Do Parents Have the Right to Refuse Standard Treatment for Their Child With Favorable-Prognosis Cancer? Ethical and Legal Concerns

Abstract

A 7-year-old boy presenting with bone pain and fever was found to have standard-risk pre–B-cell precursor acute lymphoblastic leukemia (ALL). Parental written consent was obtained to begin a standard 3.5-year chemotherapy treatment regimen with an estimated 85% chance of long-term survival. Induction chemotherapy was successful in producing remission; however, after 3 months of chemotherapy, the parents opposed continuation of the standardtreatment,citingconcerns thatchemotherapy would damage their son’s immune system and cause other long-term problems. As a replacement for standard treatment, the parents elected to pursue alternative holistic approaches including nutritional supplements, dietary changes, and stress reduction techniques. The parents transferred the care of their child to a licensed family medicine physician who was board certified in holistic medicine. The new physician agreed to monitor the patient’s blood counts to monitor the leukemia, and if the patient’s blood counts suggested relapse, he would refer him back to a pediatric oncologist. The Department of Job and Family Services in the patient’s county of residence was notified, and a hearing was held in the county Court of Common Pleas (family court division) to determine whether the parents were guilty of neglect and whether standard therapy should be mandated. The pediatric oncologist involved with this case testified that he believed that stopping standard therapy at this point would almost certainly result in a return of the leukemia. Furthermore, he testified that the child’s likelihood of being cured would be significantly less on relapse. The court dismissed the case stating that the parents’ “concerns about long-term effects of chemotherapy” did not qualify as neglect. Furthermore, the court recognized that the patient was under the care of a licensed physician and refused to judge the relative merits of the two different treatment options recommended by two different physicians licensed to practice medicine in the state. After the hearing, the holistic physician was reported to the State Medical Board to determine whether he had “departed from or failed to conform to minimal standards of care.” After an investigation, the Secretary and Supervising Member of the State Medical Board determined that formal disciplinary charges were not warranted. Approximately 4 months after the court’s decision, the patient experienced a recurrence of acute leukemia.