Friday, May 22, 2009

Colleen Hauser is a criminal


John Lantos, MD
May 22, 2009

Parents have rights to raise their children as they see fit. They can decide which church or school the children go to, what prayers they learn, what they wear, what books they read or movies they see.

But their rights are not absolute.

They do not have the right to deny their children life-saving medical treatment. Instead, they have the obligation to keep their child alive. If they do not fulfill that obligation, the state can take protective custody of their children and authorize medical treatment. If the children die, the parents can and should be criminally prosecuted.

When cases involving parental treatment refusals come to court, it should only be to establish the facts. Courts confirm the diagnosis, affirm that effective treatment is available and that non-treatment will cause imminent harm, and step in to protect the child.

Given the uncontroversial nature of these claims, and the widespread societal consensus supporting them, it is surprising that cases of parental medical neglect are newsworthy and even controversial. They should be no more controversial than other illegal acts.

There should not be discussion or debate about the morality or legality of such acts, any more than there should discussion about the morality of murder, rape, or bank robbery. There should only be discussion of how to apprehend the criminals.

Colleen Hauser is a criminal. If her son Daniel dies as a result of her reckless negligence, she should be charged with manslaughter.

Children have a right to life independent of their parents’ religious beliefs. Parents are free to make martyrs of themselves for the sake of their own deeply held beliefs. They are not free to make martyrs of their children.

Links:

Parental rights, ethics and the Hauser case, Minnesota Public Radio, May 22
Faith, medicine at odds in chemo refusal, USA Today, May 21
Parents' Rights, Judges' Rules, Newsweek, May 19

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7 Comments:

Anonymous Anonymous said...

If the boy were to die during chemo, would the hospitals and doctors similarly be held as criminals? Of course not. If it were so, we should say that hospitals have killed millions of people, but since that is not true, it can't be that withholding treatment would cause anyone to die either. Forcing people to undergo institutionalised treatment and denying them the right to their own beliefs about the right course of action is the true crime against humanity.

Friday, May 22, 2009  
Anonymous Elizabeth Uppman said...

A more thoughtful article about this case (http://www.salon.com/env/vital_signs/2009/05/22/daniel_hauser/) says this: "the Hausers didn't refuse chemotherapy outright. They defied doctors and a judge's ruling only after Daniel experienced some of its violent effects following one round." That is, Colleen Hauser made a decision based on evidence and on the rightness she felt in her heart. Doctors might scoff at that "rightness" thing, but it's a thing parents use every day and come to depend on. We develop an internal gyroscope that keeps us level.

I know parents--thougthful, educated people--who went against doctors' recommendations because they didn't trust them. It took a year and another whole set of doctors to change their minds.

My point is, it matters how doctors say things to parents, and saying things like "criminal" and "prosecution" is not going to get Colleen Hauser back to the hospital.

Saturday, May 23, 2009  
Blogger Jay said...

Elizabeth makes the most important point. How can we build a relationship with this family that will enable them to make the best decision they can for their son? How can we gain (or regain) their trust? Will Daniel's life really be improved if his mother is arrested and he is removed from her care?

There's also a huge assumption in the line "parents have an obligation to keep their children alive". Really? No matter what? If I give birth to a child with an inevitably fatal neurological disease, am I obliged to keep her alive? If Daniel Hauser had a recurrent glioblastoma, would his parents be required to accept chemotherapy?

Friends of mine found myself in precisely that situation, and they chose to forgo further disease-directed therapy for their six-year old. He died at home with hospice care. Is my friend a criminal? I don't believe so, which means there is no broad "obligation". Parents have some latitude, and it's our obligation as professionals to remain in relationship with them, no matter how difficult it is. Calling the police is not relationship-centered care.

Saturday, May 23, 2009  
Anonymous John Lantos said...

Thanks, all, for your comments. A few facts about this case might help and help show why I agree with the examples you give but do not think that they apply to this case.

Waiting a year to make the right decision is not an option with the sort of cancer in this case. The boy will be dead in a year.

The glioblastoma example is an example of a cancer for which treatment is usually ineffective. Doctors often recommend pallliative care in such cases. In this case, the boy has a 90% chance of cure.

According to the judge who heard the case, the doctors, nurses, social workers, psychologists and chaplains tried family-centered care. They did everything they could to pursuade Ms. Hauser to consent to treatment. It didn't work. They may not have done it well. Still, if the problem was that Ms. Hauser didn't trust these particular doctors, she should have sought others.

So I stick with my views - in a case where there is a 90% chance of cure with chemotherapy, a 99% chance of death without chemo, a sincere effort to communicate and control symptoms, a careful trial court review of the case, a court order, and a mother ignoring the court order and taking the law into her own hands, society, through the courts, have an obligation to protect the child.

Daniel's life will be improved if he is removed from her care - because he will most likely be alive. In her care, he will almost certainly be dead. If that isn't improvement, what is?

There are cases - and the ones Ms. Uppman and Jay describe sound like such cases - where refusing chemo is appropriate, ethically defensible, and legal. This, in my opinion, is not one of them.

John Lantos

Tuesday, May 26, 2009  
Blogger Stephen said...

Your analysis omits an important consideration. We aren't talking about an infant here. The boy is 13 years old. At this point he is closer to an adult than a child. So you forcing him to receive chemotherapy against his will seems morally problematic. If he wanted the treatment but his parents refused, you would probably be justified in calling the parents criminals in that case.

Wednesday, June 03, 2009  
Anonymous John Lantos said...

The question of whether a 13 year old can understand the risks and benefits of life-sustaining treatment is a good question and a crucially important issue in this case. If he voiced an opinion that seemed to be his own opinion, I would agree that treatment should not be forced upon him.

In this case, however, the boy, Daniel Hauser, is cognitively delayed. According to the judge who examined him, "Daniel's reading and writing skills are extremely limited. He is not able to recognize by sight the word "the." Although thirteen years of age, Daniel is currently enrolled in the fifth grade. It is clear that his reading and writing skills are significantly below even that grade level. It is as obvious as can be that somebody else provided Daniel with the information that appears in his affidavits....Daniel lacks the ability to give informed consent to medical procedures or treatments or to refuse the same. This is partly due to his age, just thirteen years and two months, but even beyond that this particular child has a very limited current capacity to understand his illness and the treatment recommended for it."

The court decision also notes that the parents sought not one second opinion but four - five different doctors and hospitals all together. All agreed that treatment was life-saving. None found any alternatives acceptable. No licensed medical practitioner in the state of Minnesota could be found who would recommend anything other than chemotherapy.

Here is the link to the court's interview of Daniel. You can read it and judge for yourself. You can get all the court documents on the case if you google "Daniel Hauser JV-09-068".

http://www.mncourts.gov/Documents/0/Public/Other/Hauser/Hauser_Transcript.pdf?elr=KArks7PYDiaK7DUvDE7aL_V_BD77:DiiUiacyKUUr

John Lantos

Thursday, June 04, 2009  
Anonymous viagra online said...

The most interesting think is that the authorize medical treatment should have to be so specific, I think that it is so interesting! excellent information!22dd
They are not free to make martyrs of their children.

Friday, March 04, 2011  

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