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Tuesday, October 2nd 2007

Age of Consent

Who remembers Starchild Abraham? This is the 16 (now 17) year old with relapsed lymphoma who tried to turn down another round of chemo and radiation therapy. In a “sickening” compromise (what good is a “compromise” otherwise?) Virginia child services and him and his family decided he could forgo chemotherapy as long as he agreed to radiation therapy.

Well, his cancer is in remission…again, but he still doesn’t want chemo.

A 17-year-old who won a court battle against state officials who tried to force him to undergo chemotherapy for his lymphatic cancer is in remission following radiation treatments over the past year, the teen and his doctor said.

Cherrix is not cured, but “he is N.E.D., our abbreviation for ‘no evidence of disease.’ He’s in a total remission,” [his radiation oncologist, Dr.] Smith said Thursday.

“There may be some microscopic tumor somewhere still there, but everything we see is gone,” Smith said.

Kind’ve happy, kind’ve sad news. His odds of relapsing are obviously very high. Beyond the plight of Starchild, there is something disturbing for the big picture. The reason I’ve revisited this story is because of this paraphrase,

Art Caplan, director of the Center for Bioethics at the University of Pennsylvania, doubted the immunotherapy had value. But he said Cherrix’s seemingly improved health shows the state was right to intervene.

“He’d probably be dead by now if they (state officials) did not react,” Caplan said.

As I’ve said before: I don’t know Starchild or his family, I don’t know how mature he is, I don’t know his level of understanding and competency. But if he meets a kind’ve minor threshold on those measurements, what is Art Caplan doing promoting this kind’ve paternalistic beneficence over Starchild’s autonomy? Maybe the reporter took whatever quotes provided in part out of context.

Even so, there are plenty who have jumped to the side of the state in forcing treatment on this kid. Yikes.

The Center for Bioethics at UPenn is pretty darn prestigious and I’m sure Dr. Caplan is incredibly well respected. But I just don’t understand how he and so many others jump on this kind’ve arbitrary date for granting autonomy. As Art Caplan himself has published,

When a patient wants to follow nontraditional medicine and chooses not to enter the hospital, no one can force him or her to do so even if it means the loss of his or her life and much grief for his or her spouse and family.

But not before you’re 18? Ethics is certainly not equivocal with law. These are separate issues: when the state grants autonomy and when it actually exists. Shouldn’t we explore each case independently? Apparently not if the reporter’s presentation of Dr. Caplan’s position is to be taken at face value (which you certainly can’t always do); the ends justify the means.


Bioethics Rule #1: Patient Autonomy
Bioethics Rule #2: Don’t Create Superintelligent Mice Bent On World Domination

I agree with every level headed health care provider out there in that Starchild was pursuing hopeless “woo” instead of reinduction chemotherapy. His course was, potentially is, a virtual death sentence.

And I think that is irrelevant.

You cannot use the decision you’re judging (in this case the therapy for his lymphoma) to determine competency or maturity, that’s a ridiculous notion.

And if in all other measurements of competency Starchild was sound then, even with his parent’s influence on his decision, he should’ve been allowed to make it. Like anyone with a heart a part of me is happy to see at least partial therapy put on him. On the one hand it is great seeing him in remission (however long lasting) but at the same time I’m worried about what this says about paternalism in medicine and government. In the end, however happy I am to see him doing well I think you have to let the kid (and indeed any mature patient) make their own decision.

The story is via Orac at Respectful Insolence, who has followed Starchild’s plight with dilligence.

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