Cancer

14 July 2017

Court confirms 12-year-old can refuse chemo

A Dutch court has confirmed that a 12-year-old boy does not have to undergo chemotherapy if he doesn't want to.

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An appeals judge in the Dutch court has confirmed that a 12-year-old boy does not have to undergo chemotherapy if he does not want it. The ruling came after the boy's father appealed to a court to order the treatment. The mother of the boy supported her son in his opposition to the chemotherapy.

Aad van de Beek, a court spokesman in Amsterdam, said the appeals court found that the boy, identified only as David, had carefully considered the situation and had the ability to make a sound decision. Chemotherapy was part of treatment for David following the successful surgical removal last year of a brain tumour. 

After consulting a psychiatric report to determine whether David has the capability to make this decision, a judge at the court ruled that David is indeed capable of making a reasonable decision, understanding the full outcome and consequences of his decision. 

1 500 new cases of cancer among children are diagnosed every year in South Africa. Owing to earlier methods of detection, improved medication and more effective treatment methods, many more children’s lives are saved than was the case thirty years ago.

But what are the legalities?

In South Africa, the Children's Act 38 of 2005 states that the best possible care must be provided by the parents, but the child's dignity, self-reliance and participation in the community must be protected at all times. The Act also states that the child has the right not to be subjected to any medical, religious, or cultural practices that are detrimental to his or her dignity or well-being.

This can be interpreted as the child having the right to refuse chemotherapy as treatment, if they argue that their dignity and well-being is affected by the outcome, if he or she can argue their decision within reason, and deemed capable of making such a decision.

But this is debatable, as the fundamental principle of law and ethics state that a parent as a competent adult should always have the final decision, even if the outcome can be interpreted as not being in the best interest of the child. Throughout the years, courts have been struggling to implement laws where minors were able to make their own decisions. For many courts in many countries, this is still deemed a grey area and open to debate. In David's case, it can be seen that courts are giving leeway to the traditional major-over-minor decision rule. 

Healthy cells affected as well

Chemotherapy is the process of treating the cancer patient with strong drugs to kill off cancer cells in a certain part of the body,  to stop them from spreading, or to shrink a tumour before surgically removing it. Because of the strength of the drugs administered to the patient, healthy cells are often affected as well. This can cause severe side-effects such as nausea and vomiting, mouth sores complete hair loss and extreme fatigue. Chemotherapy is often given in cycles to give the patient's body a break to recover.

Some drugs used for chemotherapy are stronger than others and the side-effects can have long-term effects such as infertility. Previous studies also suggested that chemotherapy for childhood cancers could also have a lasting effect on the child's memory. Although some people remain unaffected by chemotherapy and can continue with their daily lives as usual, the side-effects are often the worst, hence a person's reluctance to undertake chemotherapy. 

Even though the side-effects are a huge part of struggling with cancer, a previous Health24 article stated that chemotherapy is becoming more and more advanced, ruling out the side-effects and ensuring a higher survival rate for childhood cancers. 

Read more:

Immunotherapy vs chemotherapy for treating cancer?

Common childhood leukemia now curable

Strides made in treating childhood cancer

 

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Cancer expert

CANSA’s purpose is to lead the fight against cancer in South Africa. Its mission is to be the preferred non-profit organisation that enables research, educates the public and provides support to all people affected by cancer. Questions are answered by CANSA’s Head of Health Professor Michael Herbst. For more information, visit cansa.org.za.

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