Parents' refusal of cancer therapy raises issues

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children and parentsUnder U.S. laws, parents have wide discretionary authority in raising their children. However, when a child has cancer, and parents and cancer specialists disagree about how to treat it, a number of ethical and legal concerns come into play.

In the Journal of Clinical Oncology, Dr. Jeffrey J. Hord and colleagues explore the fallout from such decisions, made in six children over the last 30 years.

Hord, of Children's Hospital Medical Center of Akron, Ohio, told Reuters Health that in these cases "standard treatment for a favorable prognosis cancer was stopped prematurely at the request of parents who wished to pursue alternative interventions such as Bible readings, chelation, dietary changes, and medications not approved in this country such as amygdalin, Laetrile."

All of these children, he added, "had a 60 percent to 90 percent chance of long-term cure with standard treatment."

The cancer experts providing care in these situations, Hord went on to say, are obliged to report the parents to legal authorities -- as refusal of standard therapy places the children at clear and substantial risk of harm. This position is supported by both the American Academy of Pediatrics and the International Society of Pediatric Oncology.

Nevertheless, the courts' position in such situations has been inconsistent. In two of the six cases, the courts upheld the parents' point of view.

"Cases such as these often grab the attention of the media and the public early during the dispute," continued Hord. "There are often public expressions of great sympathy for the parents and outrage that the parents are having to deal with the additional stress of a court proceeding and potential loss of custody. However, rarely is there any media attention or public outcry when these children have disease recurrence or die as a result of halted therapy."

Hord and his colleagues write that "when dealing with patients with poor prognosis, limiting medical therapy is reasonable, ethical, and morally defensible because the burdens of therapy may outweigh the benefits, and parents must consider quality of life."

On the other hand, they conclude, "when standard therapy offers a high likelihood of long-term survival and a reasonable quality of life, it is difficult for the managing physician to understand withholding such therapy."

SOURCE: Journal of Clinical Oncology, December 2006.

Copyright © 2007 Reuters Limited

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