In May, I was interviewed for the Virginian Pilot about the case of Abraham Cherrix, a 16 year-old from Chincoteague with Hodgkin’s disease. The young man is making news because he is refusing further conventional cancer treatment and would like to solely pursue the controversial alternative Hoxsey method.
While the boy and his family anxiously await a judge’s ruling clearing him to pursue his own path for treatment (expected today but delayed without explanation at last check), the case raises numerous provocative ethical questions. Mainstream medical and legal authorities believe Abraham should be forced to undergo conventional chemotherapy and radiation protocols, while free choice/rights activists and CAM supporters have banded together to support the boy’s right to decide about his own treatment. What makes the issue even stickier is that Abraham has already undergone conventional therapy for his Hodgkin’s, and the cancer has progressed. Furthermore, he’s a seemingly mature 16 year-old who has researched his options and made a clear choice on both religious and medical grounds. Can the state of Virginia find his parents (who support his decision) negligent and award custody to a third party?
Legal CAM expert Michael Cohen, author of the CAMLAW blog, offers guidelines in several landmark publications. The most recent, “Legal and Ethical Issues Relating to Use of Complementary Therapies in Pediatric Hematology/Oncology” (March 2006), helps us frame the discussion around standard ethical principles like nonmaleficence (do no harm), beneficence (do good), and autonomy (the patient’s right to choose treatment or not treatment). But, as Cohen points out, “…the choice to include CAM therapies is richer than a black-and-white decision between ethical / unethical.” He discusses the 2005 Institute of Medicine report on CAM therapies, noting several factors which may help clinicians decide when CAM use is appropriate; these include severity and acuteness of illness, curability with conventional treatment, invasiveness and side-effects of conventional treatment, and quality of evidence of safety and efficacy of the CAM treatment. In Abraham’s case, all of these factors are up for debate. How severe and acute is his illness? Well, he has a potentially fatal cancer. Curability with conventional treatment? At baseline, good (estimated at 85%) – but he’s already progressed after initial treatment. I certainly don’t have access to his medical records and I am not an oncologist, so I can’t comment on his prognosis, but let’s just say it’s not as good as before he started chemo. And side-effects? Abraham notes in all interviews how sick he felt with treatment and how he does not want to suffer like that again. As for evidence for the Hoxsey method, it’s shaky at best. It’s worth reading about the history, but as far as evidence-based CAM therapies go, I wouldn’t put it at the top of list. Interestingly though, the legal battle in this case does not seem to be centering on which alternative therapy he chooses, but mainly on Abraham’s right to choose for himself his course of action.
My heart goes out to Abraham and his family. No one should ever have to make these decisions, never mind as a teenager, with the whole world watching. When I think of Chincoteague, I remember one of my all-time favorite stories, Misty, about the wild foal captured but raised with indomitable spirit. The lasting image for me is one of natural strength and bravery – and I can only wish Abraham the same.
“There is in this world no such force as the force of a man determined to rise. The human soul cannot be permanently chained.” – W.E.B. Du Bois