Respectful Insolence

There hasn’t been much news in the last two or three months about Abraham Cherrix, the 16-year-old with Hodgkin’s lymphoma who rejected conventional chemotherapy, first in favor of the quackery known as Hoxsey therapy and then for the ministrations of a radiation oncologist in Mississippi named Dr. Arnold Smith, who combines non-woo (low dose radiation therapy) with woo (a form of “immunotherapy” involving “belly plaques” that has no evidence showing efficacy, not “more innovative techniques, such as immunotherapy, which uses medications and supplements to boost the immune system,” as the latest report describes it). When I last wrote about Abraham, his lymphoma had, not unexpectedly, recurred, this time in enlarged lymph nodes under his arms. Abraham was reported as planning to go back to Dr. Smith for more of the same. Apparently, he’s done so, and this was the result:

Abraham opted for the more targeted treatment, and the tumor in his neck and one near his windpipe shrunk. In December, however, Abraham noticed a lump near his right collar bone and another under his arm.

A scan at a hospital on the Eastern Shore showed he had five new tumors, one each in the lymph nodes under his arms, one near his collarbone and two in his lower left lung.

“It wasn’t a shock,” he said.

He returned to Mississippi for “pinpoint radiation ” of the areas where the tumors were located.

Rose Cherrix, who had separated from her husband by this time, said that when she found out that Abraham needed to return to Mississippi for more treatment, she had $30.

But she said people rallied around her, particularly those within the island community of Chincoteague, and raised the money she needed to drive Abraham to Mississippi.

Abraham stayed there from late January until mid-March. He suffered a bout of pneumonia that kept him in the hospital for a couple of days when he first arrived. The tumor near his collarbone was removed for a biopsy.

A diagnostic scan before he left on March 16 showed that the radiation had shrunk the new tumors.

At the same time, a misguided legislator in Virginia named John Welch III (R-Virginia Beach) introduced an equally misguided and useless piece of legislation that came to be called “Abraham’s Law.” His rationale, if you recall, was as follows:

The bill, which Welch plans to introduce Tuesday, proposes that a decision by parents to refuse a particular treatment for a child with a life-threatening condition should not be considered medical neglect so long as the decision is made jointly by the parents and a mature child.

The family also has to have considered the treatment options available, and believe in good faith that the decision is in the child’s best interest.

This is not particularly surprising, and, without chemotherapy or at the very least more widespread radiation therapy, Dr. Smith will likely continue to end up playing Whac-A-Mole with new tumors as they pop up in different lymph node basins until the tumor finally gets out of control, a process that could take many months to play out to its likely tragic end. Of more interest, are the consequences in Virginia of Abraham’s battle, consequences that, in essence, remove protections for teens with cancer and other life-threatening illnesses against parents who wish to pursue quackery instead of evidence-based medicine. As of last week, Abraham’s Law is now the law of the land in the State of Virginia:

RICHMOND — Gov. Timothy M. Kaine signed into law legislation giving teenagers and their parents the right to refuse doctor-recommended treatments for life-threatening ailments.

Mr. Kaine also announced Wednesday that several tax-relief bills were among the measures he approved as passed by this year’s General Assembly.

“Abraham’s Law” arose from the case of Starchild Abraham Cherrix, 16, of Chincoteague, and his parents, who chose alternative therapy for his Hodgkin’s disease and waged a successful court battle in Virginia against state officials who tried to force him to undergo chemotherapy.

After state social services agents objected to the family’s decision to forgo chemotherapy and asked a court to intervene, a judge threatened to jail Abraham’s parents for neglect and force him to undergo conventional cancer treatments.

Delegate John J. Welch III, Virginia Beach Republican, and Sen. D. Nick Rerras Norfolk Republican, introduced the legislation as a result of the legal battle

“I believe this measure strikes the appropriate balance between the rights of parents and a mature child to make informed medical decisions, and the responsibility of the state to protect the health and safety of children,” Mr. Kaine said in signing the bill.

Medical and child advocacy groups, including state social services officials, opposed the measure, but it won overwhelming House and Senate approval.

The bill allows children 14 or older to refuse medical treatment if the child is sufficiently mature, all his treatment options have been considered and if the refusal of a prescribed regimen is done in what the parents believe is the child’s best interest.

Courts still would have to determine whether parents in such cases are neglectful.

When I first mentioned the possibility of this law, back in August, I characterized it as, in essence, a useless, feel-good measure that would have no real effect because it wouldn’t change the definition of what constitutes abuse. I’ve since changed my mind because Abraham’s Law appears to have morphed into something much broader than its original incarnation. In its original form, Abraham’s Law would have applied only to children with “terminal illnesses.” This law has broadened its reach to children with “life-threatening” condition and changes the definition of an “abused or neglected child” as follows:

Definition of abused or neglected child. Specifies that a decision by parents or another person with legal authority over a child to refuse a particular medical treatment for a child with a life-threatening condition shall not be deemed a refusal to provide necessary care if (i) such decision is made jointly by the parents or other person with legal authority for the child, and the child; (ii) the child has reached 14 years of age and is sufficiently mature to have an informed opinion on the subject of his medical treatment; (iii) the parents or other person with legal authority, and the child have considered alternative treatment options; and (iv) the parents or other person with legal authority, and the child believe in good faith that such decision is in the child’s best interest. Stipulates that this test shall not be construed to limit the provisions of §16.1-278.4 on children in need of services.

Worse, I hadn’t realized this before, but apparently Virginia law now lists as an exclusion in the definition of an abused or neglected child:

However, no child who in good faith is under treatment solely by spiritual means through prayer in accordance with the tenets and practices of a recognized church or religious denomination shall for that reason alone be considered to be an abused or neglected child.

In essence, if you’re a child between the ages of 14-18, the State of Virginia no longer protects you from quackery or religious idiocy. In essence, parental stupidity, something state laws normally try to protect children against as much as possible in medical matters, is now legal. Worse, it’s not just limited to children with “terminal” illnesses, where, it can be argued, nothing can save them and taking them away from their parents to have them obtain conventional therapy would cause them undue stress in the remaining weeks or months of their lives. It now includes any child with a life-threatening condition.

In other words, it now applies to all children in the State of Virginia with cancer, no matter how treatable the cancer is, because cancer is certainly a life-threatening condition.

Consider the practical import of this bill. Let’s say a 14-year-old is diagnosed with leukemia. Let’s further say that it’s an eminently treatable form of leukemia, which can be treated with chemotherapy, with an expected remission and long term survival rate of over 90%, which is not uncommon. Under this law, parents could choose any quackery they wanted, be it the Hoxsey therapy, urine therapy, homeopathy, or whatever, as long as the decision to pursue this quackery was made “jointly with the child.” Now consider this: For a 14-year-old (or even for a 16-year-old or 17-year-old) living with his or her parents. How difficult do you think that it would be for the parents to get the child to agree with them, particularly if, as most alties would do, they frame it as a choice between the horrors of chemotherapy (and, in the case of other tumors, surgery and radiation) versus a “natural” alternative that won’t cause them any pain or symptoms at all? Yes, saying it’s not neglect to use woo to treat cancer in a child as long as the child agrees to it is the height of disingenuousness, and passing a law that codifies that statement is the height of irresponsibility.

But it’s worse than that.

Consider the case of a 14- to 17-year-old whose parents are Christian Scientists or other religions that claim that prayer alone can cure disease. Naturally, in the vast majority of cases, the child will have been raised in the same religion and will believe in its tenets, as his parents do. If that child gets cancer, it’s pretty likely that he would agree with his parents that prayer and whatever rituals demanded by the religion would be the proper treatment for the cancer and thus would agree with whatever woo the religion prescribes for treatment. Here’s an even more disturbing example: What about a child whose parents are Scientologists and who is unfortunate enough to develop depression? Scientology is totally opposed to psychiatry and the use of drugs to treat mental illness; consequently, the parents would almost certainly refuse any psychiatric interventions, and the child, having been raised in the woo of Scientology, would almost certainly agree. Although, I would guess, there is case law to allow the state to intervene if the child is impaired in his ability to make decisions by mental illness, there’s nothing in Abraham’s Law that I can find that addresses that possibility.

Of course, the proponents of this travesty of a piece of legislation will point to the part that states that “nothing in this subdivision shall be construed to limit the provisions of §16.1-278.4.” Presumably that section of Virginia Law might still allow the state to step in, right? Well, read the actual provisions of §16.1-278.4. There’s nothing there defining medical neglect. I’m not a lawyer, but there’s nothing there that I can see that would prevent parents from doing anything they want, as long as the child agrees and the parents appear to believe they are acting in the best iinterests of the child.

In essence, the State of Virginia has eviscerated its child welfare services. It’s basically eliminated the ability of its child welfare services to intervene in the case of 14- to 17-year-olds whose parents decide to pursue woo instead of effective medical treatment, not just for children with terminal illnesses, but for any child in that age range with a serious, life-threatening condition. As I’ve said before, one can quibble about whether 17- or 16-year-olds are mature enough to decide their own medical care, but how can anyone argue that most 14- or 15-year-olds are or are sufficiently independent of their parents not to simply go along with their decision, be it woo or evidence-based medicine? Yes, the article claims that the courts would still have to determine whether parents in such cases are neglectful, but, given the wording of the new definition of a neglected or abused child with respect to medical matters, I can’t see how a court could do anything but rule in the parents’ favor in nearly all cases. I have to wonder how long it will be before a child in this age range dies because of this decision.

Comments

  1. #1 josh
    March 26, 2007

    Once again I am stunned. Why is it we can tell someone their ideas are stupid and harmful unless they;
    “believe in good faith that the decision is in the child’s best interest.”
    Why do stupid ‘beliefs’ get a pass to the rightful dirision we award to stupid ideas?

  2. #2 Michael Suttkus, II
    March 26, 2007

    Can we charge the legislators, every single one who voted yes, for child endangerment?

  3. #3 anonimouse
    March 26, 2007

    While I appreciate the sentiment in the law, I do have real concerns about how it would be applied and about how vague it is:

    (ii) the child has reached 14 years of age and is sufficiently mature to have an informed opinion on the subject of his medical treatment;

    My take has always been that someone who is old enough to understand the consequences of his actions should be allowed to make those actions, even when they may ultimately be detrimental to one’s health. I’d prefer to scratch “14″ from this law and simply put the burden on the state to prove that the child is not “mature” enough to make the decision on their treatment.

    But in reality, HOW will that determination be made? Are there ways to measure it at all objectively? Otherwise, it becomes a very subjective question that can differ from judge to judge. (one judge’s “mature 16-year-old” can be another’s “insolent brat.”) So while in theory I agree that a child (even a younger child) can fully understand and appreciate the magnitude of their health-care decisions, I’m not sure how you put this in practice.

    (iii) the parents or other person with legal authority, and the child have considered alternative treatment options;

    How will this be measured? This is awfully vague. What constitutes “consideration”? And how will the severity of the child’s condition be accurately measured? My big fear is that a quack doctor will convince the parents of a child isn’t really as sick as he is. It’s one thing to objectively know the state of your condition and make an “alternative” treatment decision, it’s another to be lied to about the true state of one’s health.

  4. #4 Alison
    March 26, 2007

    If the lawmakers aren’t mature enough to recognize whether a “treatment” is “effective” or not, how on earth could a 14 year old be expected to?

  5. #5 Stuart Coleman
    March 26, 2007

    This is awful. I just hope some poor child isn’t forced to die because of their parents’ stupidity. I have a feeling that happens far too often without idiotic legislation like this.

  6. #6 Jud
    March 26, 2007

    Problem is, the law is a blunt instrument, and though it may appear we’re only talking about a family’s ability (yeah, I know we pretty well mean the parents) to choose useless woo versus more or less efficacious medical treatment, we may actually also be discussing more generally the rights of individuals to refuse state-approved medical procedures. Substitute “carrying a fetus to term” for “medical care judged efficacious by the state” and see whether it makes a difference to your answer.

  7. #7 Diora
    March 26, 2007

    Scary…. If I am reading it correctly, it can be applicable to many common deseases, not just cancer. Say a kid with juvenile diabetes who isn’t happy with insuline injections whose parents are christian scientists. There are lots of deseases that are life-threatening when untreated. What about TB?

  8. #8 ou·tré
    March 26, 2007

    At 14, it didn’t even phase me all the symptoms I was having from my neurofibromatosis was weird or something to pay attention to. Granted, I wasn’t dx’ed until a few years later but I still don’t see how a typical 14 year old is capable of making ‘mature’ medical decisions on their own that isn’t their parent’s voice coming through them.

  9. #9 derek
    March 26, 2007

    a decision by parents to refuse a particular treatment for a child with a life-threatening condition should not be considered medical neglect so long as the decision is made jointly by the parents and a mature child.

    But let a sixteen year old try to get condoms, or a twenty four year old a morning-after pill, and *pow*!

    I also like the bit about “*recognised* religion”. That’s not an establishment of religion at all, nooo.

  10. #10 Ahistoricality
    March 26, 2007

    I find it interesting that they called it “Abraham’s Law” instead of “Starchild’s Law”: much more biblical that way.

  11. #11 Reed A. Cartwright
    March 26, 2007

    It is my opinion that it is so important that individuals and families have the right to choose medical treatment without the interference of authorities that we are just going to have to accept that some people and families will reject sane treatments and cause undo death and injury. I do not believe that making a wrong choice is the same as neglect. (Communicable diseases are an exception because an unvaccinated child can spread diseases.)

    As much as I opposed the Cherrixes’ choices, I much more opposed the doctors’ and governments’ intervention.

  12. #12 MR
    March 26, 2007

    I guess Mr. Cartwright that view will give us a lovely glimpse of evolution in action. Let enough woos choose bad treatment and we can test the hypothesis woo-preference is an inheritable trait.

    Frankly, I don’t think untrained persons (myself included) are fit to diagnose and treat themselves. Direct to consumer pharmacuetical ads are bad enough, but completely unregulated medicine would be a tragedy. Thousands would die and many millions more would certainly harm themselves seriously. Not all people are equally capable, it is only sensible to defer to the better trained, especially if you might die.

  13. #13 Troublesome Frog
    March 26, 2007

    For patients to make an “informed decision” on a therapy, wouldn’t the people providing the alternative therapy have to provide meaningful survivability statistics for their treatment? If a patient’s choice is between a treatment with a known statistical profile and a treatment whose portfolio of results consists of a handful of carefully selected testimonials, can that patient’s decision really be considered an informed one?

  14. #14 epador
    March 27, 2007

    I’m glad I don’t have a Virginia license anymore or I’d have to give it back.

  15. #15 Jestak
    March 27, 2007

    The whole bit about “tenets and practices of a recognized church” smacks of the kind of exemption that Christian Scientists are always trying to get written into law; it wouldn’t surprise me one bit to find that the CS Church lobbied in favor of Abraham’s Law.

  16. #16 valhar2000
    March 27, 2007

    As I’ve said before, the only people they are hurting are themselves. Let me have more doctors to myself; they can keep the sociopathic con-men.

  17. #17 Jud
    March 27, 2007

    Jestak said: “The whole bit about ‘tenets and practices of a recognized church’ smacks of the kind of exemption that Christian Scientists are always trying to get written into law….”

    They’ve succeeded. Medicare pays for Christian Science sanitoria.

  18. #18 Dunc
    March 27, 2007

    As a general rule, whenever you see a law referred to as ‘s Law, where is a high-profile case widely reported in the media, you can fairly safely assume that it’s bad law.

  19. #19 Dunc
    March 27, 2007

    Oh bugger, un-escaped angle brackets… Lets try again:

    As a general rule, whenever you see a law referred to as ‘s Law, where is a high-profile case widely reported in the media, you can fairly safely assume that it’s bad law.

  20. #20 Jenny F. Scientist
    March 27, 2007

    There’s a saying: Exceptional cases make bad law.

    I’m from Virginia- this is so typical, i.e. stupid and pandering to even fringe religions. I agree, it’s a bad law indeed.

    On Abraham himself- I read about the case in the local papers when it first came out. In his particular case, I’d argue that his decision to not do a *second* round of chemo might be at least marginally reasonable; studies like this one suggest that second-round chemo has a relatively low success rate. Having cared for someone being treated for Hodgkin’s, I can understand the desire to not do it any more. However, the woo treatment will surely be ineffective. If he’d decided to simply do nothing, would it seem sane?

  21. #21 Leni
    March 27, 2007

    Reed A. Cartwright wrote:

    As much as I opposed the Cherrixes’ choices, I much more opposed the doctors’ and governments’ intervention.

    I understand what you’re saying, and in the case of adults making decisions about themselves I think you are correct.

    However I don’t see any compelling reason not to treat this any differently than other kinds of neglect or abuse where a parent thinks they are doing something in the child’s best interests, but which in reality is demonstrably harmful. The stakes here are also very high. Much higher, I think, than if we were talking about other arguably harmful ideas that parents teach their childrem.

    Second, there is also the possibility of debilitating injuries that might result in the state having to pay the costs incurred for lifelong treatment. That alone provides more than enough compelling reason for the state intervention.

    And as a general comment: is there some reason we would consider children of 14 competent to made nuanced medical decisions, but not capable of voting or consenting to sex? That strikes me as really creepy.

  22. #22 anonimouse
    March 27, 2007

    For patients to make an “informed decision” on a therapy, wouldn’t the people providing the alternative therapy have to provide meaningful survivability statistics for their treatment? If a patient’s choice is between a treatment with a known statistical profile and a treatment whose portfolio of results consists of a handful of carefully selected testimonials, can that patient’s decision really be considered an informed one?

    The counterpoint I’ll make is that it is up to the patient, IMO, to determine what case is more compelling. You are absolutely correct in saying that a meaningful statistical profile of success with one treatment should carry more weight than testimonials. But you cannot force an individual who is otherwise competent to make that decision to accept the scientifically valid option.

    In life-or-death situations, someone who clearly understands their options and the potential consequences of their options should have the ability to make their choice of treatment – and we should not automatically assume that because that individual is below the age of traditional consent that they cannot do so.

  23. #23 Ben Ackerman
    March 28, 2007

    Hundreds if not thousands of preventable deaths will occur because of this law. There’s pretty much no other way to slice it.

  24. #24 Warpoet
    March 28, 2007

    You guys should limit your commentary to scientific matters and stay away from ethical ones, because some of the knee-jerk responses that I’m reading here are, to put it simply, absurd. I’ve had to battle with IBD (or so it was diagnosed) since I was 15, and I didn’t get it under control by letting doctor after doctor lead me around by the nose, I got it under control by questioning doctors and doing my own research. Thinking for myself. Oh, and yes, I was more than mature enough to educate myself about available treatments at 15. I could have done that at 13 if I wanted to. The idea that some magical button is pressed at 16 or even 18 that suddenly makes someone mature enough to decide how to treat their own body is nonsense.

    You can sit here and bicker about X case with Y patient, you can complain about the law and sneer at it, but don’t ever say that the government has the right to force people into accepting a treatment if they’re mature enough to decide that they don’t want it. Hell, if a cancer patient wants to sit at home all day and watch soap operas as a method of treatment, that’s his right. You don’t have to approve of his decision or anyone else’s, but you have to respect his right to make that decision, because that’s how it works in a free country. It is his decision, not yours.

  25. #25 dr_dredd
    May 8, 2007

    I just came across this post. Both sides present valid points, but consider this. So many things that have been “accepted treatments” one day have been shown to be useless or worse the next, or vice versa. (Hormone replacement therapy, anyone? Or how about H. pylori treatment? The guy who developed the H. pylori theory of ulcers was laughed out of a medical meeting in the 70′s and won a Nobel prize in the 90′s). As a clinician, I can safely say that there’s an incredible amount we don’t know. If after years of training, I still don’t always know whether something is always useful for every patient, why should I foist my (possibly incorrect) beliefs on anyone else?

    Additionally, I think that Warpoet’s and Jud’s comments are right on the mark.

  26. #26 dr_dredd
    May 8, 2007

    I just came across this post. Both sides present valid points, but consider this. So many things that have been “accepted treatments” one day have been shown to be useless or worse the next, or vice versa. (Hormone replacement therapy, anyone? Or how about H. pylori treatment? The guy who developed the H. pylori theory of ulcers was laughed out of a medical meeting in the 70′s and won a Nobel prize in the 90′s). As a clinician, I can safely say that there’s an incredible amount we don’t know. If after years of training, I still don’t always know whether something is always useful for every patient, why should I foist my (possibly incorrect) beliefs on anyone else?

    Additionally, I think that Warpoet’s and Jud’s comments are right on the mark.

  27. #27 Caledonian
    May 9, 2007

    Somehow I don’t think the people indignant because the law permits a minor to have a say in his medical treatment (instead of having the law force what they think he should do on him, as God intended) would be quite so sanguine about forced treatment if an unwanted intervention were being forced upon them.

    Freedom to make your own choices includes the freedom to make stupid, harmful, and even lethal choices for yourself. Treating everyone as incompetents who need to be managed for their own good accomplishes nothing but causing them to become so.

  28. #28 Orac
    May 9, 2007

    Oh, please, give me a break.

    No one is saying that any sort of treatment should be forced–for adults. The problem is that Abraham is not an adult. Now, we could argue whether or not a 16-year-old (or a 15-year-old, which is what he was when he first made his decision to pursue the Hoxsey therapy rather than evidence-based medicine). However, what I am really talking about is not the freedom of adults to make stupid, harmful, or lethal choices for themselves, but the duty of society to protect children from stupid, harmful, or lethal choices made on their behalf by their parents or from making stupid, harmful, or lethal choices because of their immaturity.

    As for Dr. Dredd’s comments, he’s using the old “science doesn’t know everything” canard. Just because it’s possible that what we know now might be found to be in error in the future is not a reason to justify woo; for one thing, we have no way of predicting which medical paradigms will and won’t be changed.

  29. #29 Paul A
    May 10, 2007

    As I started reading this post I had the same reaction as a few other respondents, that it’s wrong to force any kind of treatment and you have the right to pursue whatever flakey woo turns you on. I still agree with that, if I suddenly lose the plot I reserve the right to treat any cancer I might develop with a daily dose of peanut butter smeared on my eyeballs because Iron Maiden told me to.

    Then I realised the point, it’s not about forcing people into a certain course of action, it’s about helping people who are potentially being duped into a harmful course of action. In that sense I’m right behind Orac in thinking that Starchild’s Law (hehe) is ridiculous.

    It does raise a question though. If we’re saying that a child who has been indoctrinated into a Christian Science religion may be incapable of making the correct decision about treatment, why would we treat his parents differently? By virtue of their buying wholesale into all the mumbo-jumbo doesn’t that also impair their ability to look after themselves properly and imply that the state should be permitted to impose treatment on them?

    Not saying yay or nay myself (got far too much work to do, can’t spend time navigating moral minefields), just wondering if anyone else has views on this…

  30. #30 Dunc
    May 10, 2007

    If we’re saying that a child who has been indoctrinated into a Christian Science religion may be incapable of making the correct decision about treatment, why would we treat his parents differently?

    Because there comes a time when you have to treat people as adults. The whole point of this discussion is about whether parents can insist on dubious treatments for their children. If they want to insist on dubious treatments for themselves, that’s their problem. We already accept the notion that children are not necessarily capable of making independant, informed choices and that the state may need to step in to protect their best interests.

  31. #31 Paul A
    May 10, 2007

    I see what you’re saying Dunc but my point is that can we really say that an adult who was indoctrinated into religion since birth, particularly something like christian science, is truly making a responsible informed decision about their treatment? We already accept that adults cannot always make responsible decisions when mentally ill so I suppose the question I’m really posing is whether cetain forms of religious belief are sufficiently similar to such cases of mental illness to warrant the same treatment.

    I know this is veering slightly off-topic but it’s still a valid related point. Not saying it’s right or not, just wondering if anyone who has experience in a related field can chip in their two cents?

  32. #32 Caledonian
    May 10, 2007

    I see what you’re saying Dunc but my point is that can we really say that an adult who was indoctrinated into religion since birth, particularly something like christian science, is truly making a responsible informed decision about their treatment?

    By that reasoning, no patients should ever be allowed to make their own medical decisions.

  33. #33 Caledonian
    May 10, 2007

    but the duty of society to protect children from stupid, harmful, or lethal choices made on their behalf by their parents or from making stupid, harmful, or lethal choices because of their immaturity.

    Who has the duty of protecting children from stupid, harmful, or lethal choices made on their behalf by society?

  34. #34 Paul A
    May 10, 2007

    By that reasoning, no patients should ever be allowed to make their own medical decisions.

    How on earth do you come to that conclusion from what I said? I’m saying that we currently grant the majority of adults the right to accept or refuse treatment on the grounds that they are rational, mentally sound and able to understand the consequences. How does my suggestion that religious indoctrination might conceivably be capable of impairing your faculties of reason, thus limiting you ability to make reasonable medical decisions, suddenly stretch to all mankind???

  35. #35 Warpoet
    May 11, 2007

    “However, what I am really talking about is not the freedom of adults to make stupid, harmful, or lethal choices for themselves, but the duty of society to protect children from stupid, harmful, or lethal choices made on their behalf by their parents or from making stupid, harmful, or lethal choices because of their immaturity.”

    I don’t believe a word of this. You know fully well that a 16 year-old can be just as capable of making this sort of decision as someone twice his age. Perhaps even more so. The real issue here, though, at least for you, is that the kid made a choice you don’t approve of. He took the “altie” route – and that bothers you. So, without knowing anything about the individual – who he is as a person – you’ve made your mind up. As a Virginian, I’d be more concerned for my personal liberties with someone like you writing the laws than I would people like Welch or Rerras.

  36. #36 Orac
    May 11, 2007

    Give me a break.

    Sadly, you don’t seem too concerned about the welfare of the children who might be affected by this law; apparently, in your world “liberty” for parents equals the absolute authority to do with their children whatever they want, even if it results in their death.

    Be that as it may, you obviously haven’t read my posts on the subject other than this one, in some of which I quite frankly wrestled with my misgivings over whether Abraham is or is not old enough/mature enough to make this decision and weighing the question of whether he is old enough to decide with whether the state should step in to rectify his and his parents’ bad decision.

    Quite aside from the question of whether Abraham is mature enough to make the decision, are you honestly arguing that a 14-year-old is old enough to make this sort of decision? A few may be, but the vast majority are not. Moreover, this idiotic law in essence neuters any child protection law for 14-17 year olds that would guarantee that they get proper medical care. It’s not just cancer. If a 14 year old with, for instance, sickle cell anemia (which can be a “life-threatening” condition, although usually teenagers don’t die of it) had parents who thought that homeopathy would help take care of it when he’s undergoing a sickle crisis and failed to take him to the hospital for oxygen, transfusion, and morphine to control his pain, then there would be nothing the state could do to make sure this poor unfortunate child did anything other than suffer.

    No, the ramifications of this astoundingly bad piece of legislation would seem to go far beyond cancer patients and beyond the question of whether Abraham or others like him are mature enough to make treatment decisions in life-threatening illnesses for themselves.

  37. #37 Warpoet
    May 11, 2007

    Give me a break.

    Sadly, you don’t seem too concerned about the welfare of the children who might be affected by this law; apparently, in your world “liberty” for parents equals the absolute authority to do with their children whatever they want, even if it results in their death.

    The parents don’t get absolute control, they need the consent of a mature child. You’ll of course argue that the parents will essentially make the decision for the child, but that’s just your baseless conjecture.

    Be that as it may, you obviously haven’t read my posts on the subject other than this one, in some of which I quite frankly wrestled with my misgivings over whether Abraham is or is not old enough/mature enough to make this decision and weighing the question of whether he is old enough to decide with whether the state should step in to rectify his and his parents’ bad decision.

    If they’re anything like this post, I would imagine that they basically amounted to you “struggling” to see where the best place for you to put the goalpost would be in order to find an argument that seemed reasonable but was really just a manifestation of your own biases. “17? No, that won’t fly…16? No, that won’t either. OK OK, 15 and 14, that sounds better.”

    Quite aside from the question of whether Abraham is mature enough to make the decision, are you honestly arguing that a 14-year-old is old enough to make this sort of decision

    What do you mean “old enough?” It’s a question of whether or not they have the capacity to make an informed decision, and yes, a 14 year-old can certainly be capable of doing so.

    A few may be, but the vast majority are not.

    Yet more unfounded conjecture. Try backing up your assertions instead of simply throwing them out and expecting others to treat them as fact.

    Moreover, this idiotic law in essence neuters any child protection law for 14-17 year olds that would guarantee that they get proper medical care. It’s not just cancer. If a 14 year old with, for instance, sickle cell anemia (which can be a “life-threatening” condition, although usually teenagers don’t die of it) had parents who thought that homeopathy would help take care of it when he’s undergoing a sickle crisis and failed to take him to the hospital for oxygen, transfusion, and morphine to control his pain, then there would be nothing the state could do to make sure this poor unfortunate child did anything other than suffer.

    Your appeals to emotion do nothing but betray an already obvious lack of substance in your arguments. You again pretend as if the law hands over a loaded gun to the parents with which to shoot their children, which simply isn’t the case. The patient’s consent has to be given. If that weren’t the case, I’d be calling for this law to be shot down as well, but it IS the case, and so the argument is changed entirely.

    No, the ramifications of this astoundingly bad piece of legislation would seem to go far beyond cancer patients and beyond the question of whether Abraham or others like him are mature enough to make treatment decisions in life-threatening illnesses for themselves.

    More duplicitous nonsense. This has everything to do with individual choice and freedom. If you could get past your biased knee-jerking crap and look at the issue objectively, you’d understand that.

  38. #38 Caledonian
    May 11, 2007

    How does my suggestion that religious indoctrination might conceivably be capable of impairing your faculties of reason, thus limiting you ability to make reasonable medical decisions, suddenly stretch to all mankind???

    Because by that reasoning, the emotional stress of having a serious illness would be enough to disqualify people from ‘rationality’. It’s also extremely prejudicial, and puts people in the position of having to judge which religious principles are valid justifications and which lead to irrational decisions.

    Doctors have far too much power and authority as it is. They don’t need more.

  39. #39 Caledonian
    May 11, 2007

    Give me a break.

    Sadly, you don’t seem too concerned about the welfare of the children who might be affected by this law; apparently, in your world “liberty” for parents equals the absolute authority to do with their children whatever they want, even if it results in their death.

    Give me a break.

    1) This “please, won’t you think of the children” business was old before it started. I know you think it’s good rhetoric to imply that since I disagree with you, I hate children and want them to suffer. But it’s not only poor technique, it makes you look silly.

    2a) Someone has to have the authority to make medical decisions for people who (reasonably or unreasonably) are not legally permitted to make them for themselves.

    2b) All things being equal, I’d rather have parents making those decisions that doctors as a group, or even doctors as individuals. There’s no possible solution that doesn’t lead to screwups of one kind or another. Letting parents make the decisions is a terrible solution; permitting doctors to assume complete authority over sick children is even worse.

    Be that as it may, you obviously haven’t read my posts on the subject other than this one, in some of which I quite frankly wrestled with my misgivings over whether Abraham is or is not old enough/mature enough to make this decision and weighing the question of whether he is old enough to decide with whether the state should step in to rectify his and his parents’ bad decision.

    Yes, yes, you’ve wrestled with the question. Problem is, you’ve come up with the wrong answer. It makes absolutely no difference to the quality of your argument and your position whether you’ve agonized over it for years or came up with it on the spur of the moment.

    (Also, “you obviously haven’t read what I wrote” is another really ineffective rhetorical technique.)

    Quite aside from the question of whether Abraham is mature enough to make the decision, are you honestly arguing that a 14-year-old is old enough to make this sort of decision? A few may be, but the vast majority are not.

    You shouldn’t argue outside of your discipline; psychology is too complex a topic for your intution and pop knowledge to apply. After about the age of sixteen, there’s no further increase in maturity, and teenagers can no longer be distinguished from ‘adults’. Thing is, most adults are too immature to make this kind of decision, period.

    Moreover, this idiotic law in essence neuters any child protection law for 14-17 year olds that would guarantee that they get proper medical care.

    “Proper medical care” translation: what you think is appropriate.

    It’s not just cancer. If a 14 year old with, for instance, sickle cell anemia (which can be a “life-threatening” condition, although usually teenagers don’t die of it) had parents who thought that homeopathy would help take care of it when he’s undergoing a sickle crisis and failed to take him to the hospital for oxygen, transfusion, and morphine to control his pain, then there would be nothing the state could do to make sure this poor unfortunate child did anything other than suffer.

    And in cases where children and their families want to avoid chemotherapy that will prolong their life but cause significant suffering? Who will protect them from the state? (People rarely believe that, once given power, anyone will need to be protected by them, because obviously they’ll use it to do things they would agree with.) What about cases where parents and doctors disagree on the viability of a treatment with serious consequences and/or risks? Why, exactly, should doctors be able to overrule the parents?

    I think you’re vastly overestimating the danger from stupid parents making harmful decisions and vastly underestimating the danger from stupid or self-righteous physicians making harmful decisions, probably because you’re a physician – and they’re very bad at identifying the system’s gross and subtle flaws.

  40. #40 DuWayne
    May 12, 2007

    Caledonian -

    Good grief, your a ridiculous ass no matter what the subject.

    Letting parents make the decisions is a terrible solution; permitting doctors to assume complete authority over sick children is even worse.

    I didn’t realize that anyone was putting all that power in the hands of any doctor. One would assume that if their is a dispute, the courts would ultimately be the arbitrator.

    You shouldn’t argue outside of your discipline; psychology is too complex a topic for your intution and pop knowledge to apply. After about the age of sixteen, there’s no further increase in maturity, and teenagers can no longer be distinguished from ‘adults’. Thing is, most adults are too immature to make this kind of decision, period.

    What a ridiculous load of crap. Yeah, psychology is complex. Some kids are mature enough at 12, to decide they would rather have an increased quality of life, than an additional year or two, with a slim chance of long term survival – most aren’t even in their twenties. Contrary to your silly absolute, different people mature, in different ways, at very different ages. For legal purposes there has to be absolutes. Eighteen is the age that American society has decided that most decisions should be up to the individual, others don’t come until twenty one.

    As a society, Americans decided that the point when kids can make their own decisions about healthcare is eighteen. In some situations, including Abraham, a judge will here from the child and deem that said child is making an informed decision and is mature enough to do so. A law that removes that step leaves a vast opening for nutjobs to convince their child that said child should avoid procedures that can save their life, save them from potentialy serious, lifelong disabilty, or simply save them from exrutiating pain. Scientologists will have a field day with this.

    And in cases where children and their families want to avoid chemotherapy that will prolong their life but cause significant suffering? Who will protect them from the state? (People rarely believe that, once given power, anyone will need to be protected by them, because obviously they’ll use it to do things they would agree with.)

    The State, often times sides with the parents, when it comes to court. While there are obviously judges who have a strict policy, I would tend to think they are few and far between. Situations like this are not set by any strict precedence. There are no all encompassing rulings in cases like this precisely because they are and should be judged on a case by case basis.

    What about cases where parents and doctors disagree on the viability of a treatment with serious consequences and/or risks? Why, exactly, should doctors be able to overrule the parents?

    They shouldn’t and can’t. In cases where it is seriously questionable, it should be very easy to get a second opinion that would avoid said treatment.

    I am not a fan of allowing the state to have too much authority over children. Indeed, I am dead against many laws that allow the state the right to take children from their parents for the most ridiculous things, including THC found in parent UAs. But completely removing nearly all power for the state to intervene in the health and wellbeing of children. And make no mistake, they are children.

  41. #41 Orac
    May 12, 2007

    Exactly.

    Sometimes I think Caledonian is just being a contrarian annoyance just for the sake of trolling. Particularly amusing to me is the way he dismisses my telling him that he obviously hasn’t read what I wrote (which he admits) while ignoring the reason that I brought up that point: His claim that my “wrestling with the question” amounted to my “struggling” to “see where the best place to put the goalpost would be in order to find an argument that seemed reasonable.”

    Then he has the unmitigated gall when I point out that he has no way of knowing that that’s my position because he hasn’t read what my position was! It’s also rather bizarre that he would characterize my arguments as “appeals to emotion” lacking substance when he blithely spouts straw men like:

    You again pretend as if the law hands over a loaded gun to the parents with which to shoot their children, which simply isn’t the case. The patient’s consent has to be given. If that weren’t the case, I’d be calling for this law to be shot down as well, but it IS the case, and so the argument is changed entirely.

    Uh, no. My point was that the law gives woo-loving parents essentially free rein to utilize woo, rather than evidence-based medicine. His canard about the child giving “consent” is ridiculous. Children usually share belief systems of their parents of the sort that leads to the use of quackery. Few indeed are the adolescents of that age who are likely to choose EBM if, for example, raised by parents who are Christian Scientists or who fervently believe in woo–which is why the issue of maturity comes up. As you point out, somewhat arbitrarily it’s defined as age 18 when children become “adults.” And, as you point out, adolescents develop in variable ways, where some 18 year olds are not as mature as other 15 year olds. His implication of his argument seems to be that because some 14-year-olds may be mature enough to make such decisions, then we should allow all 14-year-olds to decide. And why not 13-year-olds, or 12-year-olds? Why can’t they decide, too?

    And this howler of a straw man:

    All things being equal, I’d rather have parents making those decisions that doctors as a group, or even doctors as individuals. There’s no possible solution that doesn’t lead to screwups of one kind or another. Letting parents make the decisions is a terrible solution; permitting doctors to assume complete authority over sick children is even worse.

    Uh, no. It would be the courts that would decide, with physicians’ input as one factor, albeit an influential one–which brings us to Caledonian’s other straw man:

    All things being equal, I’d rather have parents making those decisions that doctors as a group, or even doctors as individuals. There’s no possible solution that doesn’t lead to screwups of one kind or another. Letting parents make the decisions is a terrible solution; permitting doctors to assume complete authority over sick children is even worse.

    Egads! Even I never implied that letting parents in general make the decisions was that horrible or that physicians should have total control. Here’s the deal: The law already gives very wide deference to the parents and, in the case of older adolescents like Abraham, to the children themselves. Given that, even in cases of egregious gross medical neglect, it is already difficult for the state to intervene meaningfully to save the life of the child; this idiotic law will now make such intervention all but impossible in the State of Virginia if the child is 14 or older.

    As for the example of differing opinions on weighing the risks and benefits of treatment or emphasizing quality of life over quantity of life, that’s not generally a problem because such discussions and decisions fall quite comfortably within the range of EBM. In the event of disagreements, second opinions or consultation of physicians expert in the relevant disciplines, excluding woo-meisters posing as experts, can be obtained, or parents can pick a new doctor. The state already licenses physicians, and state medical boards already have regulations to determine if physicians are practicing within the standard of care; these would form the basis of deciding who is qualified to render an opinion.

  42. #42 Warpoet
    May 12, 2007

    Exactly.

    Sometimes I think Caledonian is just being a contrarian annoyance just for the sake of trolling. Particularly amusing to me is the way he dismisses my telling him that he obviously hasn’t read what I wrote (which he admits) while ignoring the reason that I brought up that point: His claim that my “wrestling with the question” amounted to my “struggling” to “see where the best place to put the goalpost would be in order to find an argument that seemed reasonable.

    You really don’t have a clue, do you, Orac?

    Ladies and gentlemen, here is a perfect example of how to make an ass out of yourself: whine about others not reading your posts closely enough and then confuse two totally different posters with one another.

    When you actually take the time to see who you’re responding to, come back.

    Uh, no. My point was that the law gives woo-loving parents essentially free rein to utilize woo, rather than evidence-based medicine. His canard about the child giving “consent” is ridiculous. Children usually share belief systems of their parents of the sort that leads to the use of quackery.

    Which still doesn’t give the state the right to intervene if the child has the capacity to make the choice on their own.

    Few indeed are the adolescents of that age who are likely to choose EBM if, for example, raised by parents who are Christian Scientists or who fervently believe in woo–which is why the issue of maturity comes up. As you point out, somewhat arbitrarily it’s defined as age 18 when children become “adults.” And, as you point out, adolescents develop in variable ways, where some 18 year olds are not as mature as other 15 year olds. His implication of his argument seems to be that because some 14-year-olds may be mature enough to make such decisions, then we should allow all 14-year-olds to decide. And why not 13-year-olds, or 12-year-olds? Why can’t they decide, too?

    This sort of backpedaling foolishness makes me wonder how anyone can take you seriously.

    When you do something more than just bitch about the law and explain how it allowing for some unavoidable cases of 14-17 year olds making poor choices because they happen to share the same beliefs as their parents (which is still their right, assuming they meet the proper criteria) justifies removing that freedom of choice from all 14-17 year olds, a preposterous notion that is unamerican and morally reprehensible, then you’ll have a leg to stand on. Until you actually cut the bullshit and start addressing people point for point instead of snipping through their comments and trying to make yourself look good to your readers, this is about as worthwhile as trying to talk sense into a fundie.

  43. #43 Orac
    May 12, 2007

    Oh, dear. It would appear that you’re right about one thing. I did mix up Caledonian’s specious arguments and strawmen with your specious arguments and strawmen. You two sound so much alike and are so obviously more interested in rhetorical posturing and perhaps trolling that perhaps the outside observer will forgive my mistake. It’s what I get for commenting so late at night while on call.

    As for addressing you and point by point, well, I’ve already done more of that than I normally do in any comment thread or particularly want to do without starting a new blog post. Wasting material and a lot of time in the comments is something I usually don’t do, particularly on posts that are a month and a half old, as I usually prefer to spend my blogging time writing new material rather than engaging in long debates in the comments. (If I wanted to continue to do that, I could have just stayed on Usenet.) I’d actually close comments on all such posts if there were an easy automated way to do it.

    I am, however, rather intrigued by your comment about “proper criteria.” You blather about 14-17 year olds should be allowed to choose their treatment if they meet the “proper criteria,” yet you conveniently neglect to enumerate what these “proper criteria” might be or how we might decide which 14-17 year olds should and should not be allowed to decide for themselves. Some specific criteria, as objective as it is possible to be, to differentiate between which 14-17 year olds are mature enough to decide for themselves and which are not. You also ignored a legitimate question as well: How do you draw the line in determining when a child is mature enough to decide these issues? Why not let them do it at 13? Why not 12? 11? None of this is “backpedaling.” It’s a logical question raised by your position. I’m merely pointing out that, if you don’t like the concept of limiting the choice of 14-17 year olds in these matters, then I don’t think it’s asking too much that you should at least have some concept about how we can tell when an adolescent is capable of making such decisions, a question you seem to be dodging most assidously.

    Come on! Educate us poor fascistic, ignorant folks who are deluded enough to think that, even though we distrust state power, there are occasionally times when it is appropriate for the state to step in to stop medical neglect or abuse and have a problem with eliminating, in essence, even the rather weak tools the state has at the moment! Dazzle us with your self-proclaimed brilliance! Given that you seem to have confirmed for me that your argument is that you’d rather let the all of these kids have the right to make life-and-death choices even if the majority of them are not mature enough to do so in order not to deprive the few that age who are of that right, then why even mention “proper criteria” at all? Why not just say that all 14-17 year olds should be considered adults and be done with it? After all, as you say, they should be allowed to decide questions of life and death such as in “Abraham’s Law,” it seems inconsistent, as far as liberty goes, to limit their rights and choices in adult issues, such as marriage, signing legally binding contracts, etc.

  44. #44 Warpoet
    May 12, 2007

    Oh, dear. It would appear that you’re right about one thing. I did mix up Caledonian’s specious arguments and strawmen with your specious arguments and strawmen. You two sound so much alike and are so obviously more interested in rhetorical posturing and perhaps trolling that perhaps the outside observer will forgive my mistake. It’s what I get for commenting so late at night while on call.

    Uh-huh. A simple “I screwed up” would have sufficed. Your comment about “rhetorical posturing” is just a glaring case of pot-kettle-black.

    As for addressing you and point by point, well, I’ve already done more of that than I normally do in any comment thread or particularly want to do without starting a new blog post. Wasting material and a lot of time in the comments is something I usually don’t do, particularly on posts that are a month and a half old, as I usually prefer to spend my blogging time writing new material rather than engaging in long debates in the comments. (If I wanted to continue to do that, I could have just stayed on Usenet.) I’d actually close comments on all such posts if there were an easy automated way to do it.

    No one twisted your arm and made you return to this discussion – your ego did that. This “wasting time” business is a just a pre-emptive excuse. You write lengthy narratives with lots of words and no real substance.

    I am, however, rather intrigued by your comment about “proper criteria.” You blather about 14-17 year olds should be allowed to choose their treatment if they meet the “proper criteria,” yet you conveniently neglect to enumerate what these “proper criteria” might be or how we might decide which 14-17 year olds should and should not be allowed to decide for themselves.

    No, I already explained what I thought the criteria should be. It was I who asked you to explain what you meant by “old enough”, and you copped out in favor of delivering a monologue. You won’t last much longer at this rate, friend.

    You also ignored a legitimate question as well: How do you draw the line in determining when a child is mature enough to decide these issues? Why not let them do it at 13? Why not 12? 11? None of this is “backpedaling.

    Yes, yes it is. You already asserted that the “majority” of 14 year-olds aren’t capable of making said decision and have provided no evidence for that claim nor answered my question of what criteria should be met in the first place.

    “It’s a logical question raised by your position. I’m merely pointing out that, if you don’t like the concept of limiting the choice of 14-17 year olds in these matters, then I don’t think it’s asking too much that you should at least have some concept about how we can tell when an adolescent is capable of making such decisions, a question you seem to be dodging most assidously.”

    Typical showmanship of poor debaters: demand proof for everyone else’s claims and then pretend that you never made any of your own.

    Come on! Educate us poor fascistic, ignorant folks

    Again playing to your audience I see.

    even though we distrust state power, there are occasionally times when it is appropriate for the state to step in to stop medical neglect or abuse and have a problem with eliminating, in essence, even the rather weak tools the state has at the moment!

    But that’s just it: your “having a problem” just amounts to complaining about the current legislation and not offering a practical alternative that safeguards people’s rights.

    Dazzle us with your self-proclaimed brilliance! Given that you seem to have confirmed for me that your argument is that you’d rather let the all of these kids have the right to make life-and-death choices even if the majority of them are not mature enough to do so in order not to deprive the few that age who are of that right, then why even mention “proper criteria” at all?

    That is not what I said. You might think that I said that, but that just makes you a delusional fool.

    After all, as you say, they should be allowed to decide questions of life and death such as in “Abraham’s Law,” it seems inconsistent, as far as liberty goes, to limit their rights and choices in adult issues, such as marriage, signing legally binding contracts, etc.

    That’s absurd and you know it. A person’s own body is something that belongs to them from the day that they are born. To suggest that letting the state manage someone’s own health is the same as allowing the state to make them attend school until they’re 16 or whatnot is ridiculous. Any child capable of making an informed choice regarding their health is entitled to do exactly that – the state isn’t entitled to that decision by default. This is the most reasonable and fair solution.

    Of course, you’ll have a problem with that, but that’s because you’re being neither reasonable nor fair.

  45. #45 Orac
    May 12, 2007

    Typical showmanship of poor debaters: demand proof for everyone else’s claims and then pretend that you never made any of your own.

    Pot. Kettle. Black.

    But that’s just it: your “having a problem” just amounts to complaining about the current legislation and not offering a practical alternative that safeguards people’s rights.

    The law before this idiotic piece of legislation passed, as imperfect as it was, was better than Abraham’s law. Passing no new legislation and leaving things at the status quo would have been a better option than this meddling.

    In any case, I tire of you and your trollery. I’ve encountered your type on Usenet enough times to know that I’ve already wasted more time than I should have. What can I say? Sometimes, I have a weakness for feeding trolls.

  46. #46 DuWayne
    May 12, 2007

    Warpoet -

    You really seem to be missing a key point here. All that this law does, is to make it virtualy impossible to for the state to step in, instead of exceptionaly hard for the state to step in, as it was before this law went into effect.

    As a parent of one with one, possibley two on the way, I am not a fan of giving the state undue power to intervene in the decisions my partner and I make on our children’s behalf. There are several state powers that I would like to see reduced. The pre-Abraham’s law satus quo is not one of them. Neither the doctors nor the state could just willy-nilly take over that decision making process. The final arbitor is always a judge. Judges are generaly not very keen on taking that power away from parents and children, especialy when the child is an older, particularly mature one, who is making a well informed decision.

    I find it ironic that you and others seem to bemoan the power of the state, when Abraham had already won the court case, before this law ever went into effect. It lends no credability to your claims that the state is this vile ogre, bent on taking the rights of parents and teens, to make their own healthcare decisions.

    I also find it ironic that this law seems to leave open the possability that parents can still be prosecuted for neglect and endangerment, if the decisions made lead to dire consequences for the child involved. They can make the bad decision that leads to their childs death or extreme endangerment, without legal intervention – then be prosecuted for it if it turns out wrong. Much like removing the horse from burning barn, after it’s dead – brilliant.

    This would be incredibly funny if it wern’t so sad.

  47. #47 Warpoet
    May 12, 2007

    Warpoet -

    You really seem to be missing a key point here. All that this law does, is to make it virtualy impossible to for the state to step in, instead of exceptionaly hard for the state to step in, as it was before this law went into effect.

    Asserting things doesn’t make them true. The wording of the law clearly explains what it is and isn’t going to do, and I don’t see where the problem is.

    As a parent of one with one, possibley two on the way, I am not a fan of giving the state undue power to intervene in the decisions my partner and I make on our children’s behalf. There are several state powers that I would like to see reduced. The pre-Abraham’s law satus quo is not one of them. Neither the doctors nor the state could just willy-nilly take over that decision making process. The final arbitor is always a judge. Judges are generaly not very keen on taking that power away from parents and children, especialy when the child is an older, particularly mature one, who is making a well informed decision.

    Again, where is the basis for any of this? How does the law in any way take too much power away from the state?

  48. #48 roseindigo
    May 12, 2007

    C’mon people, if a minor can make the decision about his sexual activity without parental consent, and can also be queried about which parent he wants to live with in a divorce case, then he ought to be able to make decisions about his own health care. It boils down to this—-Who should make the health care decisions for minors? The parents or the government?

    Personally, I’m in favor of the parents making the decision. Freedom means the freedom to be stupid without governmental interference. Direct abuse or neglect is one thing. Making a health care decision where things get complicated is quite another. If the kid is old enough to decide his sexual activity, then he’s old enough to decide whether or not he wants to undergo another chemo session. After all, he’s the one who had the side effects from it and would have a better idea of whether he wants to do this round again than the government—or his parents for that matter.

    Just like a judge can ask a kid about which parent he wants to be with when there is a divorce, a judge can also ask a kid about what health care he might want (and be able to assess how mature or immature the kid is when he gives his response).

  49. #49 DuWayne
    May 12, 2007

    Warpoet -

    Excerpt from, An Act to amend and reenact § 63.2-100 of the Code of Virginia, relating to abused or neglected children. [H 2319]Approved However, no child who in good faith is under treatment solely by spiritual means through prayer in accordance with the tenets and practices of a recognized church or religious denomination shall for that reason alone be considered to be an abused or neglected child. Further, a decision by parents who have legal authority for the child or, in the absence of parents with legal authority for the child, any person with legal authority for the child, who refuses a particular medical treatment for a child with a life-threatening condition shall not be deemed a refusal to provide necessary care if (i) such decision is made jointly by the parents or other person with legal authority and the child; (ii) the child has reached 14 years of age and is sufficiently mature to have an informed opinion on the subject of his medical treatment; (iii) the parents or other person with legal authority and the child have considered alternative treatment options; and (iv) the parents or other person with legal authority, and the child believe in good faith that such decision is in the child’s best interest. Nothing in this subdivision shall be construed to limit the provisions of § 16.1-278.4;

    If you follow the links in Orac’s original post it will take you to the provisions of § 16.1-278.4; which talk about the rules governing the removal of a child from parental control.

    So, if my child was discovered to have, say, apendicitis, and I didn’t want him to recieve medical intervention, preferring to take him out into the woods, build a bonfire and dance around him chanting, that the negative energy causing the pain in his belly – I could. While I would never do that, my faith believes that EBM is a perfectly acceptable tool for the care and healing of medical problems, some religious beliefs are flat against any intervention besides prayer. Others are against using any kind of man-made medicine, believing that man could not possibly improve on the medicines God made, in their original plant forms.

    This means that the state cannot possibley intervene to save the life of a child, as long as his parents can claim that their reasoning is spiritual in nature. It takes away all of the power of the state to intervene.

    On the flip side, pre Abrahams law, a judge gave him and his parents the right to seek alternative treatment, instead of following the course of treatment that could save his life. Had the judge felt that Abraham had been uninformed, heavily pressured by his parents or was too imature to make this decision, he could have ruled against the family. In the (admittedly few) cases that I have read about that are similar to this one, rarely does the judge rule against the family. Unfortunately, most cases that involve the medical decisions of parents are after the fact, when the child is dead or debilatated. Even then, judges and juries are often reluctant to find parents guilty of neglect, especialy if the medical decisions were religiously motivated.

    If you want to read about cases involving child endangerment of a medical sort, google “child endangerment” “medical treatment” – I have a very limited connection (I use my neighbors wireless, with their permission) and lack of html ability to post specific links, but if you google those two headings together, you’ll find a wealth of info about state reluctance to interfere with parental rights to make medical choices for their children.

    Where and when the state should intervene against parental rights is a very fine line, not easily set. This is why it should be judged on an case by case basis. Any law that takes away any power of the state to intervene, in any situation – which this one damn well does, opens the gates for serious abuse.

  50. #50 DuWayne
    May 12, 2007

    roseindigo -

    And before this law was ever written, a child had the ability to stand before a judge and do just that. Indeed, Abraham did just that and convinced the judge that he was and should be able to make just that decision. All that this law does is make it virtualy impossible for the case to end up in front of a judge.

  51. #51 DuWayne
    May 12, 2007

    roseindigo -

    And before this law was ever written, a child had the ability to stand before a judge and do just that. Indeed, Abraham did just that and convinced the judge that he was and should be able to make just that decision. All that this law does is make it virtualy impossible for the case to end up in front of a judge.

  52. #52 Warpoet
    May 12, 2007

    Excerpt from, An Act to amend and reenact § 63.2-100 of the Code of Virginia, relating to abused or neglected children. [H 2319]Approved However, no child who in good faith is under treatment solely by spiritual means through prayer in accordance with the tenets and practices of a recognized church or religious denomination shall for that reason alone be considered to be an abused or neglected child. Further, a decision by parents who have legal authority for the child or, in the absence of parents with legal authority for the child, any person with legal authority for the child, who refuses a particular medical treatment for a child with a life-threatening condition shall not be deemed a refusal to provide necessary care if (i) such decision is made jointly by the parents or other person with legal authority and the child; (ii) the child has reached 14 years of age and is sufficiently mature to have an informed opinion on the subject of his medical treatment; (iii) the parents or other person with legal authority and the child have considered alternative treatment options; and (iv) the parents or other person with legal authority, and the child believe in good faith that such decision is in the child’s best interest. Nothing in this subdivision shall be construed to limit the provisions of § 16.1-278.4;

    If you follow the links in Orac’s original post it will take you to the provisions of § 16.1-278.4; which talk about the rules governing the removal of a child from parental control.

    So, if my child was discovered to have, say, apendicitis, and I didn’t want him to recieve medical intervention, preferring to take him out into the woods, build a bonfire and dance around him chanting, that the negative energy ausing the pain in his belly – I could. While I would never do that, my faith believes that EBM is a perfectly acceptable tool for the care and healing of medical problems, some religious beliefs are flat against any intervention besides prayer. Others are against using any kind of man-made medicine, believing that man could not possibly improve on the medicines God made, in their original plant forms.

    Show me where in either provision it allows for the parents to make the decision without the consent of the child. If you can’t do that, then you’re just rehashing an argument that’s been dealt with already.

    On the flip side, pre Abrahams law, a judge gave him and his parents the right to seek alternative treatment, instead of following the course of treatment that could save his life. Had the judge felt that Abraham had been uninformed, heavily pressured by his parents or was too imature to make this decision, he could have ruled against the family. In the (admittedly few) cases that I have read about that are similar to this one, rarely does the judge rule against the family. Unfortunately, most cases that involve the medical decisions of parents are after the fact, when the child is dead or debilatated. Even then, judges and juries are often reluctant to find parents guilty of neglect, especialy if the medical decisions were religiously motivated.

    You are missing the point: it shouldn’t be the judge’s decision. The decision should lie with the family. If it is demonstrated that the child isn’t capable of making an informed choice on the matter, then you can argue that the state might be justified in stepping in, but that would not appear to be the case with Abraham and so it should not even be up for discussion. The only standard that needs to be met is whether or not the child has the capacity to make the choice, not whether he or she makes the choice that you or the judge happen to agree with. Generalities like “the judges usually rule on the family’s behalf” just aren’t going to cut it. Individual freedom comes first.

  53. #53 DuWayne
    May 12, 2007

    All the judge does is determine if the child if the child has such capacity and if the child is being coherced by the parents to make a choice they would agree with. Individual freedom to coherce a child to kill themself, should never come first. Nor should the freedom to aviod seeing a judge to determine the capacity of a child to make an informed decision or indeed if the decision is really informed, come first. Again, all this law does is make it virtualy impossible to put these cases in front of a judge at all. Something that is not particularly easy, without this law to interfere.

  54. #54 Warpoet
    May 12, 2007

    All the judge does is determine if the child if the child has such capacity and if the child is being coherced by the parents to make a choice they would agree with.

    Incorrect.

    http://www.cnn.com/2006/LAW/08/11/cancer.fight/index.html

    According to Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, judges asked to compel medical treatment of a minor normally are guided by the standards accepted by the medical establishment.

    Courts decide based on what mainstream medicine says are the appropriate treatments. They are not interested in Mexican licorice-stick treatments,” he said.

    Courts also consider the rate of success of a treatment and do not order experimental or risky treatments.”

    Individual freedom to coherce a child to kill themself, should never come first. Nor should the freedom to aviod seeing a judge to determine the capacity of a child to make an informed decision or indeed if the decision is really informed, come first.

    Considering that the current law stipulates that the child has to be able to make an informed decision, this strikes me as pretty much irrelevant.

    Again, all this law does is make it virtualy impossible to put these cases in front of a judge at all. Something that is not particularly easy, without this law to interfere.

    This is just emotive knee-jerking. What difference does it make if it goes in front of a judge or not? You aren’t disputing my suggestion that the ability of the child to make an informed decision is the only one that matters, and since the law as it stands requires exactly that, what are you complaining about?

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