Sunday, September 8, 2013

Religion vs. Medicine: Cancer Treatment for Amish Child

On August 27, 2013, an Ohio appellate court ruled that a county judge must reconsider a decision made that would not allow Akron Children’s Hospital to appoint an attorney/registered nurse as a medical guardian over Sarah Hershberger.  The child in question is a 10-year-old Amish girl suffering from leukemia.  The Hershbergers, like many Amish families, shun most modern conveniences to live more simple, religion-oriented lives.

When Sarah became very sick after treatments, she asked her parents to stop the chemotherapy and they agreed after much prayer.  Andy Hershberger, Sarah’s father, stated that the family believes “to a certain extent, [they] can use modern medicine, but at some times [they] have to stop it and do something else.”  After hearing of the family’s decision to stop treatment and turn to natural remedies and God’s will, the Akron Children’s Hospital stated that Sarah’s cancer was very treatable and pointed out that they had already seen a reduction in her tumors after some chemotherapy. Doctors at the hospital also stated that Sarah would have an 85% chance of survival with treatment, and predicted that she would die if she did not continue.

The original decision handed down by a county judge in Medina, Ohio stated that Sarah’s parents had the right to make decisions for her because of her status as a minor and because they were not deemed to be unfit parents. The appeals court ruling, in contrast, agreed with the hospital, and said “the judge failed to consider whether appointing a guardian would be in the girl’s best interest” and that parents did not have to be unsuitable for a guardian to be appointed. The case was then sent back to the county court for reconsideration.

Under the First Amendment of the U.S. Constitution, Americans are guaranteed the free exercise of religion, though exceptions to this rule can be made when religious practices conflict with other laws and rulings in place.  Certain parental rights have also traditionally been guaranteed by the Due Process Clause of the Fourteenth Amendment.  The issue at stake in this case is whether religious freedoms and parental rights over minors can be trumped by the need for medical care.

The case of the Hershberger family is a little different from other cases of this nature and enters into more of a gray area because Sarah’s parents did not refuse outright to get Sarah treatment.  The family sought chemotherapy, saw that it was hurting Sarah, and decided to stop, in part because of their religious beliefs.  Although the family has turned to natural remedies and God’s will after stopping chemotherapy, they have not ruled out returning to the hospital if Sarah’s condition worsens, complicating this case even more.  The appellate court’s decision not to affirm the ruling in favor of the parents, and the injunction they issued that ordered Sarah’s treatments to resume immediately, make room for more cases that limit both the freedom to make decisions based on religion and parental rights over children, especially because of the gray areas present this case.

I think it often feels easy to suspend people’s religious rights when a child’s life is at stake and easy to say that parents are entitled to their religious beliefs until their children are put in danger.  For people outside the faith, I also think it can be difficult to understand such ingrained beliefs and someone’s willingness to endanger a child’s life, especially since most Americans will never have to choose between deep religious views and life-saving medical treatment.

Recognizing such tendencies to restrict religious freedoms, I do still agree with the Ohio appellate court that the county court should reconsider its decision not to appoint an attorney/registered nurse to be a limited guardian for  Sarah Hershberger.  In the U.S. Supreme Court’s 1944 ruling in Prince v. Massachusetts, Justice Rutledge, writing for the majority, stated that parents “may be free to become martyrs themselves.  But it does not follow they are free, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves.”  This precedent has held in subsequent cases.

Refusing medical treatment for yourself is one thing, but using your religious beliefs to make an important life decision for another person who has not had the time or experience to develop and determine their own religious beliefs is not right.  The Supreme Court did rule in favor of Amish parents in Wisconsin v. Yoder when they decided that Amish children could not be required to stay in school past eighth grade because it conflicted with their religious beliefs and simple way of life.  Although I believe parental rights should be viewed strongly, I do not think parents have an absolute right to refuse medical treatment for their children based on religious grounds.  I also agree with the majority decision in Prince that the right to exercise religion freely does not include “the liberty to expose the community or the child to communicable disease or the latter to ill health or death.”  I think Sarah Hershberger and her family should consult the medical guardian and at least finish out the recommended two rounds of chemotherapy.  In this case, the preservation of the child’s life is paramount.

What do you think? Is this a special case?  Do you agree with the county court or the appellate court?


Yessica M said...

I will have to disagree with this post because Sarah’s parents are not permanently ending or refusing medical treatment, rather they want to try another remedy close knit with their religion. The ABC news article clearly mentions that the parents “have not ruled out returning to…hospital if Sarah’s health worsens”. If they were completely against providing Sarah treatment they would have never sought out chemotherapy to begin with. Sarah herself spoke to her parents and expressed that she did not want to continue chemotherapy. Therefore, this makes her parents stable enough to make proper decisions in regards to her health. By the appellate court requiring that they finish the two rounds of chemotherapy it would clearly violate their First Amendment right of free exercise of religion. Simply because they will be forced to comply with something that not only the parents do not want, but Sarah herself does not want to follow through with chemotherapy. At some point, the child’s decision must be respected as well. A great example that can relate to this are also Jehovah Witness, who believe that blood transfusions are completely against their religion and would refuse any treatment involving such. By forcing medical treatment upon them will not only violate their free exercise of religion but also becomes an invasion of privacy, whether religious or not. It then becomes a question of how involved the government is in our lives; a point where we will be ‘forced’ to take extra strength Advil for a migraine as oppose to drinking Manzanilla tea because it the best for our health.

Nicole D said...

I have to agree with this post, and disagree with Yessica in saying that I think there is a huge difference here between forcing someone to take Advil and allowing a doctor to make the proper decisions in saving a 10 year old girl's life. She is ten years old. There is no way that any 10 year old going through all of this fully understands the decision she is making when saying that she wants to stop chemotherapy. Chemotherapy is an unpleasant, even painful process that no child would want to go through. Most parents do not like to see their child in pain, and would therefore want to do whatever they could to remove that pain. Since these parents are already skeptical of modern medicine, it is understandable that, to them, stopping the treatment seems like the best course of action. However, since they refrain from using technology and modern medicine, I do not think they fully understand that by waiting for the cancer to get worse before they start the treatment again, they are putting their daughter at risk and decreasing her chances of survival. I highly doubt that they have the intention of allowing their daughter to die, but in this case it may be better to allow those people who are trained and capable of making this decision make the decision. The religious argument here is a weak one, since using the medical treatment does not go against their religion. She is also young enough that she has not reached the point where she gets to decide whether she wants to join the real world or remain amish. If she is not old enough to be officially an amish member, then she is not old enough to decide that stopping an unpleasant treatment is what she wants for religious reasons. We should allow the hospital to do what is in the best interest of the child, because a lack of exposure to the benefits of modern medicine has prevented her parents from understanding what that best interest is.

Cori T said...

I have conflicting feelings on this decision. If the child wishes treatment to stop and modern treatment no longer aligns with religious beliefs, then I feel like the parents have the right to stop the child’s chemotherapy. When I heard that in this case, the child’s condition was treatable with a high chance of success, I started to rethink my original stance. The problem with this, however, is that in making the court decision about how treatable Sarah’s cancer is, the question arises: what % chance of survival is the point at which you deem the parents unfit for refusing treatment? And how many opinions from different doctors will you need to determine this?

Maddie C. said...

My problem with Sarah's parents' argument is that they have decided to now use their religion as reason to stop treatment, even though they have already technically gone against their religious beliefs by subjecting their daughter to modern medicine to start with. While I understand that the parents want to respect their daughter's wishes while continuing to depend on modern conveniences as little as possible, my argument in this case is that the girl's life is at stake and the parents and the court should do what is best for the child in order to have the best chance for survival, seeing as the family is even open to going back to treatment if (and most likely when) Sarah's health worsens.

Benjamin S said...

In seeking chemotherapy to begin with, Sarah's family has already shown that they are not opposed the use of technology and modern medicine in saving their daughter's life. By going against their religious and societal beliefs to begin with, I do not see how they can make the same argument to stop treatment. With an 85% chance for survival with treatment, I view stopping the chemotherapy as a form of parental neglect. The religious argument is null and void in my personal opinion. I agree with Nicole in that Sarah is too young to decide whether or not she must follow Amish practices. Just look at all of the reality TV shows that deal with teenage Amish trying to wrestle with their beliefs. A law that protects a child from religious practices of the parents would be an ideal measure in ensuring that proper medical treatment can be provided in situations as such. Also, I find it hypocritical that the parents are willing to return to treatment if Sarah’s condition worsens. Ultimately, we should let the hospital and the state protect the welfare of this child and provide proper healthcare.

Dan W said...

I'll begin by saying that I live in the heart of Amish country, have driven them around, even been to a wedding reception. They are good people. I won't pretend to understand their religion the way they do, but the one's I know would never do anything that they did not believe was best for any of their many children. That being said, I agree with this post that the Amish parents should not be able to refuse potential life saving treatment for their child for religious reasons. Is the refusal to allow the child access to life saving treatment any different than child sacrifice? Perhaps the method is different but the end result is the same; a child loses their life because to save it would be a violation of the parents religious belief. I am an advocate of the no-harm principle and refusing potential life saving treatment on a minor certainly qualifies as harm.

Terry B said...

I would have to agree with Yessica M. on the fact that her parents was not denying their child of the proper medication for her cancer. The parents decided to take her off base don the fact that it was hurting her and they believe that traditional Amish medication could substitute the chemotherapy. What I would like to bring up what if the parents denied their child treatment based on religious belief. Would it been a legal issue? Let me explain. In the Jehovah’s Witness religion believe that the Bible prohibits ingesting blood and that Christians should therefore not accept blood transfusions or donate or store their own blood for transfusion. This is based off a scripture that falls away from the Christian denomination. For example, a Jehovah’s Witness family has a child that was just struck by a vehicle and is heading to ICU at a nearby hospital. The child has internal bleeding and has lost a great amount of blood and then the doctor is informed by the parents that he can not use a blood transfusion to help aid the child to good health. What is then done to the parents that is denying their child a greater chance of treatment from such a tremendous accident? Does the doctor disobey and save a child life with the potential of being sued? Or does he let an innocent life die because of religious purpose?

Adam J said...

I agree with Cori that with introducing a percentage there is now a large problem because of the complexity of deciding which percentage is the correct percentage especially when taking into account the chemotherapy isn’t perfect, as people who have had 95% curable cancer have died. I also believe that because they have already tried the chemotherapy that the religious argument cannot be used, as it appears they have already done what they claim they cannot. That said, I also am confused about whether or not the consideration of if the natural medicine has a possibility of working or not. I believe that this is much more than just a religious argument.

Kaela Diomede said...

I have worked in pediatric oncology for the past two summers in a highly conservative hospital. I have seen the struggles between religion and treatment on a first hand basis. Based on my experience, I would say that a ten year old is well aware of their cancer, they are mature enough to understand that they are sick, but to which they understand the magnitude of their illness depends on the individual. Its difficult from a medical or ethical standpoint to support a treatable patient's decision to discontinue treatment, however, I do believe that the decision does belong to the family. Chemotherapy and other allied therapies are not pleasant, and Sarah is going to be in an unfair amount of discomfort, but since she's already completed a few rounds of treatment, it is evident that her family was initially able to look beyond faith, and rely on modern medicine. My question is, is this really about religious injustices or is this about the difficulty of seeing your child in horrific pain?