Ethics of Intervention
When beliefs, and consequent decisions, collide between a family and the government, who should hold final authority as to the "right" course of action to follow? Given that no laws or statutes are being violated in terms of abuse or obvious neglect, does a family have the right to make decisions contrary to conventional wisdom regarding the welfare of family members?
Apparently not. Consider the Abraham Cherrix case currently being ajudicated in Virginia.
(Story here)
On the surface this case would seem to be a conventional medicine v. alternative medicine debate. If you happen to be an alternative medicine advocate, you could certainly read that into this story. But that isn't the foundational issue. The issue is freedom of belief and the ability to act on those beliefs within our current system of democracy and associated justice system.
Does the Cherrix family have rational grounds for their beliefs? The state says "No, they don't." As a result of the Child Services position, the parents have been charged with parental neglect and are under a court order to share custody of their son with the state Child Services agency. In fact, the recent ruling by Judge Demp orders the parents to present their son to the hospital by next Tuesday (25 July) for his second round of chemotherapy, against the beliefs of the family and of the patient, Abraham.
Of interest is a comment taken directly from the National Cancer Institute's website (www.cancer.gov) : "Sometimes people use statistics to try to figure out their chances of being cured. However, statistics reflect the experience of a large group of patients. They cannot be used to predict what will happen to a particular patient because no two patients are alike; treatment and responses vary greatly. The doctor who is most familiar with a patient's situation is in the best position to help interpret statistics and discuss the patient's prognosis."
The state bases it's findings of parental neglect on the efficacy of conventional treatments for teenage Hodgkin's disease patients - and the fact that the Cherrix family eschews those efficacy statistics in favor of the previous chemotherapy experience of their own son. Abraham's first round of chemotherapy left him completely incompacitated, and failed to put him into remission. As pointed out above - statistics cannot predict what will happen to a particular patient.
So - where is the line of ethical intervention here? No amount of hand-wringing over the merits of the case will produce an answer - all we are left with is consideration of the possible outcomes. First, outcomes associated with the will of the family:
- Abraham may not survive. If this is the outcome then the family will have participated in the process, as an intact family unit, and as a process of action that matches their beliefs.
- Abraham may survive. Again, an outcome that includes the process of freedom of belief for an intact family.
The outcomes associated with the state's position are significantly weaker:
-Abraham may not survive. If this is the outcome, after having compelled the youth to submit to chemotherapy against his will and the beliefs of the family - woe to all the government participants in this case. While there are no guarantees for remission in any treatment modality, having seized authority to execute the will of the government - they better be prepared for a debilitating blow back in the face of this outcome.
In fact, should the 16-year old refuse to submit to this second round of chemotherapy by Tuesday, the state has few options other than to start holding people in contempt of court - with resultant jail time as the only leverage. I suppose the court could order the administration of chemotherapy such that Abraham is strapped to a gurney or is anethestized during the procedure. I'm not sure which oncologist they would recruit to so greviously violate the hippocratic oath - perhaps from a death-row prision.
-Abraham may survive. This is the best outcome the state can hope for - and it will be questionable at that point whether his survival was actually contingent on the state's intervention - or would have occured under some other modality. The state, in essence, does not have a "we did the right thing" position. By invading the structure and functioning of this family, given the age and desires of the patient, they have entered into a "we know what is right" position though they can only hope and pray that the conventional mode of treatment will bring him into remission. In short - they have no better rational ground to stand on then the family itself.
Some may say that the life of this teenager is at stake and that all should be done to preserve his life. It is true that his life is at stake. But as in the Terri Shiavo case, there is no guaranteed outcome. Governmental influence in the Shiavo case, in the end, made laughing-stocks out of the politicians that entered into the fray to preserve her "life." Note that the most vocal of those politicians regarding that case won't utter a word about it now - and a few have been subsequently disgraced for unrelated unethical actions on their part - these paragons of virtue and the "culture of life."
The presiding Judge in this case - Judge Jesse E. Demps, has a few road bumps in his own past, such that the Virginia State Bar sanctioned him in November, 2002. (Sanctions here). While this information may not be particularly relevant to this case - it does illuminate the fallibility of all of us - and in instances where the outcome is empirically unclear - it would be reasuring to hear the government comment that, "We're really not too certain about this either."
Unfortunately, it seems in the environment today that state child services agencies have gone the way of the Papal Bull of Infallibility. While this parallelism may be unfair to the Catholic Church - unlike faith, the Cherrix family does not have the freedom to accept or deny the doctrine - they are under court order to submit.
Truly - a fine representation of the modern secular Auto De Fe.
God help us all.
Apparently not. Consider the Abraham Cherrix case currently being ajudicated in Virginia.
(Story here)
On the surface this case would seem to be a conventional medicine v. alternative medicine debate. If you happen to be an alternative medicine advocate, you could certainly read that into this story. But that isn't the foundational issue. The issue is freedom of belief and the ability to act on those beliefs within our current system of democracy and associated justice system.
Does the Cherrix family have rational grounds for their beliefs? The state says "No, they don't." As a result of the Child Services position, the parents have been charged with parental neglect and are under a court order to share custody of their son with the state Child Services agency. In fact, the recent ruling by Judge Demp orders the parents to present their son to the hospital by next Tuesday (25 July) for his second round of chemotherapy, against the beliefs of the family and of the patient, Abraham.
Of interest is a comment taken directly from the National Cancer Institute's website (www.cancer.gov) : "Sometimes people use statistics to try to figure out their chances of being cured. However, statistics reflect the experience of a large group of patients. They cannot be used to predict what will happen to a particular patient because no two patients are alike; treatment and responses vary greatly. The doctor who is most familiar with a patient's situation is in the best position to help interpret statistics and discuss the patient's prognosis."
The state bases it's findings of parental neglect on the efficacy of conventional treatments for teenage Hodgkin's disease patients - and the fact that the Cherrix family eschews those efficacy statistics in favor of the previous chemotherapy experience of their own son. Abraham's first round of chemotherapy left him completely incompacitated, and failed to put him into remission. As pointed out above - statistics cannot predict what will happen to a particular patient.
So - where is the line of ethical intervention here? No amount of hand-wringing over the merits of the case will produce an answer - all we are left with is consideration of the possible outcomes. First, outcomes associated with the will of the family:
- Abraham may not survive. If this is the outcome then the family will have participated in the process, as an intact family unit, and as a process of action that matches their beliefs.
- Abraham may survive. Again, an outcome that includes the process of freedom of belief for an intact family.
The outcomes associated with the state's position are significantly weaker:
-Abraham may not survive. If this is the outcome, after having compelled the youth to submit to chemotherapy against his will and the beliefs of the family - woe to all the government participants in this case. While there are no guarantees for remission in any treatment modality, having seized authority to execute the will of the government - they better be prepared for a debilitating blow back in the face of this outcome.
In fact, should the 16-year old refuse to submit to this second round of chemotherapy by Tuesday, the state has few options other than to start holding people in contempt of court - with resultant jail time as the only leverage. I suppose the court could order the administration of chemotherapy such that Abraham is strapped to a gurney or is anethestized during the procedure. I'm not sure which oncologist they would recruit to so greviously violate the hippocratic oath - perhaps from a death-row prision.
-Abraham may survive. This is the best outcome the state can hope for - and it will be questionable at that point whether his survival was actually contingent on the state's intervention - or would have occured under some other modality. The state, in essence, does not have a "we did the right thing" position. By invading the structure and functioning of this family, given the age and desires of the patient, they have entered into a "we know what is right" position though they can only hope and pray that the conventional mode of treatment will bring him into remission. In short - they have no better rational ground to stand on then the family itself.
Some may say that the life of this teenager is at stake and that all should be done to preserve his life. It is true that his life is at stake. But as in the Terri Shiavo case, there is no guaranteed outcome. Governmental influence in the Shiavo case, in the end, made laughing-stocks out of the politicians that entered into the fray to preserve her "life." Note that the most vocal of those politicians regarding that case won't utter a word about it now - and a few have been subsequently disgraced for unrelated unethical actions on their part - these paragons of virtue and the "culture of life."
The presiding Judge in this case - Judge Jesse E. Demps, has a few road bumps in his own past, such that the Virginia State Bar sanctioned him in November, 2002. (Sanctions here). While this information may not be particularly relevant to this case - it does illuminate the fallibility of all of us - and in instances where the outcome is empirically unclear - it would be reasuring to hear the government comment that, "We're really not too certain about this either."
Unfortunately, it seems in the environment today that state child services agencies have gone the way of the Papal Bull of Infallibility. While this parallelism may be unfair to the Catholic Church - unlike faith, the Cherrix family does not have the freedom to accept or deny the doctrine - they are under court order to submit.
Truly - a fine representation of the modern secular Auto De Fe.
God help us all.
posted by Scott Scofield | 8:11 AM
2 Comments:
Excellent writings my friend.
Interesting discussion
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