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How Old Is Old Enough in Health Care?

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I read this story yesterday and I have to bring it up with you. In Minnesota, there is this boy and his mother refusing chemotherapy and a court is issuing an arrest warrant for the mom. The article talks about forcing the boy (age thirteen) to receive chemo. Touchy issue there.

He has Hodgkin’s lymphoma which has a pretty good prognosis. But chemotherapy sucks. Chemotherapy is a poison in your body, for you and for the cancer. It makes you nauseous, weak, and may require you to get blood transfusions. You can have life threatening infections because of a weakened immune system. It can even cause cancer down the road. There are real risks and side effects.

But without treatment he will likely die. Chemotherapy destroys rapidly dividing cells (cancer). The research on effective treatment is out there and Hodgkin’s Lymphoma is highly curable. 

The mother is pursuing alternative therapies. In the article the author said regarding the judges decision:

“He also wrote that Daniel, who cannot read, did not understand the risks and benefits of chemotherapy and didn’t believe he was ill. Daniel testified that he believed the chemo would kill him and told the judge in private testimony unsealed later that if anyone tried to force him to take it, ‘I’d fight it. I’d punch them and I’d kick them.’ The Hausers, who have eight children, are Roman Catholic. They also believe in the ‘do no harm’ philosophy of the Nemenhah Band, a Missouri-based religious group that believes in natural healing methods advocated by some American Indians.”

Is thirteen old enough for that kind of decision? Should a parent be able to make those kinds of choices? A Jehovah’s Witness can refuse life saving blood transfusions.

What can other thirteen year olds do?

  • Can’t get a job in Minnesota until fourteen.
  • In New York they can be tried as an adult for serious crimes. In Minnesota, they have tried to lower the age to thirteen.
  • May get an abortion in some states with (in Minnesota) or without parental notification.
  • Can consent to medical treatment for pregnancy, STDs, or alcohol and drug abuse without parental consent

What is old enough to decide? Would you be willing to put restraints or medicate a patient in order to treat him? How much should religious and personal beliefs about health care be considered for treatment of a child?

This case should make us revisit all of our positions on what is old enough to be able to make an informed decision. How can we have a legal system that says a person is old enough to be tried as an adult but not old enough to refuse chemotherapy? I am not positioning myself on either side of the argument here, I am just trying to get us all to look a little closer at the inconsistencies. These ethical problems are not cut and dry. As a pediatric oncology nurse, I know I would have a hard time forcing treatment on a thirteen-year-old boy. It would keep me awake with questions about what is right.

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