Tempting faith

In an unprecedented move, the Supreme Court recently sanctioned chemotherapy and surgery for a young kidney cancer patient after his mother refused to give permission for the medical intervention, claiming that God would heal the child.

Doctors at the University Hospital of the West Indies (UHWI) had concluded that the child would die if the treatment was not administered.

The undernourished young boy was taken to the hospital in a very bad state with a tumour in his kidney on November 17 last year. Shortly after, he was diagnosed with stage 1 Wilms tumour, a rare type of kidney cancer that primarily affects children. The cancer is also very aggressive and manifests itself in five stages.

In a report on the child’s condition, Dr Orville Morgan said: “He was undernourished, with his weight for his age being below the 5th percentile. He had stage 2 hypertension, had hypochromic, microcytic moderate anaemia.

“So bad was he that a dietician and paediatric consult were requested,” the doctor also noted.

It was thereafter recommended that the boy, whose exact age has not been disclosed, undergo a course of chemotherapy to shrink the growing mass followed by surgery.

The child’s mother had initially consented to the procedure but changed her mind, forcing the intervention of the Office of the Children’s Advocate (OCA).

The OCA took the mother to court to secure authorisation for the required medical treatment and protection for the minor.

Justice Dale Staple, who heard the matter in January, granted the relief that was being sought by the children’s advocate, including permission for the medical treatment, and also for the mother’s consent to be dispensed with on the basis that it was being unreasonably withheld.

In the judgment, which was delivered earlier this month, the judge ordered that the matter be reviewed in six months and that the mother be prohibited from discharging the boy from the hospital while he is being treated.

“I am satisfied that he had been enduring serious medical strife for at least one month, including being undernourished, and that it was the intervention of the medical team at the UHWI that saw him steadily improve. He has a potentially fatal ailment that I am satisfied only medical intervention, as outlined in the evidence, can resolve,” the judge said.

He further indicated that “divine intervention works in many ways, including through doctors”.

In her affidavit, paediatrics expert Dr Michelle Reece-Mills said the child was suffering from abdominal pain, intermittent fever associated with significant weight loss, pallor, easy fatigability, and difficulty breathing a month before he was taken to the hospital.

He was examined and noted to have generalised lymphadenopathy (disease or swelling of the lymph nodes) and an irregular mass in the kidney. Further, she said an ultrasound that was done by another facility indicated that he was suspected to have Wilms tumour.

A month later, the child did a CT scan, which showed a mass arising from the upper pole of the kidney. Subsequent scans showed that the mass was steadily growing in size.

The doctor had, however, presented evidence that they initially started treatment to reduce the child’s blood pressure and obtained the mother’s permission for chemotherapy and surgery after consulting with her.

But the mother objected to treatment on November 29, when the chemotherapy was to begin.

According to Reece-Mills, the child’s mother refused to consent as she was of the view that divine intervention would save her boy. She was given psychological counselling and had several meetings with the medical team treating her son.

In her affidavit, Reece Millis said, “If treated quickly with chemotherapy and surgery, [the child] has an excellent chance of a good outcome once treatment is completed.”

But she warned that based on the aggressive nature of the cancer, a delay could cause the tumour to spread to distal areas far away from the kidney – where it is currently confined – and worsen the chances of a good outcome.

However, while the doctors gave evidence that they tried to involve the child’s mother in all aspects of decision-making, she told the judge that she was not aware of all of her son’s medical treatment, including all of the ultrasounds, and that he was on three different medications for high blood pressure.

Consequently, the judge adjourned the proceedings twice for the mother to obtain independent ultrasounds, which showed an increase in the size of the mass.

However, the judge noted that when the mother was asked if she was now willing to consent, “her position was that she would leave it to the court to decide as that would be demonstrative of God’s will”.

“In my respectful view, this was a cop-out on her part. It was an attempt to absolve herself of any responsibility for the decision should things go ill. The court does not have such luxuries,” he said.

Justice Staple, in his judgment, further said that while the mother was not a sophisticated person, it was evident that she loved her child and it appeared that her “overarching concern” was with how the doctors were treating her son. She was also of the view that the doctor had been lying to her.

The mother had pointed to an incident in which she reportedly observed a nurse treating her son roughly while he was crying out in pain and calling for her.

“It is fair to say that [the mother] was just, frankly, highly suspicious and distrustful of the medical staff of the UHWI. She did not – and does not to this blessed day – believe they have her son’s best interest at heart,” the judge found.

At the same time, the judge said that while he had no evidence to suggest that the medical team did not have the child’s best interest at heart, on the evidence presented, he found that they were doing the best for him with all their skills and expertise.

Furthermore, he said, “ ... It is true that a parent has certain rights above all others when exercising their responsibilities, but all parents must act in the best interest of their children. If the parent is not going to do so, or abdicate, then someone else has so to do.”

In granting the relief, the judge said the medical treatment was in the child’s best interest and that he was also satisfied that it would give the child “the best chance living and having a much-improved quality of life than he was enjoying before intervention”.

tanesha.mundle@gleanerjm.com