The Healthy Blogger

The ethics of withholding treatment from children

Is it right for parents to withhold treatment for their children?  There is still lingering debate about this.  It is even more complicated when the child is a young teen, who may be mature enough to make his/her own decisions.

Not to long ago, there was the case of the 13-year old British girl who chose not to undergo heart surgery.  She had battled cancer since childhood and the treatments resulted in heart damage.  If she did not undergo a heart transplant, it was likely that she would die.  But after many years of suffering and realising that the transplant meant a lifetime of immunosuppressive therapy, which has a lot of complications, she chose not to proceed.  Her parents backed her on this.  But the government agencies were not convinced, and for a while, there was a brouhaha over the issue.  Finally, the courts were convinced that the girl was mature enough to make up her own mind.  Needless to say, she also made a reasonable decision.  She could have gone either way and no one would have faulted her.  But the fact that she could give good reasons for her decision showed her maturity.  It was nevertheless a very difficult decision, and I cannot even contemplate being her parent at that crucial time.

More recently, we hear the story of a 13-year old boy in America who was diagnosed with Hodgkin’s lymphoma, a very curable type of cancer.  After one treatment, he and his family decided they wanted to go the alternative route.  Though his father agreed with this, he was not aware of his wife’s intentions when she and her son failed to show up for a court hearing, and instead, chose to flee.

Granted, we were not given full details of the case, but one does wonder how much the child and his parents understood the situation.  We do not know if the child suffered such adverse reactions that he did not wish to continue medical treatment.  We do understand that the mother was a believer in “traditional” or alternative healing practices.  But even the alternative practitioner was surprised at her flight.  The fact that she panicked and fled makes me wonder if she had the maturity to make a reasonable decision.

My own prejudices against alternative therapies aside, I cannot understand why someone would turn down treatment that has been shown to be effective and life-saving, to try something unproven.  I have known people to use alternative therapies to “complement” medical therapy, which in my mind, is perfectly acceptable.  But to reject legitimate treatment for a lot of hocus-pocus is irrational, illogical, incomprehensible, and completely dangerous. In such cases, if you separate the parent and child, you will probably find that the child cannot give adequate reasons for his decision and that he can only mimic his parent’s reasons.  In some cases, you might discover that with careful logical reasoning, he may even change his mind.  But then, can we suppose that the child reached his decision of his own accord?  It becomes a serious ethical question that the courts will have to answer.

I’m glad to hear the mother returned with her son.  But what will the decision be regarding his treatments?

Night shifts linked to cancer

I have pointed to all the dangers of not getting enough sleep, but I was surprised to find that some study in the past had pointed to an association between disrupted or lack of sleep and cancer risk. How they discovered this, I have no idea. But the fact that there was a link between working late night hours (or night shifts), which causes the disrupted sleep pattern, and the risk of cancer has now led to Denmark compensating women who worked night shifts and developed cancer. Of course, only those women who demonstrat that the cancer was caused by working night shifts and no other causes are the ones getting the compensation.

There is a theory that melatonin, which is produced by the brain in response to sunlight, has some protection against cancer. For those working night shifts, the production of melatonin is suppressed, which makes them vulnerable to developing cancer. So far, it appears that the women being compensated are those who developed breast cancer. It is still unclear, however, what role melatonin plays in breast cancer protection.

So, in addition to getting adequate sleep, now we must ensure that we sleep at the right time. Which means that those in financial hardships may have to give up their night jobs if they have to protect their health. For, if they are not healthy, they cannot work.

Risks and benefits of alcohol

A doctor once asked me, “What is the definition of an alcoholic?” The answer: “Someone who drinks more than their doctor.” Typical doctor joke, but what is one to do when there are mixed messages regarding drinking alcohol? OK, so drinking too much (that definition will vary depending on the person as the joke implies) is definitely bad for you. Not to mention the damage to your heart and liver.

But the recommended daily dosage of alcohol to remain safe does vary depending on who you ask. That French study years ago suggested that a glass or two of wine a night could be good for your heart. However, some government agencies would put a limit of 3-4 drinks (again, the type of alcohol varies) a day as safe. Now, there is data to suggest that even one drink increases your risk for certain types of cancer, with breast cancer being most prevalent in women. The study was not done in men, so perhaps, they will ignore the advice.

My own conclusion is that there is no safe limit to alcohol. A person may consume the recommended dose and probably will not be helping his heart or increasing his risk of cancer. At the same time, that dose may actually be hurting his liver. Government agencies have reported an increase in the rate of cirrhosis, which they blame on young people drinking more and at an early age. This may be true, but it may be that the youth only consumed the recommended dosage. You see, not everyone’s constitution is the same. Your body can metabolise the alcohol in different ways, at different rates, etc.

That’s where the risks and benefits come in. Each person will have to assess his particular risks and benefits individually. It can be daunting if you had to sit down and realistically and rationally look at your own health and well-being. If you are honest, you will find that all the information out there only serve to confuse you. And the reason so many people make bad choices is because they don’t want to have to examine their life in that detail. They would rather accept the fact that best supports their decision. Those who enjoy drinking will point to the benefits, while those teetotallers will emphasise the risks. The debate will never end.