An Ontario court dooms a First Nations girl with cancer

A few weeks ago, Steve Novella invited me on his podcast, The Skeptics’ Guide to the Universe, to discuss a cancer case that has been in the news for several months now. The case was about an 11-year-old girl with leukemia who is a member of Canada’s largest aboriginal community. Steve wrote about this case nearly a month ago. Basically, the girl’s parents have been fighting for the right to use “natural healing” on their daughter after they stopped her chemotherapy in August because of side effects. It is a profoundly disturbing case, just as all the other cases I’ve discussed in which children’s lives are sacrificed at the altar of belief in alternative medicine, but this one has a twist that I don’t recall having dealt with before: The girl’s status as part of the First Nations. Sadly, on Friday, Ontario Court Justice Gethin Edward has ruled that the parents can let their daughter die.

The First Nations consist of various Aboriginal peoples in Canada who are neither Inuit nor Métis. There are currently more than 630 recognized First Nations governments or bands in Canada, half of which are located in Ontario and British Columbia. This girl lives in Ontario, which is basically just next door to Detroit, just across the Detroit River. Unlike previous cases of minors who refuse chemotherapy or whose parents refuse chemotherapy for them that I’ve discussed, such as Sarah Hershberger, an Amish girl whose parents were taken to court by authorities in Medina County, Ohio at the behest of Akron General Hospital, where she had been treated because they stopped her chemotherapy for lymphoblastic lymphoma in favor of “Katie Wernecke, Abraham Cherrix, Daniel Hauser, Jeremy Fraser, Jacob Stieler, Sarah Hershberger, or others, follow a very similar script. It’s a script that on many an occasion has led me to quote Elton John sadly, “I’ve seen that movie, too.” Here’s the basic script:

  1. A child is diagnosed with a treatable, curable pediatric cancer. (Note that most pediatric cancers are among the most curable cancers there are. Pediatric leukemias and lymphomas, for example, have gone from a virtually-zero survival rate 50 years ago to survival rates that approach 90% or even more. Truly, if there is a triumph of science based medicine, it is in pediatric cancers.)
  2. The child begins chemotherapy, going through part of the recommended protocol, and suffers the expected side effects.
  3. The parents, who quite naturally have a hard time watching their child suffer, hear about some quackery or other that promises to treat their child without the side effects of chemotherapy. If they are prone to belief in “natural healing” or alternative medicine, there is a good chance that they will stop their child’s chemotherapy and opt for the promise of the “natural healing” that claims to be a cure without the pain.
  4. Doctors, alarmed at the likelihood that the child will die, report the child to the child protective service authorities, who intervene.
  5. There is a court case. If the court case goes against the parents, frequently they flee with the child, as Daniel Hauser’s mother did, as did the parents of Katie Wernecke, Abraham Cherrix, and Sarah Hershberger, among others.
  6. At this point, one of two things happens. Either the parents are persuaded or ordered to treat their child properly (as in the case of Daniel Hauser); they come to some sort of compromise that allows the child to get some treatment plus “alternative healing” (as in the case of Abraham Cherrix); or, a depressingly common outcome, they win the “right” to let their child die through medical neglect, as has just happened with this First Nations girl with lymphoma.
  7. Through it all, quacks leap on these stories as examples of “fascism,” and “gunpoint medicine” in order to promote their world view of “health freedom” (otherwise known to skeptics as the freedom from pesky laws and regulations outlawing fraud and quackery), as happened in virtually all these cases, but most notably recently for the case of Sarah Hershberger.

How do these stories end? Sometimes they end with the death of the child. Sometimes the child lives (I’ll explain why a little later). Ofttimes it’s very difficult to find out what happened to the child, as I’ve found out to my frustration over the years. For instance, I have not been able to find out much about Sarah Hershberger since March, when Tracy Oppenheimer of Reason.com defended her medical neglect in the name of health freedom. (What are the deaths of some children with cancer compared to health freedom, eh?)

This First Nations case adds a different spin on the subject, but the script remains more or less the same. This time around, the parents have won the right to let their daughter die a horrible death from cancer based on Aboriginal rights.

Aboriginal children now have the right to refuse life-saving medical treatment in favour of traditional healing.

The Friday ruling has nothing to do with whether aboriginal medicine works.

Family court heard unequivocally in the case of a First Nations girl refusing chemotherapy that no child has survived acute lymphoblastic leukemia without treatment.

Instead, it’s about Canada’s Constitution protecting aboriginal rights.

Ontario Court Justice Gethin Edward has now expanded those rights to include traditional healing, saying “there is no question it forms an integral part.”

“This is monumental for our people all across the country,” said Six Nations Chief Ava Hill. “This is precedent-setting for us.”

No doubt this ruling is monumental and precedent-setting, but in a very bad way. So, in other words, our neighbor to the south (at least to me in southeast Michigan, which is the only place where Canada is to the south) have declared that letting children die of cancer is an “integral” part of Aboriginal identity. I am not exaggerating. The court apparently didn’t even take into account whether the “natural healing” chosen by the girl’s family works. Meanwhile, Six Nations Chief Ava Hill is exulting over the ruling, apparently unconcerned that it will result in the death of an 11 year old girl. As I’ve said many times before, a competent adult should have the right to choose any form of medicine he likes or even to choose no treatment at all, but children are different. They are not capable of understanding the implications of their decision, and this girl, at 11 years old, isn’t even in the gray area of the later teen years where an argument can sometimes be made for self-determination even though the child is a minor. They need and deserve protection from such outrageously bad choices on the part of the parents.

This case is a complete failure on the part of the province of Ontario and of Canada itself to protect the lives of its most vulnerable members, children, particularly children of a minority group. Even worse, it is an indictment of the First Nations, which, rather than seeking to protect one of the most vulnerable members of its community, a girl with a treatable, potentially curable cancer, instead glommed onto this case as a vehicle to promote its rights vis-a-vis the Canadian government. I don’t think it was cynically done; no doubt the leaders of this particular First Nations community and Six Nations Chief Ava Hill believe in their Aboriginal natural healing. On the other hand, it’s hard not to think that there was some opportunism given that the parents appear not to have even chosen to use Aboriginal “natural healing” techniques.

Instead, they are using the rankest quackery, which has nothing to do with aboriginal natural medicine, administered by Brian Clement in a “massage establishment” in Florida:

A Florida health resort licensed as a “massage establishment” is treating a young Ontario First Nations girl with leukemia using cold laser therapy, Vitamin C injections and a strict raw food diet, among other therapies.

The mother of the 11-year-old girl, who can not be identified because of a publication ban, says the resort’s director, Brian Clement, who goes by the title “Dr.,” told her leukemia is “not difficult to treat.”

Another First Nations girl, Makayla Sault, was also treated at Hippocrates Health Institute in West Palm Beach and is now critically ill after a relapse of her leukemia.

Somehow, I doubt that the traditional healing methods used by First Nations people have ever included cold laser therapy or vitamin C injections. Looking at Makalaya Sault, you will see the future of this First Nations girl: Relapse. But what about Brian Clement? It turns out that I’ve written about him before.

In brief, Clement is, in my opinion, a quack. If you have any doubt, start by looking at what he is quoted as saying in this news story:

He’s been giving lectures in and around both girls’ communities in recent months, including one event attended by Makayla’s family this past May.

In a video obtained by CBC News, Clement says his institute teaches people to “heal themselves” from cancer by eating raw, organic vegetables and having a positive attitude.
“We've had more people reverse cancer than any institute in the history of health care,” he says.

“So when McGill fails or Toronto hospital fails, they come to us. Stage four (cancer), and they reverse it.”

The mother of the girl whose identity is protected says she knew as soon as her daughter was diagnosed that she wanted to seek treatment at Hippocrates, a clinic she was familiar with through a relative, but didn’t have the money to go.

After securing financial support from family, she called Clement from the hospital waiting room on the 10th day of her daughter’s chemotherapy.

The story goes on to describe how the mother called Clement while her child was receiving chemotherapy and found how “confident” he sounded. As soon as he said he could help, the mother quit the chemotherapy for her daughter.

It’s all depressingly similar to a story I encountered about a year ago. It was the story of a young mother in Ireland who had been diagnosed with stage IV breast cancer and chosen the “alternative route.” She, like the anonymous young First Nations girl and Makayla Sault, found her way to the Hippocrates Health Institute. The young woman, Stephanie O’Halloran, was only 23 years old, an age range at which breast cancer is rare, but not unheard of.

These are the sorts of things Clement offers through HHI's "Life Transformation Program":

  • Superior nutrition through a diet of organically-grown, enzyme-rich, raw, life-giving foods
  • Detoxification
  • Wheatgrass therapies, green juice, juice fasting
  • Colonics, enemas, implants
  • Exercise, including cardio, strength training and stretching
  • Far infrared saunas, steam room
  • Ozone pools, including: dead sea salt, swimming, jacuzzi and cold plunge
  • Weekly massages
  • Bio-energy treatments
  • Med-spa & therapy services

That’s not all. Read my old post for more details. Basically, almost every form of cancer quackery known to humans is available at the HHI.

This is the “alternative healing” that the First Nations girl’s mother has chosen instead of effective chemotherapy. In essence, the parents and First Nations petitioned Ontario courts and Justice Gethin Edward acquiesced to letting First Nations parents have the right to let their children die through medical neglect. It might well be that Justice Edward’s ruling was legally correct and he had no real choice, but the end result will be the same: The death of a girl who otherwise would have a very good chance of living a long and productive life. Worse, his reasoning included this:

But Justice Gethin Edward of the Ontario Court of Justice suggested physicians essentially want to “impose our world view on First Nation culture.” The idea of a cancer treatment being judged on the basis of statistics that quantify patients’ five-year survival rate is “completely foreign” to aboriginal ways, he said.

“Even if we say there is not one child who has been cured of acute lymphoblastic leukemia by traditional methods, is that a reason to invoke child protection?” asked Justice Edward, noting that the girl’s mother believes she is doing what is best for her daughter.

“Are we to second guess her and say ‘You know what, we don’t care?’ … Maybe First Nations culture doesn’t require every child to be treated with chemotherapy and to survive for that culture to have value.”

Every parent who chooses quackery over effective medicine believes she is doing what’s best for her child. Every single one of them. The same is true of parents who thought that prayer could cure pneumonia or diabetes. That’s not a reason to deny such children protection. More disturbing, however, is Justice Edward’s last sentence, in which he seems to be shrugging his shoulders and saying, “So what if a few aboriginal children die anyway? It’s just their culture.” Or, as Steve aptly put it, using human sacrifice as a reductio ad absurdum of the judge’s argument: “Are we to second guess her and say ‘You know what, we don’t care?’ … Maybe First Nations culture doesn’t require every child to survive infancy without being sacrificed for that culture to have value.”

It’s understandable, given Canada’s history of riding roughshod over the wishes of First Nations families, such as the case of residential schools pointed out by Arthur Schafer, that the court would want to bend over backwards to respect the wishes of the parents. However, in doing so, Justice Edward utterly failed to take the best interests of the child into proper account.

How does this sort of thing happen?

Steve also correctly noted that the outcome of such legal battles often hinge on the reasons given by the parents for refusing chemotherapy. If, for example, they simply use medical opinions as a justification (i.e., they disagree with their doctors), the state is usually pretty quick and decisive in taking action. This is the sort of situation that ruled Daniel Hauser’s case, and ultimately Hauser underwent effective chemotherapy and lived. If, on the other hand, religion or culture is used as justification for choosing quackery over effective treatment, courts seem to be much less willing to step in and see that the child receive effective treatment. For instance, in 2009 Catherine and Herbert Schaible in the Philadelphia area to choose prayer over antibiotics for pneumonia for their first child. The child died. The Schaibles received ten years' probation and had to promise, in essence, that their other children, who were not removed from their care, would receive modern medical care. In 2013, a second child, who was 8 months old at the time, died the same way. It took the second death of a child before the state actually took their children away and put them in jail. The same dynamic came into play in the case of Sarah Hershberger, where Medina County authorities were reluctant to be too harsh because they were Amish, and their culture valued “natural healing.” Clearly, the same dynamic has led to Justice Edward’s tragic decision with respect to this First Nations girl.

Also at play is an attitude that ascribes absolute rights to parents over their children. It’s a toxic attitude that is often mixed with a general distrust of government and medical authority that fails to acknowledge that children are separate beings with their own rights separate from the rights of the parents. Those rights include the right to not to suffer from medical neglect. As has been pointed out, parents don’t have the right to kill their children; they shouldn’t have the right to let them die through medical neglect, as the parents of this First Nations child are doing.

For all my railing against the medical system, what’s really critical here is understanding why parents make these choices. Having a child with cancer is a horrible, terrifying thing to go through. Having to watch a child suffer the complications of chemotherapy with the child not understanding why it’s necessary is even harder. It’s very understandable that parents with a tendency toward believing in natural medicine or with just a distrust of medical authorities in general would be tempted by the siren song of quacks claiming that they can cure the child without all the toxic side effects of chemotherapy. In particular, it’s often hard for parents to understand why, after tumors frequently shrink away to nothing after the first couple of courses of chemotherapy, more chemotherapy is needed.

Unfortunately, for most pediatric tumors it takes a lot more than just a round or two of chemotherapy, a lesson painfully learned by pioneering pediatric oncologists back in the 1960s and 1970s. For the type of tumor that, for example, Sarah Hershberger has, lymphoblastic lymphoma, the duration of one standard treatment is two years. For chemotherapy for lymphoma, there are at least three phases. The induction phase is designed to put the patient into remission. Consolidation chemotherapy is given to patients who have gone into remission and is designed to kill off any residual cancer cells that might be present, thus increasing the chance of complete cure. Maintenance chemotherapy is the ongoing, longer term use of chemotherapy to lower the risk of recurrence after a cancer has gone into remission. It's basically lower-dose chemotherapy given for two to three years to help keep the cancer from returning. In Sarah Hershberger's case, her oncologist recommended chemotherapy consisting of five phases: induction (5 weeks), consolidation (seven weeks), interim maintenance (eight weeks), delayed intensification (six weeks), and maintenance (90 weeks), for a total duration of two years, three months. In the case of this First Nations girl, who has lymphoblastic leukemia, the treatment would have involved at least three phases: remission induction, consolidation/intensification, and maintenance lasting a similar amount of time.

It’s thus understandable how parents, after seeing the tumor melt away during induction chemotherapy, wonder why all this additional chemotherapy is needed. It’s quite possible that after induction chemotherapy the First Nations girl had no detectable cancer. If that's the case, it's the chemotherapy that she's received thus far that almost certainly caused that result, not any quackery to which Clement has been subjecting her. If the girl is apparently tumor-free, it also means that failing to consolidation and maintenance chemotherapy greatly increases the chance that her leukemia will relapse. Worse, relapsed cancer is always harder to treat. The first shot at treating cancer is always the best shot, with the best odds of eradicating the cancer. Letting cancer relapse through incomplete treatment breeds resistant tumor cells the same way that not finishing a complete course of antibiotics contributes to the development of resistant bacteria. It's evolution in action.

Some children will be fortunate enough to have had their cancer eliminated completely after induction and will survive to become testimonials used in support of such parents’ actions, but they are the minority. Depending on when the chemotherapy is stopped relative to the complete recommended course, most will not be so lucky. Parents also often have a view that it is the chemotherapy that is the cause of the child’s suffering, believing that if they stopped the chemotherapy the suffering would stop, and even if the child dies it would not be as bad for her as the chemotherapy. Unfortunately, death from cancer is not pretty. It’s worse than chemotherapy. Stopping chemotherapy early might relieve suffering for a while, but only at the price of an ugly death later.

Somehow, there has to be a way to get such parents to see this, to teach them the very basics of cancer biology, why chemotherapy regimens for pediatric malignancies are as long as they are, and what the consequences of not finishing chemotherapy are. Remember, the parents are almost always only interested in what they believe to be best for their child, and they are suffering in a different way as they watch their child suffer the side effects of chemotherapy. When their child is crying that she can’t take it any more, when she’s vomiting and feeling very sick due to the chemotherapy, it’s very hard for parents to see that it’s worth this pain if the tumor is already gone. They need support systems to help them deal with this. Most pediatric cancer centers provide such support, but it isn’t always enough. Again, although my memory is by no means comprehensive, since I started paying attention to these cases ten years ago, I can’t recall a single case of parents who refused chemotherapy for their child until after the child had undergone at least a couple of cycles and suffered the expected side effects. I’m sure such parents probably exist, but they must be rare, because I’ve paid a lot of attention to these sorts of cases over the years, and I can’t recall one.

Finally, when faced with parents wanting to stop chemotherapy, oncologists have to be very careful not to come across as bullying, something I suspect that they sometimes do without realizing it when hearing a parent tell them she is going to stop chemotherapy. It’s understandable that physicians and nurses would react that way. Pediatric oncologists become pediatric oncologists because they want to save the lives of children with cancer, and nurses working on pediatric oncology wards work there for the same reason. It’s understandable that they react with alarm to such pronouncements by parents and might become angry or strident. After all, the child is their patient, not the parents, and the parents have just become an obstacle to saving the child’s life. When parents threaten to stop chemotherapy, it is often a cry for help; they’re telling doctors that they can’t handle seeing their child undergo chemotherapy any more. Sensitivity is required in working with them.

None of this, however, means that, if push comes to shove and the parents can’t be moved with all the understanding and empathy in the world, the interests of the child shouldn’t come first. The interests of the child must come first, and if parents can’t be persuaded to continue treatment of a highly curable tumor, then the state has a duty to step in. It’s a duty at which Ontario and Canada have failed in the case of this First Nations girl. It’s also a duty that First Nations authorities who supported the parents in filing suit have utterly failed to uphold.

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Orac, I'd like to offer another dimension to what is going on in Ontario.

Before I begin, I absolutely agree that what is happening to this child is a tragedy that will lead to a lingering and painful death. I'm banging my head on the table as I write this.

But having worked with First Nation tribes in North Dakota, I have some understanding of their history and culture that explains why Chief Hill responded the way he did. These cultures were systematically targeted for destruction by both the American and Canadian governments in the late 19th/early 20th centuries. Children were stolen from their parents and placed in "boarding schools" where they were treated horribly, and punished severely for speaking in their native languages or following their tribal customs or culture.

Both governments systematically violated many, if not all, of the treaties signed with the tribes.

There is a long standing history of mistrust between First Nation tribes and the American and Canadian governments as a result. That mistrust is why Chief Hill sees this as a tribal matter rather than a medical one. I'm not condoning it. I simply understand where they are coming from.

To really get how many of these tribal members feel about paternalistic whites, you've got to meet them. They have an anger about it that is very real and runs very deep. Not all First Nation members feel that way. But many do, and it impacts tribal relations with both the American and Canadian governments; it's real and it can't be ignored or wished away.

And I think the judge gets it as well. I don't think he misunderstands what's at stake here. I think, like the parents, he wants what is best for the child. I think he's trying to balance the interests of justice in a case that has more than one dimension. The fall out is, the child will die. And I think the judge has lost some sleep thinking about that.

Until our governments are willing to crack down on quackery through regulation, these tragedies will continue. Desperate parents will always resort to quackery if it is available because that's what desperate people do: they grasp as straws.

The only solution is to make the quackery unavailable. So we need to develop the political will to do that. And in our current anti-science political environment, that isn't going to happen soon.

That is beautifully said, Panacea. The level of distrust for "paternalistic medicine" that your average crunchy-granola-warrior-mom has cannot hold a tiny candle the inferno of justifiable rage many of the First Nations have for the indignities to which they were subjected. "Paternalistic" would be an Orwellian euphemism for what was done to them; a better word would be "eugenics". And it really hasn't stopped; although there are now laws protecting native children from being taken away by CPS on the basis that being raised native is bad for them, it does still happen. If the child is from a relatively powerful tribe, like the Cherokee, the parents may prevail. Sometimes. It doesn't help that the conditions on the reservation are often quite dire, so the children legitimately are at more risk. But there is a particularly cruel irony to forcing people into horrible living conditions and then taking away their children because they have horrible living conditions.

In this sad case, a child is going to die because the parents are being exploited by a quack; it has nothing to do with preserving their heritage. But I too can sympathize with the chief in this case, and with the judge, who know all too well how slippery the slope is in the case of native children. It has not been long at all since it was common practice to simply seize the children, since it would be "better" if they were raised by good, white, Christian families.

It is the quacks in this case that I hold in the most contempt, and I hope there's a special place in hell for those who prey upon the most vulnerable.

From the quoted article:

Aboriginal children now have the right to refuse life-saving medical treatment in favour of traditional healing.

Hah. No, they don't. Their parents have the right to refuse it for them. I wish the press would be more clear on this point, because it's a very important distinction.

By Calli Arcale (not verified) on 17 Nov 2014 #permalink

Could the state of Florida intervene? As I write this, I realize how completely unlikely that solution is.
Can they shut down the Hippocrates "Health" Center? I suppose not, and even if they could, they wouldn't.
Or even more unlikely, couldn't the federal government refuse entry to the U.S.?

Even if we say there is not one child who has been cured of acute lymphoblastic leukemia by traditional methods, is that a reason to invoke child protection?” asked Justice Edward..."

Hell, yes.

<blockquote...noting that the girl’s mother believes she is doing what is best for her daughter.

One wonders if the judge also also find in favor of a fundamentalist parent who wanted to reject standard medical care for their child with leukemia, who wanted instead to go with traditional treatment comprised of laying on of hands and intercessory prayer.

After all, that parent would also be doing what they believed was best for their child.

I am a social worker in Canada. I completely understand the fears of the FN community with regards to imposed cultural practices. The residential school system nearly killed an entire generation.
That being said, if this child was a Jehova's witness, the child protection system would have steped in. The issue here is CPS did not. The university had to take CPS to court to get them to do their job. I have worked for CPS. If this case came on my desk I would not hesitate to step in.
The challenging history between Canada and its FN popuation while complex should not, in my opinion, mean this girl should have to die.
But when you try explaining that to other social workers in my area, I am called a racist. Apparently I am supposed to believe that quackery will work.

THis case really really makes me sad. WHen this girl dies, the family is going to blame the few treatments of Chemo she got instead of the lack of treatment after.

I should add the supreme court of canada decided that as of age 14 the child may argue their competency. This child is 11 years old so she would not be deemed competent to make her own medical decisions. For that reason it comes down to the competency of the parents to make that decision. I would argue that this case is a no brainer and the child should be "removed" to get the treatment she needs to live.

But when you try explaining that to other social workers in my area, I am called a racist. Apparently I am supposed to believe that quackery will work.

When I hear this charge, I like to ask: What's more racist? To fight to save the life of a First Nations girl, or to shrug one's shoulders and say, "Well, it's just an aborigine girl," which is basically what the attitude of letting these parents choose comes down to?

But Justice Gethin Edward of the Ontario Court of Justice suggested physicians essentially want to “impose our world view on First Nation culture.” The idea of a cancer treatment being judged on the basis of statistics that quantify patients’ five-year survival rate is “completely foreign” to aboriginal ways, he said.

Yes indeed, aboriginal minds cannot comprehend what you call "statistics." Aborigines no doubt think that "science" is white-man's magic and electricity is demons in the wires. Our cultures are so different, they cannot and should not be expected to think rationally like we do.

I'm sorry, but how is this attitude anything other than racist? I don't care whether it's coming from the judge or the native leaders.

"it’s about Canada’s Constitution protecting aboriginal rights"

You'd think the right to life would be protected in there somewhere.

Here's the end of Stephanie O'Halloran's tragic story (the young Irish mother mentioned in Orac's previous posting on Hippocrates Health Institute). The end would have been the same without HHI, of course, except the money raised for Ms O'Halloran might have gone somewhere where it would have done some good.

http://www.rip.ie/showdn.php?dn=226463/StephanieO_HALLORAN/Garryowen/Li…

By Simea mirans (not verified) on 17 Nov 2014 #permalink

Does the Six Nations tribe not have anything comparable to our social services? Is removing a child from a dangerous situation over the wishes of a parent just not done?

I looked into this Friday, when it came up on the Dose of Woo thread. Orac seems to have distorted the issue before the court in the OP above. The politics surrounding the specific case seem pretty complicated. The Toronto Star noted the judge was ruling on an application by the hospital “to have the girl apprehended” by the government chartered Family and Children’s Services Agency in the area “and forced into treatment.” However, the agency had refused to intervene, and it’s executive director supported the family in the trial.

So the case was about jurisdiction in the last analysis. To rule other than he did, the judge would have been saying the court has the authority to compel the FACS to forcibly apprehend a First Nations child and place her in protective custody, against not only the will of the parents, but against the decision of the FACS agency.

The First Nations communities obviously had reasons to oppose that having nothing to do with medicine. Six Nations Chief Ava Hill said, "“We have a right to look after our own kids, We’re not going to let anyone take our kids. This is a big boost for this.” The mother of the girl the hospital was seeking to force into treatment said, ""As a member of the Six Nations Confederacy, I will not have my decisions of health care for my child debated and judged in the Canadian judicial system.… The Canadian judicial system does not have the authority to determine our law or practices, which predates the existence of Canada, valid or otherwise."

The Star also noted Hill and the leader of the other major tribe in the area, New Credit Chief Bryan LaForme, are raising the prospect of the First Nations creating their own child welfare agency.

What's not clear from the few news stories I've seen linked is how the First Nations communities as a whole, and especially the leadership, actually view 'alternative medicine.' Why would the leaders seek to create their own child welfare agency unless they were concerned that children may need protection from their families?

It’s not clear from the few news stories I've seen linked whether the First Nations communities in question actually support the families’ decisions to withdraw their daughters from chemo, or just oppose Canadian government intervention. I've seen no indication that Ava Hill believes in Aboriginal healing as a cancer cure, or is "unconcerned [the ruling] will result in the death of an 11 year old girl."

Rather than appeal the decision, the hospital is trying to “reach out” to the family. I’d guess they figure that’s the best way to get the girls back into chemo, which suggests they have reason to believe the parents might be persuadable, perhaps by working through the Chiefs. With Makalaya Sault having gone into relapse the parents may come to take a more skeptical view of Brian Clement's scam promises. It's premature to assume these children are doomed.

Again, I have no idea how woo-ish Hill, LaForme of other influential members of the New Credit or Six Nations communities may be. They would have to VERY woo-ish to misunderstand the political situation. They have just won an important ruling on self-determination that will come under severe threat if Makalaya Sault or the girl in the court case die without seeking chemo. Having established jurisdiction over their communitiy's children, they now face considerable political pressure to act in those kid's best interests. The decision will be validated if the First Nations get the girls back into treatment at McMaster and they survive. The consequences may not be lost on the parents either.

On numerous occasions I've witnessed a 'kill the messenger first, then consider the message' phenomenon. An institution or individual with authority has established policy X. A subordinate presents a forceful argument that X is misguided, leads to results undesired by all, and urges implementation of reforms Y. Seeing their authority challenged, the powers that be not only reject Y, but push the subordinate out for failure to conform. After a short interim of forced forgetting once the unruly subordinate has departed the scene, some version of Y is implemented by TPTB, having been magically transformed now into their idea.

I wonder of the same thing might be happening here. I wouldn't be surprised if Judge Edward understands this, and the case is more political theater than it may appear on the surface. It might even have been a done deal from the get-go, with the tribes letting Edward know that if he ruled against the McMaster petition, they'd provide him political cover by doing what they can to get the kids back into chemo. In fact, I wouldn't be surprised if both McMaster and the family in the case were in on the deal. Why didn't McMaster apply to get Makalaya Sault forced back into chemo in the first place, and why did they not include her in the application just denied by the court? Could everyone involved have understood the Sault's Evangelical commitments to spiritual healing are so strong, Makalaya would indeed be doomed once the judge made the only ruling he could make without totally shattering the legal framework of Aboriginal rights? Could the un-named family in the case even have been recruited exactly because they would be willing to put their daughter back into McMaster once the court established the Canadian authorities did not have the power to force them to do so?

Obviously, I don't know the answers, and any speculation may be wishful thinking. But I've seen enough politics play out to know that things are often not what they seem. This affair may not be over, and a happier ending may emerge than the one Orac has envisioned.

I’m sorry, but how is this attitude anything other than racist? I don’t care whether it’s coming from the judge or the native leaders.

It's been pointed out to me elsewhere that Justice Edward is partly of aboriginal descent and that he's been a champion of aboriginal rights, including having worked to get a separate court for them. Now, on the one hand, I could understand why Ontario might have chosen a judge like this, but on the other hand he strikes me as anything but unbiased.

Also, methinks Sadmar is engaging in seriously wishful thinking if he thinks this was a "done deal" from the get-go and that the docs or social workers at McMaster will be likely to persuade the parents to resume chemotherapy. I'd love to be proven wrong on this, but I don't think I am. As tragic as Makalaya Sault's case is (even if her family resumes chemotherapy, now that she's relapsed it's much less likely to be successful than the first time around given how breaks in chemotherapy allow resistant cancer clones to arise), maybe it will be the prod in the posterior the family needs to see what is going to happen if they don't treat their daughter with known effective chemotherapy regimens.

I wouldn't bet on it, though.

Aside from the death of a child who could be saved, there is another thing that make me ragey in this article.
Here it is:

"But Justice Gethin Edward of the Ontario Court of Justice suggested physicians essentially want to “impose our world view on First Nation culture.” The idea of a cancer treatment being judged on the basis of statistics that quantify patients’ five-year survival rate is “completely foreign” to aboriginal ways, he said."

This is utter and complete bullshit.
This is like saying that the idea that the Earth is a spheroid is contrary to aborigenal culture (I don't know if it is , using a metaphor here).
This is the sort of post-modernist BS that imply that science is "western stuff".
No.
It isn't.
I bet that a First Nation person could become an amazing scientist. There are scientists everywhere, in Asia and Africa and South America and Oceania. GOOD scientists, who do science because science is for EVERYBODY.
It is not something that belongs to this or that culture. Yes, it was invented in Europe, but that is it. It is like me saying that I shouldn't study algebra, because that has been invented by Muslim and as such is not part of my culture.
It is utter bollocks. Period.

4. Doctors, alarmed at the likelihood that the child will die the parents would allow the child to hit the hashpipe to alleviate some *side effects*, report the child to the child protective service authorities, who intervene.

fixed it for him.

It’s been pointed out to me elsewhere that Justice Edward is partly of aboriginal descent and that he’s been a champion of aboriginal rights, including having worked to get a separate court for them. Now, on the one hand, I could understand why Ontario might have chosen a judge like this, but on the other hand he strikes me as anything but unbiased.

I suppose the reasoning behind chosing him, could be, that if he wouldn't decide in favour of the parents, they were less likely to accuse him of racism.

If I look at the pictures of the team of the Hippocrates Health Center, I mostly see white people. So apparently white quacks are better than white doctors.

Last month I went to my niece's wedding. Dancing at the wedding were the 7 year old twins, her sister's kids. Several years back one of the twins was diagnosed with leukemia. Now he's in remission, he's keeping up with his twin, and it was joyous to see them and their terrible little boy dancing.

There is no question the treatment was horrible at times. The fear was real. The pain, unthinkable. The boy's mom describing how she had to hold him for the spinal taps. Really, it takes strength that not everyone has--or thinks they have.

But it's over, and it worked. And I stood watching them and wondered what it would have been like if they had bailed on the treatment. It would have been decades of sadness at all the family events, and this kid would not have been there. Now he has a chance at the rest of his life, and I hope we will dance at his wedding someday.

I wonder if there are outreach videos from parents who made it through. I hope so. I am sure it will never be easy, but maybe if they heard from other parents....

Sigh.

In case I haven't mentioned it, Sarah Hershberger's guardianship is still in effect a month after the October 17 motion hearing (the nature of which isn't specified on the docket).

Has anyone heard how Sarah Hershberger is doing? I haven't been able to find anything out, even with my mad Google skillz. Is she OK? Has her cancer recurred?

As I mentioned above, the most recent news I could find was that execrable Reason.com apologia for health freedom.

On February 13, there was an "Order Establishing Media Coverage Conditions," so that may have something do with the lack of stories.

Oh, and it appears that the motion hearing was likely on the June 18 motion to terminate guardianship.

^ Or the July 21 motion to terminate. I find the Medina probate site rather difficult to parse.

The other Aboriginal child,Makayla Sault, is terminally ill.
http://www.thespec.com/news-story/5028666-aboriginal-girl-who-refused-c…

The Band also raised money to send her to that butcher in Florida. He should be in a lockup in that State. I used to practice in Florida and was amazed at that quackery that was there, and that was in the late 70s and early 80s. What happened in Ontario will just repeat itself until our legislators face up to their responsibility to our children. It doesn't matter that she is an Aboriginal.

Here is a view from an Aboriginal healthworker from the area. She is shocked at what happened and the irresponsibility of the Band and her family, not to mention the courts.

http://deyoyonwatheh.blogspot.ca/2014/11/criminal-negligence-two-local-…

By Dr. Terry Polevoy (not verified) on 17 Nov 2014 #permalink

BTW, HIN has a recent, garbled story (the years don't match the "Free Christopher" FB page) on an allegedly similar story. I say "alleged" because a search of the Maricopa County probate court docket search turns up nothing.

In the United States, Native American reservations officially have the legal status, in many ways, of separate countries - notwithstanding relatively recent FBI murders, ongoing land thefts, etc. Tribes are considered to be nations that have the right to govern themselves, and though that right has been seriously limited by various federal actions, the principle of tribal sovereignty prohibits most state government interference on lands where tribal laws apply. This is why various tribes were eventually able to make a living by running casinos or selling cigarettes in ways not permitted on white-ruled lands surrounding them.

If this girl belongs to a group with such recognized sovereignty, saying that the state, or province in this case, had the right to come and take her away for medical treatment would be like saying that an American or Canadian court could send armed officers to Mexico to take a Mexican child away from parents who were not choosing the correct treatment. I am not familiar with the legal status of the First Nations in Canada, but if this group is legally a separate nation, their sovereignty must be the first principle considered. No lower-level court has the power to abrogate a national treaty or order what might technically be an act of war.

Think it's complicated to have different people living on the same continent who have different sets of legal rights? Well, that whole invasion, rapine and ethnic cleansing thing paid off big-time for white folks - but it had consequences, and one of them is that now you have to accept that some of the survivors of the indigenous people live among you but are NOT you, don't want to be you, and now don't have to try.

On this subject, I don't know whether you're aware of the latest developments in the Ashya King case. Steven Novella had a post on this in September:

http://theness.com/neurologicablog/index.php/ashya-king-and-proton-beam…

However it has recently become apparent that the parents have refused adjuvant chemotherapy:

http://www.bbc.co.uk/news/uk-england-hampshire-29944626

This is perhaps not surprising given some of their previous statements in the media, (particularly these interviews with the Mail: http://www.dailymail.co.uk/news/article-2772994/They-locked-left-Ashya-… http://www.dailymail.co.uk/news/article-2774361/The-final-insult-Police… ) but the family played a PR blinder by making this about proton vs conventional radiotherapy.

There is concern over how they have managed to coral the media and political and public opinion to get around the usually robust systems in the UK, that make sure that children get appropriate, evidence based treatment:

http://www.bbc.co.uk/news/uk-england-30038007

It would be interesting to get your input on this, since you have an interest in paediatric chemotherapy refusal. Perhaps not insignificantly, the parents are Jehovah's Witnesses.

By Elihphile (not verified) on 17 Nov 2014 #permalink

now you have to accept that some of the survivors of the indigenous people live among you but are NOT you, don’t want to be you, and now don’t have to try

When 'not being like me' means 'wanting your kids to die,' I have to say that I've reached my breaking point when it comes to cultural tolerance.

90+% chance of survival vs 0% chance of survival. I'm not Arabic, but I will break from my heritage enough to understand their numerals.

By Roadstergal (not verified) on 17 Nov 2014 #permalink

On this subject, I don’t know whether you’re aware of the latest developments in the Ashya King case. Steven Novella had a post on this in September:

h ttp://theness.com/neurologicablog/index.php/ashya-king-and-proton-beam-therapy/

However it has recently become apparent that the parents have refused adjuvant chemotherapy:

h ttp://www.bbc.co.uk/news/uk-england-hampshire-29944626

This is perhaps not surprising given some of their previous statements in the media, (particularly these interviews with the Mail: h ttp://www.dailymail.co.uk/news/article-2772994/They-locked-left-Ashya-frighte… h ttp://www.dailymail.co.uk/news/article-2774361/The-final-insult-Police-chief-… ) but the family played a PR blinder by making this about proton vs conventional radiotherapy.

There is concern over how they have managed to coral the media and political and public opinion to get around the usually robust systems in the UK, that make sure that children get appropriate, evidence based treatment:

h ttp://www.bbc.co.uk/news/uk-england-30038007

It would be interesting to get your input on this, since you have an interest in paediatric chemotherapy refusal. Perhaps not insignificantly, the parents are Jehovah’s Witnesses.

By Elihphile (not verified) on 17 Nov 2014 #permalink

jane are you actually gloating about the plight of this young girl who most certainly will die, because her parents have denied her the chance for a total cure?

Tribes are considered to be nations that have the right to govern themselves, and though that right has been seriously limited by various federal actions, the principle of tribal sovereignty prohibits most state government interference on lands where tribal laws apply.

I was going to start in on the Indian Child Welfare Act, but fortunately, it occurred to me that the whole comment would have only had bearing on tribal lands.

So, Jane, is Brantford, Ontario, sovereign territory? If so, one could proceed to ask where the tribal court failed.

Let me just reinforce this before I play Mr. Natural Does the Dishes:

If this girl belongs to a group with such recognized sovereignty, saying that the state, or province in this case, had the right to come and take her away for medical treatment would be like saying that an American or Canadian court could send armed officers to Mexico to take a Mexican child away from parents who were not choosing the correct treatment.

This is where it all falls apart. Unless Brantford is sovereign territory, the correct simile would be the notion that, say, Canadian law should govern in the case of an "ethnic Canadian" living in the U.S. being haled into court in the U.S. on charges of child medical neglect.

^ To be more precise, change "living in" to "domiciled in."

OK, I can't resist.

Well, that whole invasion, rapine and ethnic cleansing thing paid off big-time for white folks – but it had consequences, and one of them is that now you have to accept that some of the survivors of the indigenous people live among you but are NOT you, don’t want to be you, and now don’t have to try.

From the original article:

"Sault said she saw a vision of Christ in her hospital room telling her [Makayla] was already healed."

How "NOT" "white folks."

Eight months later, Sault's chemo, rather than the disease, is being blamed:

"As many of you know Makayla suffered a major infection and had to be hospitalized (Nov 5)," read the post.
"At that point because of her weakened immune system from chemo (that she stopped 8 months ago) the doctors gave her 24 hours. She is home (Nov. 8)..."

Engage sarcasm mode:

If chemo weakening the immune system is the preferred excuse, do these quack clinics give the parents accurate survival figures based on the woo being able to counteract the chemo as well as cure the cancer?

Disengage sarcasm mode:

By NumberWang (not verified) on 17 Nov 2014 #permalink

@ Mary M:

I know the feelings you're describing-
I play tennis at an indoor facility where a 40-ish guy occasionally teaches kids: he always seemed to look down and keep to himself rather unlike the other pros who are outgoing and perhaps over-friendly ( seeking out potential students as it were). Months later, I found out why - he brought his ( 12 year old?) son who was emaciated, frighteningly pale and had lost his hair. I learned that his son was being treated for Leukemia.

About a year later, his son was back, looking much more average- the treatments were a success. Now, a few years down the road, he sometimes takes a lesson, is 6 feet tall, average weight, has hair and his father looks happy.

By Denice Walter (not verified) on 18 Nov 2014 #permalink

From the article by the aboriginal Health Care worker Dr. Polevoy provided a link to:

This is not about culture, it is about physiology.

This! Just this!.

lilady and Roadstergal, your total reliance on pitiful slanders for "argument" shames only you. In today's news, the US House of Representatives' vote to force the construction of the Keystone Pipeline, with a planned route through the Rosebud Sioux reservation and without the prior approval of the tribe, is being termed an "act of war" by the tribe president. He has vowed, if necessary, to close the borders of the reservation and resist incursions by white pipeline-builders. And they have the right under international law to do that, because by treaty, the meager lands left to them constitute a sovereign nation.

Now, my personal opinion happens to be that it would be Good for this girl to accept more chemo - those who cannot argue without ad homs, please note that - and Bad to construct the pipeline. However, international law trumps the desire of judges to ensure that individuals make good choices. I do not know what the law is regarding tribes in Canada, but IF this girl and her parents are technically citizens of a separate nation, the fact that they have set foot on white-ruled Canadian land would not make them ordinary Canadians who are fully subject to Canadian law wherever they may go in future. Neither would the fact that, as a result of the past forced imposition of Western beliefs on First Nations peoples, they are Christians.

However, international law trumps the desire of judges to ensure that individuals make good choices.

The judge whoupheld the rights of the parents to to discontinue chemotherapy and seek alternative treatment for their child didn't cite retrictions due to international law in his ruling, and I'm not aware that any principles of international law which would have prervented him from finding instead against the parents.

And clearly the parents and their tribal leaders have no issue with the court's authority to decide the issue--they've enthusiastically embraced the judges ruling.

The court heard "an application by McMaster Children’s Hospital to have the girl apprehended by Brant Family and Children’s Services and forced into treatment" because "[t]hat agency had refused to intervene/"
Brant FCS had full legal authority to apprehend the girl without any order from the court and almost certainly has apprehended many First Nations kids before. In this case they decided not to and the hospital asked them the court to compel them to do so.
Canadian courts are not in the habit of hearing cases over which they have no jurisdiction.
In the neighboring province of Manitoba, there are something like ten thousand aboriginal kids "in care."

I will point out that the residential schools in Canada, while funded by "the government" were mostly operated by the Catholic and Anglican churches. Astoundingly, many aboriginal people still embrace those very churches.
While much is made of the abuse the kids suffered in the schools, the horrible impact of breaking the chain of mothering skills rarely gets mentioned. Its hard to learn to be a mother when your children are gone. It is hard to know what to do as a mother when you have grown up where the children are "cared" for by a bunch of nuns and priests.

"lilady and Roadstergal, your total reliance on pitiful slanders for “argument” shames only you."

Hell no, jane. Your dumb insensitive comment about the plight of these young girls, who are condemned to painful, unnecessary deaths, shames you.

It has already been pointed out to you, that Indian nation status does not protect you from charges of medical neglect of your child.

What are those native Indian treatments the parents of both girls are using in lieu of proven "Western/White" treatments which have a verified record of total cure at ~ 90 %-versus-0% cure, jane?

I do not know what the law is regarding tribes in Canada, but IF this girl and her parents are technically citizens of a separate nation, the fact that they have set foot on white-ruled Canadian land would not make them ordinary Canadians who are fully subject to Canadian law wherever they may go in future.

I'm not interested in investigating your attempt to slip in the distortion "set[s] foot on," as it has no bearing on my earlier comment. In the U.S., if one is domiciled outside of tribal land, the state has jurisdiction.

The judge whoupheld the rights of the parents to to discontinue chemotherapy and seek alternative treatment for their child didn’t cite retrictions due to international law in his ruling, and I’m not aware that any principles of international law which would have prervented him from finding instead against the parents.

For that matter, international law has about as much bearing on disputes between states and individual tribes as it does on disputes between U.S. states themselves, i.e., none. Federally recognized tribes are "domestic dependent nations," not foreign countries.

I would further note that Jane's absurd construction of international law directly implies that in the case of a crime committed by a foreign national, a country's only option is deportation, which is trivially false.

In today’s news, the US House of Representatives’ vote to force the construction of the Keystone Pipeline, with a planned route through the Rosebud Sioux reservation and without the prior approval of the tribe, is being termed an “act of war” by the tribe president.

That seems to have been a bit premature.

Ah, well, Orientalism never sleeps.

Jane:

I realize this is months late but you said "However, international law trumps the desire of judges to ensure that individuals make good choices." Actually, no it most certainly does not. In the US at least, international law has absolutely no standing in court, whatsoever. National law trumps international law. Only when a specific portion of international law is signed and ratified as a treaty and even then, treaties do not trump statutes. If the US congress passed a law in violation of a treaty the US was a signatory of, the treaty would be considered abrogated by the subsequent legislation. I do not know with 100% certainty if the Canadian constitution is the same in this regard, but I highly suspect so, as this is something that is true in most countries. Particularly those descended from the British tradition.