I have to be honest here. I don't know for sure what I think of the latest developments in the Mazeratti Mitchell case.
As you may recall from a couple of days ago, Mazeratti Mitchell is a 16 year old wrestler in Philadelphia who suffered a spinal cord injury while wrestling. Fortunately, given his subsequent course in which he has been recovering function, it was clearly not a complete transection of the spinal cord, but it was severe. His doctors recommended surgery to stabilize his spine and allow his injured spinal cord to heal. Having had extensive experience in trauma during my training, that I agree with. The physicians also apparently wanted to use steroids, which are, as I pointed out before, not really indicated anymore in spinal cord trauma, a victim of the "decline effect," where a promising initial study gave way to negative studies later.
Unfortunately for Mazeratti, his mother Vermell Mitchell is a naturopath and thinks that she can heal her son's spine with herbal remedies, (one of which whose name she can't even remember!). So, while I don't find her unreasonable for not wanting her son to receive steroids, given how poor the evidence is to support their use in this sort of situation, I do find her extremely unreasonable for refusing to authorize surgery for her son and wanting to take him home to use her herbal woo on him to "heal" him. Such a course would be extremely dangerous. Hospitals have skilled personnel who can more patients with spinal cord injuries and an unstable spine. Somehow, I doubt that Mrs. Mitchell has the skill set to be able to move her son around without putting him at high risk for re-injuring his spinal cord, with the attendant risk of paralysis up to and including permanent quadriplegia. Fortunately, the court awarded temporary custody of Mazeratti to Delaware County, where he lives. Unfortunately, as of yesterday, Mazeratti still hadn't undergone surgery.
That might change soon:
A Delaware County judge has ruled an injured teen wrestler in the Philadelphia area must have spinal surgery, against the wishes of the teen and his parents.Fox 29 just spoke with Vermell Mitchell, the mother of 16-year-old Mazzerati Mitchell.
She confirmed that Judge Mary Alice Brennan told Thomas Jefferson University Hospital the surgery must happen.
It is now up to the hospital to decide when and where it will happen.
The Philadelphia Inquirer reports that a lawyer for the Mitchell family will appeal the decision.
Vermell Mitchell appeared on Fox 29 on Thursday and gave us a video that shows Mazzerati Mitchell moving around. Vermell Mitchell says the video supports her claim that local government doesn't have the right to take parental rights away in a medical case.
Delaware County took custody of the 16-year-old athlete after his parents refused spinal surgery for their son.
As I described for Abraham Cherrix and chemotherapy, these sorts of decisions are always difficult, and no judge wants to have to make them. For one thing, in this country, as I've complained time and time again, parental rights tend to be viewed as near absolute--or even absolute. If you don't believe me, all it takes is to look at the number of cases of faith healing that endanger children and how rare it is for any of these parents to be prosecuted. In cases where parents choose quackery instead of effective science-based medicine to treat their children, in fact the courts bend over backward not to take parental rights away, even on a temporary basis. They only tend to do so when all negotiations have failed and the danger to the child is acute. Think Katie Wernecke. Think Abraham Cherrix. Think Daniel Hauser.
And now think Mazeratti Mitchell.
Personally, I find the video that Mazeratti's mother released to be offensive in the extreme. No, it's not because there's something disturbing about it, at least not to someone with medical training. Basically, all it shows is Mazeratti moving each of his limbs. That's great! It means he's recovering in spite of his mother's interference with his receiving effective medical care. As long as the injury is not too severe, the spinal cord can actually heal pretty well. The key is simply not to re-injure it, which is catastrophic when it happens. One of the reasons to surgically stabilize the spine is to minimize the chance of re-injury. Without knowing the full extent of Mazeratti's injuries, I can only make an educated speculation, but my guess is that the surgeons would not want to stabilize his spine surgically if there wasn't a reason. There must be some injury or instability there that the surgeons believe needs to be corrected to maximize Mazeratti's chances of a full functional recovery. It's all a matter of risks. If Mazeratti's spine is still unstable, it might well heal on its own with just the cervical collar, but I'd be very, very worried about his spine being inadvertently injured again, just from moving around or from caregivers moving him around. Worse, because he can't be moved around vigorously, he'll spend more time in bed, with the resultant higher risk of bed sores, blood clots, pulmonary emboli, and pneumonia. With is spine immobilized with pins and plates, possibly also with a temporary halo brace, Mazeratti would be able get up and undergo much more intensive physical therapy.
Is it possible that he will regain all of his function without surgery? Sure. Is it possible that he might be paralyzed by the surgery? Sure. Again, it's a matter of risk versus benefit. What is the risk of doing nothing versus the risk of surgery? What I find disgusting, however, is how Mrs. Mitchell is displaying her son to the world, Foley catheter and all, all in order to make a point and to prove that she's right. Never mind that Mazeratti's ability to move his arms and legs is more indicative that he is healing in spite of his mother's interference than it is that her herbal woo is working.
Even though I am happy that Mazeratti is getting the treatment he needs in spite of his mother's interference, that doesn't mean I'm fully comfortable with what has had to happen. A few years ago, back when Abraham Cherrix was fighting having to undergo chemotherapy, even though I agreed that he needed it, I saw a huge difficulty with the judge ordering him to undergo treatment. The problem, of course, is that for the hospital to do this would require doctors and other medical personnel to use force to subject a teenager to medical care that he needs. First off, no physician that I'm aware of became a physician to force patients to undergo treatment against resistance. Second, doing so in essence crosses the line into battery. Once again, age matters. Pretty much every surgery performed on very young children is performed against the child's will and requires either subterfuge or even force to make the child submit. Howver, somewhere between 14 and 18, it starts becoming a gray area, where the child is old enough to be not only much more aware but is starting to develop enough mentally to be capable of making more and more decisions for himself. Unfortunately, Mazeratti, being 16, ir right in that gray area.
It never ceases to depress me to read about cases like this. The power of irrationality is strong, and it can just as easily infect the child as the mother. Sometimes when it does so we can morally justify not only abrogating parental rights but even compelling treatment in an almost adult, but that doesn't mean we have to like it or that it isn't a horrible decision. It's a decision that has consequences that can haunt the child and family forever. Unfortunately, quackery sometimes leaves reasonable people little choice.
- Log in to post comments
As a physiotherapist (physical therapist for you Americans), I would hate to see another quadriplegic, especially one that is preventable with surgery.
I wonder how this boy would feel with a urine bag for the rest of his life?????
I understand what you mean about a 'gray area' in maturity here, but certainly the fact that his mother (probably his most trusted authority figure) is filling his head with the idea that her magic herbs are all he needs should have some effect on our judgment of his decision-making capacity? Even a totally rational adult can't make a good decision if he's getting bad advice and doesn't realize it.
perhaps the most worrisome aspect to that news story was the reporter's false equivalence between real medicine and bollocks. "Doctors say that he injured his spine and needs surgery " and then put the crying mother on TV, all without bothering to explain that naturopathy = quackism.
How can a 16 year old make any decision when he has already been thoroughly indoctrinated by his nutjob mother? Its like asking a 16 year old evangelical homeschooler if he "believes" in evolution.
On the other hand, I agree that it is going to be difficult, therefore, to force this young man to accept treatment. Someone needs to "deprogram" him--it's probably too late for the mother.
I wonder what Oprah thinks. (Not really).
I saw the newscast (local to me) and was quite disgusted by the mother's ignorance and emotional pleading. While the presentation might have stressed the stupid woman and her son in the hospital bed too much, they did have a medical expert and a legal expert on.
The medico stressed the need for the surgery due to the possibility of further damage to the cord. He also stressed the non-scientific nature of the treatments idiot mom was providing. I could sense he wanted to say more on that but didn't. The legal guy discussed the rules for how and why the judge allowed the county to assume custody. All very sad.
I was shouting at the teevee every time the mom came on and teared up.
I hate to be the one to say it but...natural selection, Darwinism, call it what you wish but I have about zero sympathy for this whole case. Yes, it sucks that the kid has an injury. Yes, it sucks that his so-called mother is so thoroughly inculcated with woo that she wants to personally guarantee that he is going to be paralyzed or worse.
Having said that, if they wish to be morons then let them, and let this poor kid become a beacon against further stupidity. I have no sympathy for people who willingly and willfully ignore the facts for nonsense. I can just hear it now- she wins, she takes him home, he is permanently paralyzed or dies, and then she sues the hospital for something even more idiotic, like not telling her "just how bad it was".
Just sayin.
Perhaps Mrs. Mitchell would agree to a compromise: Mazeratti's spine can be stabilized by a chiropractor who would find and manipulate subluxations.
Scott,
I'm with you. Let the idiots exist as a warning to others. But I have one condition: I do not want any public money used to treat the kid after mom takes him home against doctor's orders. He's off the grid medically speaking.
This case is bringing out all the local "naturalists" and vaccine denialists in the area. AGAIN I had to listen to call after call on a local radio program saying that the mom's herbs and homeopathic remedies are PROVEN to work in other parts of the world. The are allowed to say this without backing it up, and without question by the interviewer/ host in most cases. That people die in surgery every day, so using an alternative approach is just as good. It's like they are getting free ad time on all the local tv and radio outlets. Infuriating.
How can a thoroughly indoctrinated 30-year-old make a rational decision? It's still a gray area no matter how much indoctrination has been received... If our criteria for whether a person is legally allowed to make a certain choice is whether that person is making a halfway-decent decision, we will descend into totalitarianism rather quickly.
Which is just to say I agree it's not clear-cut. I tend to think a reasonable compromise would be to allow him to forgo surgery and to do the herbal treatment, but he has to stay in the hospital with caretakers that are professionally trained to minimize the possibility of him reinjuring himself. But who knows...
You're a fucking asshole. Even if the idea of Darwinian selection being moral weren't absolutely disgusting, there's absolutely no evidence that what is putting this kid at risk is genetically inherited. Hell, for all we know, Mazerrati might carry a dominant allele from his father that will make him extremely rational and skeptical as he becomes an adult. You're not even endorsing Social Darwinism here, you are endorsing Social Lamarckism. You're not just being morally reprehensible, you're also being stupid.
Just sayin.
James,
You are an utter moron.
A "reasonable alternative" is to let the kid have his woo but be monitored by medical professionals? Are you kidding? THE HERBAL TREATMENT IS COMPLETELY UNPROVEN AND HAS NO MEDICAL BENEFIT, you twit, and whether or not you dress it up with a nice comfy hospital bed and training professionals it is still NONSENSE.
And for your second statement- grow a set and man up. Studies have shown that texting while driving increases the chance of an accident; well every time some moron zooms by me on the freeway with cell in hand I have two thoughts. One, don't hit me, and two, when you wipe out and kill yourself you got precisely what you deserved. Life is NOT egalitarian.
I never suggested that the risk faced by this kid was genetic. I was making a reference to survival of the fittest and perhaps had you, I don't know, READ what I wrote you'd have gotten that. What is stupid is when people like you suggest that my tax dollars be used to allow some complete idiot to keep her kid in a hospital and be treated with herbs and homeopathy. What is stupid is allowing people to choose completely unproven and medically worthless treatments and then, after the fact, come crawling back for help. If you want to make that bed then you ought to be forced to lie in it.
Try reading this whole thing and perhaps even understanding it before you reply.
Scott--If you have to be the one to say it, don't. There is no sense in which that needed to be said, even if it was in some sense correct.
The problem with blithely invoking "survival of the fittest" is that people doing so are generally talking about tweaking the definition of fitness in one direction or another: providing or not providing medical resources, adequate meals, or vaccines, for example. You're saying "don't bother fixing X, it's Darwinian." When people say that, X is almost never something that harms them, or increases their own risk.
Other than the vacuous "survivors survive," where is the fitness or otherwise in being put on the wrong bus and going over a cliff, or being disorganized and missing a plane that goes on to crash? Every idiot who drives an SUV too fast in the city increases my risk of death. How does any individual, society, or the species benefit from that?
The human trick of working together and sharing ideas and tools is all about helping each other survive and prosper.
If you're ever hospitalized or disabled, feel free to remind strangers not to help you, financially or otherwise. But I'm not going to try to decide who is a "worthy cripple," virtuous enough and sufficiently not responsible in any way for their illness or accident.
Hi Orac, I've been reading your blog for a while now, but this is the first time I comment.
You say "I don't know for sure what I think of the latest developments in the Mazeratti Mitchell case"
I do. I understand that the doctors may have a problem in forcing surgery on a child, but the judges were absolutely right...
There was a case here in Italy a few years ago of a 16 years old girl who had diabetes. She didn't like having to use insulin everyday, so her parents (her father in particular), sought for some "alternative" cure. A doctor (a REAL doctor) sent them to a kind of guru of anthroposophic medicine who tried to cure her with VITAMINS (and taking away her insulin).
The girl died 13 days later.
The "healer" died less than 1 year later for a gastric ulcer (and here's some kind of justice, as she tried to cure her ulcer with alternative medicine), but last year her parents were sentenced to 3 and 2 years' imprisonment for unintentionally killing their daughter.
If someone had known what they were doing, and a judge had forced them to re-establish the correct therapy, the girl would be alive and well, now...
Scott, I think your mistake was invoking the name of Darwin without being clear you were using it in a Darwin AWARDS type reference.
Big difference.
I understood it, though, and I kind of agree. At some level, everyone has the right to refuse treatment, but it would aggravate the crap out of me to learn down the road that the kid was receiving six kinds of expensive public assistance because he becomes paralyzed for life through his mother's arrogant ignorance.
A 16 year old is injured, grievously, doing something he loves. It is explained to him (and his parents) that his condition is precarious. He can suffer complete, irreversible paralysis if he does not get surgery to repair/stabilize his spine. The danger of a bump, twist or other movement can trigger the damage.
What does he do? He relies on the teaching his mother has drilled into him since forever that doctors, with all their education and experience are no match for ancient wisdom and herbs. Painful, somewhat risky surgery vs herbal wraps (or whatever) and vitamins, none of which show any scientific validity.
Kid is in a tough spot and even if he had the critical thinking skills to evaluate the bogus claims his mother is making, he will not cross her. He does not trust doctors. I would not be surprised to learn that he is unvaccinated.
Even if doctors and the courts successfully reduce his risk of paralysis, this poor kid is already indoctrinated into a life fraught with woo and a myriad opportunities to be injured or die due to lack of proper medical care. Even if this incident is fixed, what about the next one or the one after that? He and many like him are potential future Darwin award winners. Suicide by stupid.
How about a tax on alternative medicines, that is placed in a compensation fund to pay out when the woo fails. If the tax is high enough to actually reflect the real cost of injury from woo, the cost increase might cause fence-sitters to think. I know people who smoked until the tax reached a critical level.
Two things...
First, from what I have read about adolescent brains, probably few teens are capable of truly, rationally, determining the risks and benefits in this situation. Combine that with a general sense of invincibility and parents saying "Momma's gonna make it alright." and you have a near zero chance of making the right (the rational) choice.
Second, the issue of refusing medical treatment to someone who has checked out "against medical advice" has been brought up. A little OT, but I think that the fact that anyone can get treated at an ER without having to prove an ability to pay, while a good and moral position, allows the anti-mandatory insurance crowd the psychic space to be boldy against big gubmint, while knowing all along the nanny state will care for them if they get sick or injured and on someone else's dime.
Two comments:
1) I have no problems with the ruling in this case, because, I pointed out in the other thread, it actually is irrespective of the quackitude of the mother. A doctor is not allowed to provide consent for a patient for them, regardless of whether or not it is their child. IOW, it is not a "parental right" to treat their own child as a doctor.
I would agree that it would be a fuzzier issue if she were to eschew medical treatment in favor of a local quack, but she isn't even smart enough to do that (more likely, she can't even find another naturopath stupid enough to do that for her).
2) I think it is silly to harp on the steroid issue. Although it might be true that a steroid therapy isn't indicated here, she isn't "right" in that regard, even though she believes the same thing. Her objection to steroids has nothing to with whether it is actually a good approach for preventing inflammation and thereby helping healing in these types of injuries. It is solely because "it's evil allopathic medicine." Sorry, the enemy of my enemy is not necessarily my friend.
I do not. Steroids do a lot of harm when used inappropriately. Yes, the reason for the mother's objection to steroids is so wrong it's not even wrong and she's right for horrendously wrong reasons in this one objection, but look at it this way. If the only intervention to which the the mother had objected was steroids, would you be supportive of taking away her parental rights because she is going against the recommendations of her son's doctors? I certainly wouldn't, even it it meant she was giving him whatever herbs after he underwent surgery. All I'd ask for is to make sure they didn't interfere with his real medicines.
What non-surgeons don't understand is that doing surgery on an unwilling patient is not as simple as just overpowering him or shooting some sedative into his IV and whisking him off to the OR. Most surgeons are profoundly uncomfortable doing surgery on an unwilling patient, except in extreme emergencies whether the patient might have a head injury or be intoxicated with drugs and/or alcohol and as a result not be in his right mind--as well we should be. We quite correctly view operating on an unwilling patient something to be done as a last resort, either because there is no time and the patient's life is in danger, or because all other options have been exhausted, which appears to be the case here. Even so, it never "feels right" to operate on a kid like Mazerrati.
If the surgeons operate on the child and there are some small problems with recovery, such as infection at the operative site that requires "traditional" medicine, mama herbalist sues.
If the surgery is performed and it is totally uneventful recovery with return to full function, mama herbalist still sues...for battery.
It is a win-win situation for the mama herbalist.
Vicki you totally miss the point here.
Let's say I get cancer- and, let's say it is totally unrelated to anything that I did to perhaps increase my cancer risk. I do not smoke, I do not drink to excess, etc; the cancer just happens. If I am indigent, or have serious financial problems and people want to help me, great.
Now, let's say I have smoked for 40 years in direct contravention of my doc's orders. Let's say that I have a family history of lung cancer. In this example, do I deserve to be assisted?
The difference here is simple- if you bring something on yourself through action or inaction (inaction in this sense being defined as treating an injury or illness with totally unproven remedies) then I would argue you deserve nothing but the fate you have brought on yourself.
This DOES have to be said because in the silly, PC, don't keep score in athletic leagues world in which we live it seems that we allow people to be rewarded for stupidity, and we allow those people who insist on doing things we know won't work to do them (and then help them when they realize they've made a massive mistake).
Again I am sorry that a 16 year old boy has been thrust into this position...but, too bad.
Scott #21 wrote:
You may deserve your fate from a cause-and-effect standpoint, but the "you made your bed, now lie on it" approach to ethics is just too one-dimensional for me. People are not flat cartoon characters easily categorized and treated as "bad," "good," "stupid," "careless," "arrogant," "foolish," and so forth. They are a mass of contradictions. They get to have redeeming qualities. They can change. They are allowed to have 'blind spots' which fail to diminish their overall character.
And when dealing with life, death, and flourishing I think we are allowed to exercise a reasonable amount of compassion and mercy, and consider a human life in toto -- and not reduce it to a narrow representation of That Bad/Stupid/Careless Thing They Did. Or believed.
No, I don't know what to do about the money aspect. But I'm not sure that should be the ethical bottom line here.
No, Scott, I don't "miss the point," I profoundly disagree with it. Nobody deserves to die of cancer. Nobody deserves to be paralyzed.
I also know that, in practice, once certain conditions become something that some people are considered to "deserve," everyone with that condition is presumed guilty. A friend of mine's mother died of emphysema. My friend got very tired of people saying things like "I'm sorry, but she should have known that smoking could do this" about a woman who had never smoked in her life.
If that texting driver you mention does hit your car and leave you unable to walk or otherwise disabled, people who think like you aren't going to think "poor guy, he must have been the victim of a selfish idiot" if they see you in the supermarket. They're going to think "he should have known better than to drive drunk." It's a weird backwards logic in which illness and disability are seen as punishments, and the universe is assumed to be entirely just: if you are handicapped, you must have done something to deserve it.
@scott
I posted this reply to a remarkably similar post by Jason in the other thread:
"Firstly when the issue of consent is involved, including cases of age, coersion (which parents are well capable of), and being improperly informed, it is an issue of compassion to intervene.
Secondly, your ideas about genetics and intelligence/reason are pretty simplistic. To pick an example I was reading today, only about 30% of southern baptist children stay in the flock. This is despite coersion and brainwashing. To assume that a child would maintain all the beliefs of his mother into adulthood is downright moronic.
Overall you come off as a faux-rational, libertarian type. It's not a worldview that survives scrutiny all that well, but I suggest you try it out anyhow. It might stop you from getting culled when your simple-minded impulses would otherwise put you on the evolutionary chopping block."
He was more overtly libertarian, so I don't know if the last paragraph applies to you. Either way, you seem to have a very loose grasp on the concept of evolution and how it relates to human morality.
Also, the problem with not treating people who "deserve it" is that it's difficult to know where to draw the line. For example, should we not treat all people who contract AIDS through unsafe sex or drug use? How do you define "unsafe sex"? And also, in many cases, what if the untreated people infect others?
Michael,
Let me make a distinction- if you can afford to pay for treatment out of pocket then OK. My argument is against the use of public funds for the treatment of stupidity.
So, if a gay man (and nothing wrong with being gay) chooses to engage in unsafe, high risk sex despite knowing the risks, then no, I do not think he deserves treatment on my dime. I am not a doctor, so I have no "Hippocratic Oath" problem; to me it is a simple, straight line in the san. You did something you KNEW could lead to your own death and you did it willfully.
Vicki, I still think you've missed the point. I understand the issue with the friend's mother, but that is little more than a shining example of people making a bad assumption. I personally would not assume someone with emphysema had contracted it from smoking; I'd ask if they smoked first. I also think you are dead wrong; no one sees a person in a wheelchair in a grocery store and assumes that said person was paralyzed due to the fact they drove while drunk! Now I am sure some people do view disability as somehow deserved (I'll bet a lot of them flock to worship a fable on Sunday as well) but a disability in and of itself is no more deserved than winning the lottery- it's chance.
Again my point is that I believe we have to hold people accountable for their actions- personal responsibility. If this boy dies because of his mother's insistence on herbal remedies, then she ought to be tried for negligent homicide or manslaughter. As much as I despise the "woo", I would be perfectly fine if she did her woo well after modern medicine was given a chance to fix the poor kid.
What about someone who drives in a car, gets in an accident, and needs care? Should they similarly be denied care, since they knowingly engaged in the dangerous behavior of driving?
I want a piece of this juicy argument, and I'm going to stake my position out near Scott on this issue.
I feel that people should both be allowed to make choices and, to a certain extent, protected from the outcomes of those choices. The kid chose to wrestle, a sport that has been known now and again for grievous injury. He was injured, and we as a society have agreed to treat him with the very best medicine that we have thus far developed.
However, now he is being presented with this ultimatum: either you will undergo this surgery and almost certainly recover to an extent, or you can use magic and probably wind up in a wheelchair. That is the choice being put before him, and it sounds like he is militantly angling for a lifetime of rolling.
This particular instance is galling, as his mother is clearly a despicable tool, but what I propose is applicable across the spectrum:
The long-term cheaper option has been presented, but they are pushing to choose the long-term more expensive, more painful option. Let them pay for it.
I think there is a basic level past which society's agreement with you is void, and rejecting the best of medicine for the worst of magic is such a plateau. To take Scott's smoking analogy, I do think that society should help someone with lung cancer, however they got it. But if the guy finds out he has lung cancer and decides to take homeopathy instead of medicine, I think that he should bear the full brunt of all costs and consequences after that.
In short, I suppose I've realized the bare minimum of my own argument when I say that you should be allowed to do most anything you like, but you shouldn't be allowed to bite the hand that heals you only to expect more help once things get worse.
Ok, so scott is some flavor of libertarian. It's a very adolescent viewpoint and one which has, apparently in your case, been subject to zero introspection. I say that because it only takes about a minute of critical thought to realize that what you propose is ludicrous.
As a previous poster mentioned, I hope you don't ever drive (especially a non-essential trip in inclement weather), play a sport, get someone pregnant, volunteer or choose to work around sick people, engage in any sex (hey, no such thing as safe sex), own a dog, etc, etc, etc.
Seriously.
The main problem with treating people by the yardstick of whether or not they, on some level, "deserve" the outcome is that that sort of judgment is extremely difficult to make. If we do as Damien suggests, and eliminate the option of public funding for treatment after he attempts alt med and finds out it doesn't work, then we are essentially penalizing being wrong.
In addition to being potentially unconstitutional (I would think at minimum it would violate the First Amendment to penalize people for being wrong) it seems that it means the victim of a con artist would be punished for being victimized. What's more, the line between "wrong" and "bad luck" can be very slim. We all can see him being wrong in deciding that herbs can prevent nerve damage in this case. But what about more ambiguous cases? What if the error isn't on the part of a quackish naturopath, but on the part of a doctor who failed to note something crucial or simply was unlucky? I don't think you'd support the latter case being punished, so you can see how the line is not at all clear. Times when the line is unclear are bad times to employ legislation.
The more extreme proposal by Scott is tantamount to corporal punishment for non-criminal actions. While I do think there are cases where a person should forfeit certain advantages due to having taken certain choices early on, we get on very shakey ethical ground if we apply that to medical decisions, and I think the risk of harm is far greater than any cost savings. (Besides which, by my personal sense of ethics and morality, it's just plain wrong. The ancient Hebrews believed people were injured or ill due to divine punishment; we really don't need to return to that philosophy.)
Ack, hit post too soon... I meant to add this quote:
Ham. 'Tis well. I'll have thee speak out the rest of this soon.â Good my lord, will you see the players well bestowed? Do you hear? Let them be well used; for they are the abstracts and brief chronicles of the time; after your death you were better have a bad epitaph than their ill report while you live.
Pol. My lord, I will use them according to their desert.
Ham. Odd's bodikin, man, better: use every man after his desert, and who should scape whipping? Use them after your own honour and dignity: the less they deserve, the more merit is in your bounty. Take them in.
-- Hamlet, Act II, Scene II
@ Enkidu waaaaaaaaay upthread at #9
You said "This case is bringing out all the local "naturalists" and vaccine denialists in the area. AGAIN I had to listen to call after call on a local radio program saying that the mom's herbs and homeopathic remedies are PROVEN to work in other parts of the world."
I would like to add this little bit. Yes. But here it's also bringing out a lot of guys who wrestled in high shcool (wrestling's huge here, so the story's gotten some notice,) and almost all of them, particularly the black wrestlers, are in favor of the kid getting the surgery; a few to the point of asking if anyone had contact information for the family. It's not only the loonybats paying attention!
@Calli Arcale, I don't think it's necessarily being punished solely for being wrong. There is a very clear demarcation line that I would propose, because we clearly cannot have people being brutally punished for the mistakes which we are all bound to make as human beings. As a brief aside, I'd like to know why you think even punishing people for being wrong would be against the First Amendment? Are you thinking of the religious protections?
Anyway, I feel the line that should separate punishment-worthy offenses versus those that we ought not to would come down to this: have you been specifically told that this course of action will almost certainly lead to a specific harm? E.g. in regards to your example of the conman/conned connection, if you received an email from a Nigerian prince requesting $10,000, and when you asked an FBI agent about it he explains specifically how 419 scams work and that if you give the prince 10k, you will almost surely lose that money, should we bail you out if you go ahead and give the guy the money? No.
As another example, let's look at sexual promiscuity. You are categorically more likely to pick up and STIs or become pregnant, but we can't say that having a lot of unprotected sex will almost certainly lead to a specific bad outcome.
This is where I think we ought to draw the line of support. To return to my previous example of lung cancer/homeopathy, if a doctor says to you, "if you don't have chemotherapy and surgery, your tumor will grow inoperable and terminal. Homeopathy doesn't have any effect on tumor growth, the best course of action if chemotherapy and surgery," and you go ahead and go use homeopathy anyway, I think that you have forfeited your right for society to pay for any further treatments, nor do I think insurance companies should have to pay either.
As another example, I apparently have gallstones, and I wound up in the ER this past weekend from the pain. My insurance will cover it, thank God; while I was there, however, I was told in no uncertain terms that if I didn't have my gall bladder removed, I could look forward to much, much more pain in the future and probably more ER visits. If I reject the surgery, which is the best course of action, even if I don't go to an alternative, I would not expect my insurance provider to pay again and again for my bad decisions.
The same should go for any dichotomous decisions like that: if there is a clear, reasonable and established best course of action, and you ignore it, the social contract should be void.
I love it when idiots argue in favor of barbarism because it's 'Darwinian.' Yes, let's allow people to suffer so that their weakness can be properly weeded out of society. And while we're embracing our most animalistic legacies, let's make sure to be racist and xenophobic, because after all, tribalism was good enough for great-great-great uncle Grog, and by gosh, it's good enough for me! Oh, and we'd better get all Spartan and make sure that we leave sickly babies out on a hill to die, because sheesh, what a drain of resources to have to care for them!
Or, you could BE A FUCKING HUMAN BEING, and recognize that while it is not possible, (nor perhaps in all cases desirable) to protect everyone from the consequences of their poor decision making, when we CAN reduce the suffering of our fellow man, we MUST. Doesn't matter if they're crippled because somebody ran them over or because they decided to dive into the shallow end.
I mean, just to clarify, Scott, you ARE claiming that the proper punishment for a 16 year old with bad judgment is a lifetime of paralysis, right? Your kids have a lot to look forward to.
so Damien, will your title in this new regime be "arbitrary line-drawer"? The privilege fucking oozes from your post.
so Damien, will your title in this new regime be "arbitrary line-drawer"? Typical egocentric libertarian, the privilege is just dripping off your post.
@ Kate from Iowa: It seems like the looneys are getting all the air time here. Or, perhaps, wrestlers in Iowa have more sense than people in the metro-Philly area. :)
I should clarify. From a medical issue, of course the question of whether to use steroids is important. And that is certainly something that real medical professionals should be wondering.
But in terms of this case, and in terms of the loony woman, she has nothing to do with steroids. As you noted, her opposition to steroids is not even wrong. So not even wrong, in fact, that there is no business mentioning her and steroids in the same sentence.
Orac, if you want to talk about whether steroids are medically appropriate, go for it. But I fear that your comments imply some legitimacy to her objections. Just because steroid therapy is likely not appropriate, and she is opposed to steroid therapy, does not mean she is right, or has a point, or that there is any merit to her position. Even though she doesn't want to use steroids, she is still wrong. Completely wrong.
didn't read the rest of the comments as social Darwinism and fitness discussion make me puke but,
Scott and MikeMa, the kid (and any kids for that matter) should never have to pay for the idiocy of the mother; is that clear enough?
A.L.
She wouldn't be wrong if she didn't want to use steroids. She'd be a classic case of being (probably) right for all the wrong reasons. In such a case, as long as her son got her surgery, I'd let it slide. The patient always comes first. Always.
In any case, I notice that you didn't answer my question, so I'll ask again: " If the only intervention to which the the mother had objected was steroids, would you be supportive of taking away her parental rights because she is going against the recommendations of her son's doctors?"
Where the rubber hits the road and you have to take care of a patient in front of you, reasons don't matter as much as results or potential harms. At least not to me.
That poor kid already has damage to his spinal cord, you can tell by his abnormal movements and his hand position. He must be incontinent of urine already or he wouldn't (I sincerely hope) have a urinary catheter. And his mother wants to move him? What is she going to do, put him in a wheelchair and roll him out the the family car?
Pablo,
It's a moot point. There's no indication for use of steroids this far out from his injury. I think that's Orac's point (although I don't want to put words in his mouth). The National Acute Spinal Cord Injury Study (NASCIS) suggested that patients with spinal cord injury secondary to blunt trauma (as in this kids case) have improved neurologic function 6 months out from injury if given methylprednisolone within 8 hours of injury. It also states that there appears to be no benefit after 8 hours. This is 2-weeks later. Jefferson can't be suggesting steroid use this far out. Are they?
As Orac states she would have some legitimacy to object (for the wrong reasons) this far out from injury. If she objected upon her child's arrival to the hospital, it's still her right...no matter how stupid and misinformed. This is why we must obtain informed consent. We can't save everyone, but the hospital did the correct thing by temporarily taking custody.
But, I also understand why Orac would not want to take this kid to the OR. It's something quite different if the child is 16 months and yelling no. But a 16 years old, who has the ability to understand the concept of surgery and risks?
How would the surgeon and hospital suffer if there's a complication? I wonder if this will be an Attending only case?
Becky,
There's probably a few reasons he has a Foley catheter in his bladder. One of which is that he's not supposed to be moving or getting up to use the toilet. Having a foley isn't necessarily indicative of incontinence secondary to spinal cord injury. But I agree, his mother is out of her depth, and is making decisions based on pseudoscience (does it even rise to that level?).
@mikerattlesnake, I don't think that's particularly helpful. And, frankly, what exactly is so arbitrary about my line? A doctor says to you: if you do X you will almost certainly injure yourself further and require more investment into your long-term care, or if you do Y you will more than likely recover. If you do X anyway, you should pay the consequences of your stupid actions.
Or look at it a different way. Let's say your car insurance (i.e. everyone paying into the program) pays to have your car checked out and there's a hole in the gas line. The auto technician comes over and says that either it will cost 200 now to fix the hole and almost certainly make the car drivable, but if you ignore it the line will burst and probably set the car on fire. If you ignore this, drive away and your car bursts into flames, why on gods' green earth should the insurance company be liable for your stupid decision?
I don't think they should. Now, just to be clear, I don't think that this kid should be in this situation and I think that it's unfair that his literally retarded mother inculcated him with bad ideas that might cripple him. However, I look at it the same as if someone took a gun, stuck it against their spine and pulled the trigger, and I would be hard pressed to justify others paying for the long-term consequences of that stupid decision.
Would I say don't care for him if he has a complication from quadriplegia? No, that would be cruel. But I feel that those people making these decisions have violated their social contract and thus should have to pay for their decisions out of pocket. Similarly, they have violated their insurance contract, and that should be void.
Last thing, considering that I would be perfectly fine living under such a system, in what way am I acting privileged?
But she is not objecting to steroids "this far out from injury." She is objecting to steroids because she thinks they are the spawn of satan. Nothing she says has any legitimacy whatsoever.
And Orac, your question really doesn't apply, because it isn't the case. No one is claiming that steroids should be the only treatment, are they? (and as asked, is anyone really arguing for steroid treatment now? The time window is long past...)
For what condition would a medical practitioner advise steroid treatment only to prevent a dire outcome like paralysis?
Sorry.. I think a "WAIT n SEE" approach would NOT have hurt.. if they did the surgery next week, they would have had more info to figure out if it was still REQUIRED..
This became a battle of wills of who's right and who's wrong that this CHILD has been made to feel that he has NO CONTROL over what happens to HIS BODY..
VIOLATION.. pure n simple..
They could have WAITED and let the boy have a week to just sit and think about it..
I think they just wanted him out of that hospital bed.
Wonder if he had good insurance.. Or maybe he was on MEDICAID.. betcha it was medicaid
@46 Redstepchild
Thinking FAIL.
To start, wow, way to assume that the people who spend half their lives and go through the hell of medical school are callous bastards who'll slap together any treatment if it frees up a bed.
Second, no, they couldn't have waited. If you break your arm, do you wait a couple weeks to make a decision whether to have it set? No, you do not. Many medical cases have critical periods where treatment HAS to be done, or risk greater harm down the line.
Clearly, the urgency for surgical aid was being made because it was felt there was an imminent need.
Too, how would surgery get him out of bed sooner? Most people, if you're unaware, require time and rest and observation after surgery, to recover, check for post-surgical infection, etc. So even your basic premise, that surgery would get him out of the hospital all that sooner, is potentially wrong.
And again, way to impute evil motives to people without any particular cause to do so. We KNOW the mother's motives, but nothing in the story indicates the doctors are motivated by anything other than the desire for this child, as you say, to heal without risk of further injury.
Pablo,
"For what condition would a medical practitioner advise steroid treatment only to prevent a dire outcome like paralysis?"
Bells Palsy. Prednisone may be used to decrease facial nerve swelling.
It doesn't matter why she objected to steroids. Jehovah's Witnesses try to stuff literature in your hands about bloodless surgery all the time (a couple of times before severe trauma's--they must carry pamphlets around with them), I've seen an elderly woman request that she keep her "Matriz" (uterus) during an ovarian cancer operation...because she feared she wouldn't be a woman without it.
People reject medical treatment for a variety of personal reasons. We don't get court orders to override their autonomy just because we think their reasons are stupid. Stupidity is not a crime (but, I'm not President yet...).
The main point here is that she's rejecting operative management of his injury that his surgeon has said is the best course of action AND she plans to treat the injury with herbs AND he's a minor. Treatment of a minor with unreasonable alternative modalities by an unlicensed practitioner, when a proven conventional management is available is why Jefferson sought temporary custody.
The early steroid treatment is controversial anyway. http://www.trauma.org/archive/spine/steroids.html. Steroid treatment can inhibit wound healing, can lower infection resistance, and is an important cause of hyperglycemia, especially in the ICU setting.
If she were a savvy woman and gave you all of these reasons instead of the woo, would that be a good enough reject the corticosteroids on admission? The outcome is the same. And if her son were an 18 year old high school senior, he'd be home getting herbs, spices, and "P" sprinkled on him right now.
While I agree that children from 14-18 are becoming more capable of making their own decisions, I do not agree that they are capable of making GOOD decisions.
From what I have learned of brain development, which admittedly isn't much, the ability to understand future consequences of present actions isn't firmly stabilized until well into a person's 20's.
Mazeratti probably can't even imagine a future in which he has to pee into a bag or use a wheelchair his whole life. He has probably never noticed how telephone poles, fire hydrants, and road signs tend to sprout in the middle of urban sidewalks, making them impassable to the disabled. He has probably never thought about what it would be like to be unable to move from the neck down after sixteen years of being able to do whatever he wanted without help. He would cope, surely, but it is hard work to forge a new life.
Because he can't see those future consequences, and the consequences are serious, he really shouldn't be asked his opinion on the matter.
In a somewhat related story, I received news today about a friend who will likely die within the next month. This friend is thoroughly indoctrinated in many forms of magical thinking, including alternative medicine. For several years his health has been declining. In the past year it has become more difficult for him to eat, his throat becoming inflamed and swollen. Recently his diet has been nothing but thin broth.
His course of action has been to see a naturopathic practitioner. ("Naturopathic doctor" is an oxymoron.) Apparently this practitioner ruled out cancer through some battery of tests and diagnosed pancreatic fatigue. The prescribed treatment included a series of colonics and some sort of enzyme supplements. This has continued for weeks, maybe months.
Yesterday, my friend's wife took him to a hospital emergency room as he was unable to swallow water. Later the same day he had a new diagnosis of esophageal cancer, which has likely spread to his stomach and liver. His esophagus is so inflamed that there is barely a passage through it.
Apparently, this sort of cancer is usually very slow growing. His real doctors expect he has had it for years, perhaps more than 10. I can only speculate that his prognosis would have been better if his condition had been properly diagnosed years ago (and he had been open to scientifically supported treatment).
This is an extreme example of the harmful potential of magical thinking and "alternative medicine". When my friend dies he will leave a wife and 19 year old daughter to grieve. I used to be a "shruggie". Let others believe what they want. What's the harm? No more.
Many people in my community believe in alternative medicine. I am curious to hear how they react to my friend's condition and final days. I expect they will be able to explain it away. "It was meant to be," being my favorite statement that defies any rational argument.
At least they will know what I believe. That I cannot accept the senseless loss of a life. That alternative medicine is a form of misguided magical thinking that should be discouraged. One that I will actively discourage.
Although I completely agree with the fact Mazeratti's woo is not going to work on her son. I cannot abide by the court making subverting parental decisions even ones that will definitely lead to paralysis (I have no doubt that her son will be paralyzed if he doesn't get the surgery he needs, nothing could convince me otherwise).
We cannot be emotional about this. Mazeratti's son's doctors should only present the benefits and risks of the surgery and the benefits and risks of not having the surgery (I'm sure the case will be VERY compelling FOR the surgery) and leave it to them.
We all have to live with our decisions. Regardless if they are informed decisions or ignorant decisions. At the end of the day Mazeratti will have to live with herself and unfortunately her son will as well.
Hey, Orac, I decided to look up Wernecke and Cherrix, and while I couldn't find anything recent on Katie, the alties are waving Cherrix around like a banner as "proof" that woo works. Of course, they totally ignore the state-ordered chemo as the real factor in saving his life.
With regard to the steroid question:
1. The original study, if I recall correctly, showed a benefit to recovery of motor function which was only marginally statistically significant, and small enough to arguably not be, in many cases, clinically significant (it was basically something like regaining one extra grade of muscle strength in one tested muscle group, on average, which could mean the difference between anti-gravity strength in the shoulder girdle or not, which would be important for functional recovery in a quadriparetic patient confined to a wheelchair, but could also mean going from no movement in say the bicep to having muscle contractions not strong enough to move the limb against gravity, which would be meaningless, in terms of useful function).
2. The original study also showed an increase in death from pneumonia in the steroid group (steroids suppress immune function). And the proportion of deaths was greater than the proportion of benefit. In other words, even in the original study, the data can be interpreted to show that steroids do more harm than good.
3. The benefit such as it is from the steroids is only accrued if administered within the acute window immediately after the injury. If administered later they are worse than useless. Which means that at this point in this particular case, the steroid question is mute.
4. The way the original study was hyped after its publication, combined with the terrible nature of spinal cord injury, created an atmosphere where any clinician who failed to give steroids risk being sued. And to this day, despite the change in how we regard the evidence, there are a substantial fraction of spine surgeons who give steroids, and when asked with respect to their reasons, do so because they fear litigation, even though in private they do not believe that steroids provide any benefit. (In one conference I attended, an informal anonymous poll was conducted, and this group who gave steroids solely due to fear of litigation, was a super-majority of over 80%).
5. Since the benefit of steroids is in motor recovery, and the harm seems to be mostly from immunosuppression, there are some who believe that steroids may still provide worthwhile benefit for young, healthy, athletic patients, whose immune systems are strong enough to withstand the steroid induced immune suppression. The young man in this particular case would seem to fit into this criteria, and possibly this is why he was offered steroids.
With regard to the mother's decision respecting steroids, in acute triage situations what matters is that the correct decisions are made, not why they are made. A good decision made for the wrong reason, in such a situation, is just as useful as a good decision made for the right reason. One can worry about correcting the misperceptions underlying the decision after the acute situation has stabilized, and there is time for the luxury of reflection.
With respect to the stabilization surgery, and the following;
In the days before we had stabilization surgery, spinal injuries of this sort were treated with external immobilization (collar or halo vest) and bedrest for months to allow the fractured bones to heal/fuse. This period of bedrest had to be entirely within a hospital setting, in order for the patient to receive the specialized nursing care that patients on prolonged bedrest require.
With internal stabilization (ie surgery), the patient can be safely mobilized and begin physiotherapy immediately after recovery from surgery, which is in the order of a few days to a week or two at the most. That is how surgery gets this patient out of bed and out of hospital sooner.
Prolonged bedrest of course has a whole host of associated risks and complications, such as muscle wasting, bone demineralization, pneumonia, deep vein thrombosis, pulmonary embolism, pressure sores, etc, etc. However, in the pre-surgery days, the success rate of external immobilization and bedrest was not abyssmal - more patients did well with this than did poorly. Of course the results with surgery today are at least an order of magnitude better. So if the mother in this case could be persuaded to keep her son in bed, and if she knows how to administer the necessary specialized nursing care (not all that likely on either count, granted), then what it amounts to basically, is the standard of care from the 1950's.
With respect to Scott;
This is a classic example of the ignoring the first rule of holes. People who insist that is=ought are jerks, irrespective of how right or wrong they might be.
Actually, in the ICU we get them out of bed asap. After surgery, he will not be reclining gracefully in the bed for days, he will be out of the bed later that day, if not the next day. His spine will be stable and there is no good reason to keep him in bed. They will be working on pain control for a few days, after which he should be on oral pills for a little while. I agree with Orac about the steroids, hospitals have gotten away from using steroids for spinal injuries, there is no good evidence that it does anything other than slow healing and increase infection rates. His mom is sadly mistaken, I feel for her but wrong is wrong. I also feel anger at the station for presenting her case as if it were the correct position without speaking with the doctors for their point.
@John #51
"We all have to live with our decisions. Regardless if they are informed decisions or ignorant decisions. At the end of the day Mazeratti will have to live with herself and unfortunately her son will as well."
The fact is that WE will have to live with THEIR decision and, in all likelihood, pay for it. In an era with health insurance and state-provided medical services, if he ends up as a quadraplegic, you can be guaranteed WE will be paying for his care one way or another.
To me, taking him out of the hospital and giving him an unproven treatment would be child abuse. The state has an obligation to intervene.
Wow. Do those of you who have hammered me not understand the concept of extremes?
Dont be collectively daft. Choosing to get into my car and drive to the grocery store is altogether different than drinking a fifth of Jack Daniels and then getting into my car to drive to the grocery store. Sure, choosing to drive is a risk in and of itself but it does not fall into the category of "stupid decision, the consequences of which are your own fault". This is why if I drive sober and get into an accident that kills someone I am (perhaps) civilly liable, but if the same thing happens when I am loaded I am criminally liable.
My father suffers from PKD and had a kidney transplant in 1987. If I remember correctly is was right around the same time that a famous former baseball player was on his second liver transplant. Now, I may have the story wrong, but for the sake of argument let's say I have it right. This ballplayer was on his 2nd transplant because he refused to quit drinking and smoking despite a virtually dead medical certainty that he would ruin his first transplant. Now, there are a limited number of livers available for legitimate transplantation, so guess what- this guy would NOT be deserving of a second liver and as sad and draconian as it is to say, he would deserve to be allowed to die. Someone who desperately needed that liver was denied it- someone who would have maximized the reprieve- because of the stupidity and selfishness of the former ballplayer.
So please, don't give me any hyperbole about driving, or walking, or flying, or any of those behaviors. Risky, sure, but not anywhere near the same moral ground. Again I will reiterate the point- if you are too stupid, misinformed, etc. to choose the best, most likely to succeed course of action but instead choose a path of woo that has no chance to succeed, then you get whatever the end result is, plain and simple.
According to the local Philadelphia Fox TV station, he had surgery on Friday, February 11th. Mommy "Doctor" herbalist Vermell was interviewed just after surgery was begun; video available at myfoxphilly.com.
During the four minute interview she is still adamant that it is unnecessary surgery, the doctors refused to do another MRI or X-Ray and she "suspects that because the hospital is a teaching hospital, they are using my son as a human guinea pig/human specimen to teach the resident doctors". She also states that "conservative treatment by chiropractic treatments to decompress and fuse the spinal bones" was her treatment choice.
As I stated in an earlier post...I sense a lawsuit abrewing here.
HAHAHAHAHAHA! Lilady I suspect that you are correct- here we go, the whole thing a scam and a sham! I wonder if she's done this before...
*jaw drops*
Okay, I probably shouldn't be shocked that she wanted chiropractic care for a kid with a spinal injury, but WOW. That just seems insanely stupid. (Also, how does she think a chiropractor can fuse the spinal bones?)