, morals and manners that will make him an asset to the community? If the answer to all that is “Yes,” then how could you possibly rule the parents are unfit?
If you were the judge, would you allow the opinion of a doctor or team of doctors to persuade you? What kind of judge would you be if you were swayed by emotional claims about “lifesaving” treatment? Thousands of cancer patients die every year in spite of receiving "lifesaving" chemotherapy. And thousands of cancer patients have survived despite refusing it. I’ve read hundreds of articles about blood transfusion. Nearly all of them were sprinkled – if not littered – with the adjective “lifesaving.” Yet thousands of patients die each year in spite of being transfused, and thousands more live despite refusing blood.
If you were going to judge a case like this, wouldn’t you need to be informed about alternative treatments?
At what point does the government’s responsibility for the welfare of a child outweigh the parent’s responsibility? Sadly, for some judges, that point is far too easily reached. Kudos to Judge Edward.

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