Pediatric CAM case on abuse and neglect resolved

The Whole Child integrative medicine pediatrician Larry Rosen forwarded information about resolution of the Virginia case involving pediatric avoidance of conventional care (oncology) in favor of alternative therapies.

The case was reported in the The Free Lance-Star - Fredericksburg,VA by Chelyen Davis on 1/10/07. The case involves a balancing of ethical values such as patient autonomy, the right to make choices, and a paternalistic interest in protecting children.

In Complementary Therapies in Pediatrics: A Legal Perspective (Published in Pediatrics), pediatrician Kathi Kemper and I provided a framework to help pediatricians advising and clinical decision-making about CAM therapies to address the best interest of the pediatric patient while helping to manage potential liability risk.

The framework included asking the following questions: (1) Do parents elect to abandon effective care when the child's condition is serious or life-threatening? (2) Will use of the CAM therapy otherwise divert the child from imminently necessary conventional treatment? (3) Are the CAM therapies selected known to be unsafe and/or ineffective? (4) Have the proper parties consented to the use of the CAM therapy? (5) Is the risk-benefit ratio of the proposed CAM therapy acceptable to a reasonable, similarly situated clinician, and does the therapy have at least minority acceptance or support in the medical literature?

We argued that: "Such an approach ideally can help guide the pediatrician toward clinical conduct that is clinically responsible, ethically appropriate, and legally defensible."

The case study below picks up on and modifies some of these factors. For interest, instead of the court deciding that conventional care is objectively in the "best interest of the child," the new legislation allows the parent and the child together to decide what is in the best interest of the child, and the legislation supports that subjective decision rather than trying to second-guess the patient's choice with an 'objective,' critical view of CAM use vis-a-vis the child's best interest.


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From the article:

'Last year, Abraham Cherrix's parents were charged with neglect for allowing the cancer-stricken teenager to reject radiation therapy and pursue alternative medicine.

Now, a state delegate is introducing legislation--called "Abraham's Law"--that would ensure that other parents don't have the same court battle to make medical decisions with their children.

The bill, filed yesterday by Del. John Welch, R-Virginia Beach, amends the child neglect part of the state code. It says that it is not to be considered neglect if the parents or guardian of a child with a life-threatening condition decide to refuse certain medical treatments, if the child and parent make the decision together; if the child is mature enough to have an "informed opinion"; if the parents and child have considered alternative treatment options; and if the parents and child truly believe such a decision is in the child's best interest.

The Cherrix case made national headlines last summer when he and his parents decided to forgo chemotherapy and pursue alternative therapies for his Hodgkin's lymphoma, after a previous round of chemotherapy did not cure him.

His oncologist reported the Cherrixes to social services, which began legal proceedings. Cherrix could have been forced to undergo chemotherapy, which he and his parents felt could kill him, and his parents could have been jailed.

Last August, however, a judge in Accomack County cleared Cherrix's parents of neglect and allowed Cherrix to pursue the alternative treatment. Since then, Cherrix says, his tumors have shrunk, he feels much healthier, and he's back at school, at Chincoteague High School.'

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Law Offices of Michael H. Cohen offers general corporate legal services, litigation consultation, and expertise in health law with a unique focus on alternative, complementary, and integrative medical therapies.

Michael H. Cohen is Principal in Law Offices of Michael H. Cohen and also President of the Institute for Integrative and Energy Medicine (also known as the Institute for Health, Ethics, Law, Policy & Society), a forum for exploration of legal, regulatory, ethical, and health policy issues involved in the judicious integration of complementary and alternative medical therapies (such as acupuncture and traditional oriental medicine, chiropractic, massage therapy, herbal medicine) and conventional clinical care. The most recent published book by Michael H. Cohen on health care law, regulation, ethics and policy pertaining to complementary, alternative and integrative medicine and related fields is Healing at the Borderland of Medicine and Religion. This is the fourth book in a series, following Complementary and Alternative Medicine: Legal Boundaries and Regulatory Perspectives (1998), Beyond Complementary Medicine: Legal and Ethical Perspectives on Health Care and Human Evolution (2000), and Future Medicine: Ethical Dilemmas, Regulatory Challenges, and Therapeutic Pathways to Health Care and Healing in Human Transformation (2003).

Michael H. Cohen has also been admitted to the Bar of England and Wales as a Solicitor (non-practicing), adding to Bar membership in four U.S. states.
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