Public Health

Abraham vs. Hodgkin

Is a 16-year-old wise enough to decide to skip chemotherapy?

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Should the government intervene to save the life of a 16-year-old boy, even if it means forcing him into medical care against his and his parents' wishes?

This is the question at stake in the case of Starchild Abraham Cherrix, a teenage boy who has Hodgkin's disease, a cancer of the lymph nodes that is highly treatable if diagnosed early. After completing chemotherapy, Abraham learned earlier this year that the cancer had returned. The boy decided to forgo further chemotherapy (the first round had left him severely nauseated and so weak that he could barely walk at times) and instead to pursue an "alternative" treatment known as the Hoxsey method—a sugar-free, organic diet and herbal supplements under the supervision of a clinic in Mexico. His parents, Jay and Rose Cherrix, approved of his decision.

The Accomack County Department of Social Services then intervened, asking the courts to order Abraham to resume conventional medical treatment of chemotherapy and radiation. On July 23, Judge Jesse E. Demps of the county Juvenile and Domestic Relations Court ruled that the parents were neglectful in allowing the alternative treatment, made the county a partial custodian of the boy, and ordered him to report to a hospital and accept the treatment recommended by the doctors. The Cherrixes appealed, and on July 26 Circuit Court Judge Glen Tyler reversed the orders of the lower court. Abraham has been returned to the full custody of his parents pending a Circuit Court trial scheduled for August 16; meanwhile, he can continue to refuse chemotherapy and be treated with the Hoxsey method.

Family attorney John Stepanovich has hailed the Circuit Court ruling as a victory for liberty. "This is not a case about what treatment is best," he told the press after the hearing. "It's a case about who gets to decide." After the earlier ruling, he had darkly warned that "Social Services may be pounding on your door next when they disagree with the decision you've made about the healthcare of your child."

Most of my libertarian friends are cheering the judge's ruling and condemning the actions of the Department of Social Services as an example of the state poking its nose into people's personal affairs—and few things are more personal than decisions about medical care. On principle, as someone who believes in minimizing government intervention in people's lives, I should agree.

And yet the fact is that without conventional treatment, Abraham is virtually certain to die. All solid research shows the Hoxsey method to be quack medicine and claims Abraham, despite the evidence of his relapse, has very good prospects of recovery with conventional treatment. Is Abraham mature enough to make reasonable decisions about his care? At his age, one often doesn't think far ahead, and the prospect of short-term pain and suffering caused by chemo treatments may seem more important than long-term survival, particularly to a teenage boy who is not used to being weak and physically dependent.

These wrenching questions are maximized when conventional medical treatments are rejected not by patients themselves, but by parents of offspring too young to decide anything. The law in most states currently exempts parents from prosecution if their decision to withhold medical treatment from their children is motivated by religious beliefs. Real libertarians decry attempts to hold parents criminally responsible or civilly liable for the deaths of children in such cases as infringements on religious liberty and family privacy.

All of which, once again, is fine in principle. But what happens when the result of a principle is a dead child?

Some would say that hard cases such as these are the true test of one's commitment to individual liberty and limited government. It's easy to be a fair-weather libertarian and oppose an interventionist government when supporting personal freedom has no high, visible, immediate costs. But freedom, as they say, isn't free, and must be defended even when such costs are involved. That means opposing government surveillance that can foil terrorist plots, or restrictions on free speech even when the speech causes profound anguish—such as the picketing of military funerals by antigay preacher Fred Phelps and his followers, who claim that the deaths of US soldiers in Iraq are God's punishment for America's tolerance of gays.

The argument for a principled opposition to state infringements on liberty is a compelling one. And yet at what point does such opposition turn into upholding ideology over common sense? It seems to me that when principle and real life collide, any reasonable person has to be torn over the outcome.