CAMLAW: Complementary and Alternative Medicine Law Blog

Court orders teenager to undergo integrative cancer care

A court ordered 16-year-old Abraham Cherrix to undergo integrative cancer treatment, which integrates conventional medicine and alternative therapies to treat cancer.

The court's order to visit an integrative oncology program at a regional cancer care center came as a compromise to an earlier attempt to order Mr. Cherrix to undergo chemotherapy.

The Chicago Tribune reported on the case in "Cancer patients desperate for options," with the subheading: "Not satisfied with traditional treatments, many are seeking alternative therapies that are now making their way into the mainstream." (October 30, 2006)

Although the article gives a balanced perspective, the headline is not the spin I would have put on the piece. Imagine that Abraham is your son, brother, cousin, friend. He wants to try a number of alternative therapies rather than chemotherapy, and because of his choice -- which his parents support -- he is not only forced to have chemo but also finds his parents prosecuted for criminal abuse and neglect. Does this seem right?

Ethically, an order to undergo chemotherapy is a form of medical paternalism, which should be tolerated in extreme form, but rather must be balanced against other ethical values such as the patient's right to engage in informed decision-making (or autonomy). This same point was echoed in the Institute of Medicine's Report on Complementary and Alternative Medicine.

The Tribune reports: 'Cherrix's struggle to use herbs and diet supplements to fight Hodgkin's disease, a cancer of the lymphatic system--rather than have a series of debilitating rounds of chemotherapy--has brought attention to a growing movement in the U.S. to bring alternative medicine into the mainstream.

'Although Americans have been crossing the border into Mexico for more than 40 years in search of cancer treatments illegal in the United States, interest in alternative and complementary healing methods in this country is rising. The move is being fueled by the Internet's ability to provide easy access to information and by personal testimonials of patients.

'Advertisements for alternative therapies are everywhere, from highway billboards to health magazines. Clinics specializing in acupuncture, dietary supplements and herbal medicines--considered unconventional a decade ago--can be found in almost every U.S. city. To remain competitive, a fifth of U.S. hospitals now offer some type of alternative or complementary therapy such as massage, yoga, homeopathy or mind-body therapy.'

That's quite a number. (See The Practice of Integrative Medicine: A Legal and Operational Guide for a recent report on top twenty-five or so integrative medicine clinics in academic medical centers, including cancer care centers, incorporate complementary and alternative medicine therapies into conventional clinical care.)

The article also cited the familiar figure that Americans spend an estimated $36 billion to $47 billion a year on alternative and complementary treatments, either as a substitute for conventional medicine or in conjunction with it, according to national surveys.

Other familiar statistics canvassed in the piece include: 'A 2002 study by the Centers for Disease Control and Prevention and the National Center for Complementary and Alternative Medicine found that 36 percent of Americans use some form of alternative healing. When prayer was included as a means of healing, the figure jumped to 62 percent. The use of herbs, which do not require FDA approval, doubled from 1997 to 2002, researchers said, adding that Americans spend $5billion alone on herbal products.'

As to the patient, the article reports that: 'After five weeks of treatment, Cherrix returned home to Chincoteague, Va., in early October having undergone immunotheraphy, which strengthens the immune system with supplements and diet and low-dose radiation to shrink the tumor in his neck....

'His doctors notified state authorities after Cherrix refused a second round of chemotherapy, which he said made him deathly ill, and the state took his parents to court alleging medical neglect.

'Cherrix, who also has traveled to Mexico for the controversial Hoxsey treatment, a concoction of herbs, vitamins and tree bark, said he believes his case has helped others who seek alternative care, particularly children whose parents could end up in court.'

The piece rightly points out that there are sanitary and other hazards associated with travel to foreign lands for alternative treatments not available in the U.S. At the same time, one of the purposes of the proposed Access to Medical Treatment Act -- originally proposed in 1995 -- is to make such alternative therapies available in the United States, with a strong system of disclosure and informed consent.

Related links on the Complementary and Alternative Medicine Law Blog:

* Legal and ethical issues relating to use of complementary therapies in pediatric hematology/oncology

* Pediatric Use of Complementary Therapies: Ethical and Policy Choices

* Complementary Therapies in Pediatrics: A Legal Perspective

* A Tribute to Jesse Koochin: Making Progress in CAM and Parental Rights

* Ethics in Pediatric CAM Care

* Complementary and Alternative Medicine: Legal Boundaries and Regulatory Perspectives

* Integrative Oncology

* New Integrative Pediatrics Blog for the Whole Child

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Michael H. Cohen, Esq.; 468 North Camden Dr. | Beverly Hills, California 90210 | 310-844-3173