Child of the Stars or Ward of the State?

A 16-year-old Virginian with lymph node cancer is sick of chemotherapy; a social worker wants him to be forced to undergo it. A judge has granted a temporary order finding his parents neglectful for allowing him to make his own medical choices, and claims joint custody of young Starchild Abraham Cherrix for the Accomack County Department of Social Services. Starchild's father summed it up well in this Associated Press account:

"What it boils down to is does the American family have the right to decide on the health of their child or is the government allowed to come in and determine that themselves and threaten one way or the other to split our family up?"

A 2001 Reason feature story from me about government and families butting heads over medical decisions about minors.

A 1997 Reason feature story from me about cancer patients--adults and children--who wanted to pursue some very alternative cancer treatments butting heads with an FDA that thought it knew best. Here is a list from the National Cancer Institute of clinical trials involving the particular alternative therapy/rank quackery (you make the call!) at issue in that piece.

Comments

[Dan T.]

Sounds like the government is probably right here, sorry. They very much have the right to protect a child from neglegent parents.

[Born Again Iconoclast]

It's stuff like this and court-ordered medications for young children by idiot judges WITHOUT medical degrees that makes me take my hat off to all you parents out there.

Kids I can deal with, welfare state intervention I can't. I'd love to have kids, but with crap like this I'm afraid I'd just be another Randy Weaver when some hippie-dippie Janet Reno-ish "social" worker came round ...

[Dan T.]

It's stuff like this and court-ordered medications for young children by idiot judges WITHOUT medical degrees that makes me take my hat off to all you parents out there.

I don't know why you would assume the judge is an idiot or why not having a medical degree means that he could not have an informed opinion about this case. Surely a number of medical professionals were consulted?

Kids I can deal with, welfare state intervention I can't. I'd love to have kids, but with crap like this I'm afraid I'd just be another Randy Weaver when some hippie-dippie Janet Reno-ish "social" worker came round ...

Actually, you'd be surprised just how rarely social workers come around to harass good parents. From what I hear, they have more cases of legitimate abuse and neglect than what they can handle.

[Ayn_Randian]

I am going to channel Cathy Young here...

If anything is going to rend libertarians asunder, it will be issues like this. First, this child is not old enough (according to law) to make decisions for himself...whether that law is right is another matter.

How far do we let parents choose? Do we let them disallow innoculations? Getting a cast for a broken arm or leg? If we make parental choice an absolute, make no mistake, kids will die as a result of some asinine cult's (read: the Amish) loony-tunes beliefs about healing and medicine.

OTOH, interference on behalf of "the children" is what's destroying liberties as we speak. If we intervene for their physical health, what about their mental health? Will we let children be raised as communists, or anti-Semites, or neurotics? Where is the line?

Ayn Rand didn't have children, so my knee-jerk answers are lacking on this one:-) I look forward to the Reasonistas duking this out.

[Madog]

Children are a difficult area for libertarianism. Are children property or people? If they're people, then their rights and freedoms need to be protected, even from their parents. Since they can't protect themselves and may not have other family members to do it for them, it's a legitimate function of the state.

Probably 10% of parents out there shouldn't be raising children.

[Jennifer]

I could support the government in cases where the parents are denying the child a proven cure--if your kid has appendicitis and you won't let him get an appendectomy, I think the government should step in. But something like chemotherapy, which is iffy to begin with and might cause as much if not more damage than it prevents, is another matter.

Also, a 16-year-old should have some say in what is or is not done to his body.

[scottp]

They very much have the right to protect a child from neglegent parents.

I don't think these parents are negligent. This kid has been through chemo once and doesn't want to do it again. Who the hell is some social worker to tell him he has to? He's sixteen, not six.

[Dan T.]

Not that it's exactly right, but let's face it - people naming their kid "Starchild" are going to have one strike against them when an outside party is evaluating their competence as parents.

[Dan T.]

I don't think these parents are negligent. This kid has been through chemo once and doesn't want to do it again. Who the hell is some social worker to tell him he has to? He's sixteen, not six.

You answered your own question - he's sixteen, not eighteen.

[MainstreamMan]

That 18 year-old thing ain't so solid in this area:

Here's, for example, the Illinois rules...note sections II & III.

I. The parent generally has the right and duty to make decisions concerning medical care for his/her child.

A. However, the minor may consent:

1. When she is pregnant, she may consent to her own medical care and surgery, 410 ILCS 210/1;

2. When (s)he is married, the minor may consent to his/her own medical care and surgery, 410 ILCS 210/1;

3. When (s)he is a parent, the minor may consent to the medical care, surgery, or dental care for his/her child, 410 ILCS 210/2.

4. When (s)he is 12 years of age or older, the minor may consent to his/her treatment of venereal disease or for abuse of alcohol or narcotic drugs, 410 ILCS 210/4.

5. When (s)he is the victim of a criminal sexual assault or abuse, the minor may consent to his/her medical care and/or counseling. 410 ILCS 210/3.

6. When she is pregnant, she may consent to an abortion if considered mature enough to make that decision or if she can show it is in her best interest. Bellotti v. Baird, 443 U.S. 662, 99 S. Ct. 3035, 61 L. Ed. 2nd 797, (1979).

B. Physicians may consent to and render emergency medical care to a child when a parent is not available during the emergency and it is the judgment of the physician that there is not additional time to await the parent's involvement. Ill. Rev. Stat., Ch. 111, section 4503.

C. Dentists may consent to and render emergency dental care to a child when a parent is not available during the emergency and it is the judgment of the dentist that there is not additional time to wait the parent's involvement. Ill. Rev. Stat., Ch. 111, section 4503.

II. The courts can and will intervene in a parent's decision which places a child in danger or leaves a child in danger of death or permanent harm. Prince v. Massachusetts, 321 U.S. 158, 64 S. Ct. 438, 88 L. Ed. 645, (1944) rehearing denied, 321 U.S. 804, 64 S. Ct. 784, (1944) [a case concerning child labor].

III. A parent's denial of medical treatment necessary to save a child's life is neglect pursuant to the Juvenile Court. Intent to neglect is not a factor Wallace v. Labrenz, 411 Ill. 618, 104 N.E. 2d 769 (1952), cert. denied 344 U.S. 824, 73 S. Ct. 24, 97 L. Ed. 2nd 642 (1952).

[keith]

Thinking out of the box...

Can a social worker make decisions for an emancipated minor? Can the 16 year old seek EM status just to shut up the caseworker?

Of course, the downside: I presume the status of emanicpated minor mean that the parents' (presumably family policy) health insurance could no longer cover him.

[Ayn_Randian]

A parent's denial of medical treatment necessary to save a child's life is neglect pursuant to the Juvenile Court.

In my mind, that settles the legal side of it...now about the philosophical/moral side?

[Cedarburg]

Dan T. writes:

Actually, you'd be surprised just how rarely social workers come around to harass good parents. From what I hear, they have more cases of legitimate abuse and neglect than what they can handle.

In my experience, Children & Youth Services social workers harass any parent brought to their attention who doesn't hew to white, upper-middle-class values. They have power over families that borders on absolute. If you think they only wield that power over abusive and neglectful parents, you are quite mistaken.

[doublespeak]

Morally the kid can solve this himself by removeing himself from the situation...If he is forced to comply then in my mind that is morally wrong

the moment a child can make independent choices is the moment he can make the choice to not get the "cure" if he wants to

[Phileleutherus Lipsiensis]

My God. It's full of stars.

[Steve Horwitz]

I think Jennifer has it exactly right in her 12:00pm comment above. I would draw the line with a strong presumption in favor of parental judgment, but where such a presumption weakens when:

1. The science is clearer that their choice is unlikely to help or very likely to harm

2. The child approaches an age where he/she is able to make competent adult decisions

In this case, I would imagine, presumptively, that a 16 year old is able to understand the issues at stake and that his wishes about what happens to his body should be respected. Were he 14 or 12, I would be less likely to accept that presumption.

The psychological research, especially that involving adolescent abortion decisions and children in cutody battles, is fairly clear that by the mid-teens, most kids are fully capable of making these sorts of decisions.

I'm not arguing for giving 15 year olds all the rights of adults, but I am arguing that just saying "he's not 18" is simply unhelpful.

[Huh]

There should be what I'll deem "accepted medical practice".

If the parents AND child agree to go against the "accepted medical practice", there is nothing the State should be able to do. This includes if the child is too young to offer an opinion. Some situations WILL suck. Sometimes life sucks.

If the parents want to go against, but the kid wants the "accepted medical practice", the State should force the parents to allow it.

If the parents want "accepted medical practice" and the kid doesn't, it should be left to the parents.

Of course, if both the parents and child want the "accepted medical practice", there is no issue.

[Captain Holly]

I just commented on the "Libertarianism: For Adults Only?" thread about a very similar case, that of Parker Jensen. Very illuminating.

As one who followed it closely, one of the most disgusting things about it was the incredibly arrogant "we-know-what's-best-for-your-kid-so-shut-up" attitude of the Utah child protection employees. They kept that attitude, even when it was obvious they were wrong.

[ChicagoTom]

The kid did the "Accepted medical practice" already, and it failed to prevent a recurrence. Now he and his family have decided that they don't want to go through it again (chemo and radiation treatments aren't like taking antibiotics...its a horrible experience) and have decided to take their chances with alternative / homeopathic medicine.

That should be their choice. Conventional medicine failed them (at least in their opinion) and now the state is saying that they don't have the right to pursue other treatments for their child?

And then an idiot like Dan T comes along and calls the parents "negligent" ?? You sir, are an idiot!

It should also be noted that Homepathic medicine is being recognized by more and more states and it is not quackery or anything of the sort. Many states are accrediting Homeopaths, but the AMA cartel is doing everything they can to prevent it.

Whether you agree / believe / trust / respect homeopathy or not, it should be a valid option for people who do believe in it or are looking for another option when traditional medicine has failed them.

[Dan T.]

In my experience, Children & Youth Services social workers harass any parent brought to their attention who doesn't hew to white, upper-middle-class values. They have power over families that borders on absolute. If you think they only wield that power over abusive and neglectful parents, you are quite mistaken.

I don't know what your experience is, but I will admit that you could be right. Perhaps the trailer parks and ghettos of America are teeming with literally hundreds of thousands of brownshirted social workers who accept lousy pay and long hours in order to break up otherwise innocent families.

Or maybe not?

[Shelby]

It should also be noted that Homepathic medicine is being recognized by more and more states and it is not quackery or anything of the sort. Many states are accrediting Homeopaths, but the AMA cartel is doing everything they can to prevent it.

Um, no, it's pure quackery. States recognize and accredit all kinds of nonsense, but it's for political reasons, not medical or scientific ones. The only way homeopathy is better than snake oil is that it's less likely to be actually poisonous.

Oh, and can't Reason fire someone to free up the money to fix the goddamn servers so we don't always have to post something five times?

[Downward]

I'm pretty sure Dan T. is being sarcastic with his remarks, but damn, Ayn, this is one heck-of-a-statement here: "...some asinine cult's (read: the Amish) loony-tunes beliefs..."

I would like to take this opportunity to apologize to all true Amish people that are reading this right now....all libertarians aren't as mean as Ayn.

[martin]

I'm afraid there will never be agreement on this topic.
Some of the reasons I see:

It involves a child.
Quite a number of adults simply lose reason when children are mentioned. They take the safe absolutist position, such as "He/she is not of legal age and doesn't know what he's doing." Doesn't seem to matter that, if the same kid screws up he/she gets treated as an adult all the way by the publicly supported legal apparatus.
Or they appear to not trust parents to be unsupervised. While still assigning them full responsibility when something goes wrong.
I call that hypocrisy.

When children are involved, for many the "compelling State interest" doctrine can't be expansive enough. Even if that doctrine sets bad precedent and grossly interferes with everybody's liberties.
As a result a huge public and private bureaucracy
has been created with a life, power and survival instinct typical of such bodies.
I call that illogic.

My modest proposal: Individuals and the State should stay away, hard as that will be, especially when the, thankfully rare and often anecdotal horrible cases are splashed around by the media. They mostly do it for their own purposes too, just like those idiotic politicians dreaming up stupid catchy sounding childrens' protection measures.
As long as we, by waging war (Viet-Nam, Iraq) or by inaction (Rwanda, Cambodia)cause other peoples' children to suffer far more harm than I want to imagine, a bit of modest retreat in the face of one family's tragedy would become us all.

End of sermon.

And Downward, I second that comment. Ayn seems to be a bit ignorant about the Amish.

[.]

A 16-year old who has gone thru chemotherapy probably already knows more about chemotherapy than most doctors who have never undergone it.

My God this country is full of stupid fucktards who put book learnin' ahead of actual experience.

[David]

I don't know what your experience is, but I will admit that you could be right. Perhaps the trailer parks and ghettos of America are teeming with literally hundreds of thousands of brownshirted social workers who accept lousy pay and long hours in order to break up otherwise innocent families.

Or maybe not?

I think it's so more a combination of the presumption of guilt that an accusation brings with the belief that it's better to err on the side of caution in such cases. I also think that after seeing enough monsters, DCF workers tend to develop a Don Quixote complex.

[David]

And on topic, if it's not acceptable for the parents and child to agree on a course of treatment that experts oppose, doesn't that make it unacceptable for the parent to choose such treatment for themselves? The priciple is the same.

[Dan T.]

I think it's so more a combination of the presumption of guilt that an accusation brings with the belief that it's better to err on the side of caution in such cases. I also think that after seeing enough monsters, DCF workers tend to develop a Don Quixote complex.

I guess I've just never seen any evidence that social workers are abusing their power on anythign that resembles a widespread basis. I'm sure it's happened from time to time, but I'd wager that for the most part if a child is removed from a home it's for good reason.

[ChicagoTom]

Shelby said:
Um, no, it's pure quackery. States recognize and accredit all kinds of nonsense, but it's for political reasons, not medical or scientific ones. The only way homeopathy is better than snake oil is that it's less likely to be actually poisonous.

That's just not true. As someone who has a naturopath in his family, I can say that there is very little quackery and it is based on sound science.

And you have it absolutley backwards. The reason states refuse to accredit many programs are political rathter then scientific. Lots of pressure by the AMA -- who don't have the same kind of control over naturopaths. Furthermore, the number of patients who are seeking out and using homeopaths and alternative medicines is skyrocketting. The demand is there, and most of them are repeat customers.

My personal experience with homeopathy has also been quite good. There are many natural / organic compounds that have the same anti-oxident or blood clotting properties (to use just one example) as many of the commercially produced pharmacuticals -- but you dont need a prescritption and you dont pay an arm and a leg.

Furhtermore, homeopathy focus more on root causes of your illness rather than merely focusing on symptoms. They incorporate lifestyle changes into a treatment program as well as nutritional changes to diets for their patients. It's all based on rather sound science.

It may not be up your alley, but to disparage it and call it quackery merely because you don't like it is ignorant and small minded on your part.

[MainstreamMan]

Chicago Tom,

As much as I respect your right to believe in it, it is disingenuous to say there is sound science behind homeopathy.

Here are some scientific assessments of homeopathy
http://www.cochrane.org/reviews/en/ab003803.html
http://www.cochrane.org/reviews/en/ab003399.html

This seems to cover the basic problems:
A systematic review of the quality of homeopathic clinical trials
Jonas W. B., Shasha M., Anderson R. L. and Lyons J. S. Office of Alternative Medicine, National Institutes of Health, Bethesda, MD, USA.
Introduction/Objective: To review the quality of clinical trial research in homeopathy and identify the extent of threats to validity of causal interpretations in these trials. In addition, we compared the type and extent of these threats to validity to research on conventional therapies.
Methods: A comprehensive, multiple-strategy search for all clinical trials published on homeopathic treatments was done. Inclusion criteria for studies: 1) published in English between 1945-1995; 2) examining an intervention for a clinical condition in a comparative trial, 3) be prospective and involve a parallel control group; 4) assess the outcome of the intervention using an empirical measure of some type. All trials were evaluated using an established method of quality assessment involving 33 validity criteria covering statistical conclusion, internal, construct and external validity. Reliability of criteria application is greater than 0.95.
Results: A total of 59 studies met the inclusion criteria and of these 79% were from peer-reviewed journals. In research design 29% used a placebo control, 51% used random assignment, and 86% failed to consider potentially confounding variables. In measurement 96% did not report the proportion of subjects screened, and 64% did not report attrition rate. An average of 17% of subjects dropped out in studies where this was reported. Of 229 outcome variables, 32% were significantly improved from homeopathic treatment, 39% were unaffected and 2% were made worse by the treatment. The probability of a positive outcome was significantly lower when randomization and placebo were used than when another method of group assignment or comparison to conventional therapy was used. There was practically no replication of or overlap in the conditions studied and most studies were relatively small and done at a single-site. Compared to research on conventional therapies the overall quality of studies was similar except that homeopathic studies were more prone to sampling biases and the use of multiple outcome measures than conventional therapy. Both conventional and homeopathic studies consistently fail to report on the reliability of outcome measures used to control for heterogeneity among groups. There is a higher proportion of placebo-controlled studies in homeopathic compared to conventional medicine research.
Discussion: Clinical homeopathic research is clearly in its infancy with most studies using poor sampling and measurement techniques, few subjects, single sites and no replication. While some of these methodological flaws may arise out of an attempt to identify specific effects of a "holistic" treatment approach, many of these problems are correctable even within such a paradigm given sufficient research expertise and support.
Maryland 1998 PBO7

And remember, one of the premises behind homeopathy is extreme dilution of a substance in water until there is not a single molecule of the treatment left in what you ingest. No plausible scientific theory has been put forward that would explain the health effects claimed. Life style changes and better diet, however, have a good history of research supporting their impact on health. To the extent that homeopathy encourages better living, and healthier eating, it is not quackery. To the extent it encourages a belief in the healing powers of the spiritual essense of substances, it is.

[John Rhoads]

I find the notion that a 16 year old is not capable of making this decision for himself to be completely offensive. I understand the need to have an arbitrary line of adulthood, but 18 is definitely too high. This particular case is very cut and dry. Chemotherapy is an extremely painful procedure that has limited success in treating cancer. This is not to say that there are not legitimate reasons for having chemotherapy, but reasonable adults make the decision not to have chemo all the time. Having seen my mother go through chemo, I would definitely not force that kind of pain on anyone that wasn't prepared for it. The fact that his parents agreed with his decision really makes this case a no brainer.

[ChicagoTom]

To the extent that homeopathy encourages better living, and healthier eating, it is not quackery. To the extent it encourages a belief in the healing powers of the spiritual essense of substances, it is.

I don't disagree with the "spiritual essense of substances part"....but just because a certain portion of the science is considered bunk doesn't discredit the movement en masse. There may be certain aspects - but the nutrition and lifestyle stuff is right on.

And as far as the herbal treatments that naturopaths suggest -- there is sound science behind that as well. Naturopaths study pharmacology just like conventional doctors...but they focus on organic / natural substances that have healing properties similar to commercial pharmacuticals.

There is a reason that more and more people are seeking out naturopaths and natural remedies -- and it isn't because they are all stupid rubes who are being duped -- its because conventional medicine has failed or is failing them and they are seeking out other options and many are finding successful treatments.

[MainstreamMan]

C Tom,

I agree.
If you want to keep tabs on what the science says, the best evidence is available here:
http://www.cochrane.org/reviews/en/

A group dedicated to studying the evidence for efficacy of alternative medicine:

http://www.compmed.umm.edu/Cochrane/index.html

[Eric the .5b]

I find the notion that a 16 year old is not capable of making this decision for himself to be completely offensive.

And as far as I know, absurd in the eyes of state law in less benighted parts of the country.

[crimethink]

I would like to take this opportunity to apologize to all true Amish people that are reading this right now....all libertarians aren't as mean as Ayn.

And I'd like to tell all the Amish reading this right now...what are you doing on the Internet, you're friggin Amish!

[Ken Shultz]

I'd love to see the LP become the party of parental choice. ...especially when it comes to the abortion issue.

[Todd Fletcher]

Oncologists can only give statistical probablities that chemo will work, and for a second time patient, these are much lower. This is not at all the same thing as a parent refusing to give a child immunization - however you decide on that issue.

[bombadil]

Reason often cites that it sides with "Choice" no matter the issue. But in the case of 'alternative medicine' (no matter what kind of specific alternative medicince we are talking about), anything outside the AMA's purview, it appears that Reason sides against increasing choices for people - that is that the state might have a right to step in merely because the parent has decided to opt for an alternative treatment.

I think Jennifer had it about right. It depends on the dangers of the condition and what the prognosis is for effective treatment/recovery under the mainstream allopathic treatment. Any kind of emergency medical condition should be treated by mainstream doctors. But chronic issues, or some forms of cancer, where allopathic treatments have not worked well, especially for the people involved who want to see if something else will work because their condition hasn't come around under the allopathic treatment, seem like good candidates for allowing choice.

[just some guy hanging out in f]

Here's another angle. Holistic medicine is based on a completely different paradigm from allopathic medicine. The latter treats only the disease, believing in a reductionistic view of health and a cartesian dualism. The former is based on the paradigm that when one part of the body is sick then other parts are not well either - there is a relationship between seemingly separate parts of the body; the mental/emotional system is necessarily related to health and sickness as well. Therefore, the whole person needs to be treated. But this paradigm runs into problems when it is measured only with tools or methods suitable to the allopathic paradigm. The results might take longer to appear, for one thing. So a test that compares the effectiveness of both treatments, but is only measured in the same, short term time frame, and only for one condition is bound to be biased towards allopathic medicine. Given these other variables, and the fact we are measuring the health of people, not nonsentient organisms, short term quantitative studies are not sufficient. To complement these, what is needed is long term, qualitative studies, case studies, etc. that can shed more light on the long term effects as well as the overall health of the patients - studies that are in keeping with the paradigm of holistic medicine itself.

As a personal example, I was treated for a sciatica problem with cortisone treatments. My doctor, who also thought holistic medicine was woo woo, discouraged any other treatment possibilities, other than some physical therapy, from a state licensed physical therapist of course. I was also taking medication for a bronchial condition. But I was concerned about the long term effects of cortisone treatments and even my doctor warned me away from having treatments too often. So, I began to look into other possibilities. I eventually found some alternative treatments and tried a number of them. Some didn't do anything at all - but part of that might have been my impatience in wanting to heal quickly. I did eventually find some treatments that worked well. I mostly settled on these as I liked how my overall sense of well being was improving. So, through a change in diet, lifestyle, various kinds of therapies and herbs, my condition did improve. I didn't recover all the way - but about 75 percent of the way (which is another issue - when we talk about what 'works' to what standard are we shooting for?). But everything else about my health, physical and emotional had improved as well.

Btw, I want to back up the statement that not all alternative treatments should be considered equally effective. Each needs their own separate evaluation. To lump them all together is a conflationary fallacy - like saying street walkers, high priced escorts, or women trapped in a brothel, all fall under the same category. Or that marijuana is no more dangerous than meth because they are both illicit substances.

And this is also not an argument that suggests that alternative medicine is superior to allopathic medicine - just that each might have their own place, depending on the condition, the risks involved, etc. I think the term that is common now is complementary medicine, which makes sense to me. If you have a broken leg, have suffered internal injuries from a car accident, etc. by all means, get you and your loved ones to the regular hospital. But if you have a chronic condition that's been long resistant to allopathic treatments, and you find you are only getting worse - not just the specific condition but your whole sense of well being - why not try something else?