[I'm out of town today; this post was written on 5/14/2009 and published ahead of time to keep me on schedule with my one-post-a-day challenge for May.]

If an adult decides that he would rather forego treatment for a condition that is extremely likely to be fatal to him, it’s easy enough to simply shake your head and say that it’s his decision. If a thirteen-year-old decides to get his ear pierced, we’d have more or less the same reaction.

So, what do we do when a thirteen-year-old decides to forego a potentially life-saving treatment?

A Minnesota judge is weighing whether to force a 13-year-old boy who claims to be a medicine man in his church to get chemotherapy for his cancer – a treatment the boy and his parents have resisted for religious reasons.

…

Doctors testified in court last week that Daniel could have a 90 percent chance of being cured through chemotherapy and radiation. But they said there’s a 95 percent chance of death if the family decides to forgo the treatment.

The county attorney is arguing that the young man is not mature enough to make his own medical decisions. He’s thirteen, so I can get behind that easily enough^[a]. Who gets to make medical decisions for someone who is not considered competent to make decisions for themselves?

Generally speaking, it’s the parents (or, in the absence of parents, legal guardians or whoever has power of attorney, for [disabled? incompentent?] adults). I’ve written in the past that I have a problem with the government getting too involved in children’s healthcare decisions, but what about in a case like this?

Rationally, if we accept that a parent gets to make medical choices for their children, shouldn’t we extend that to include the times when we really, really don’t like their decisions? In this case, I’d wager that it seems pretty cut-and-dry to most people that he should get the treatment. The given chance of the treatment working is 90%. The chance of death without the treatment is given as 95%^[b]. But what if the chances are less stark? What if there were a 30% chance of survival without the treatment (rather than 5%), and only a 60% chance that it would work regardless? What if both percentages were 50/50? What if the treatment involves a serious risk of potentially devestating side effects ^[c]? Where are the cutoffs?

Of course, there’s also a good argument that every decision cannot (and, indeed, should not) be made rationally. Is the right to the freedom of religion so sacrosanct that it must stand even when the exercise of that right would doom a child? Is it right that we would allow a child to die because he and his parents have objections to the treatment? Are their objections even “purely” religious in nature, as far as such things can be determined? Does the child’s opinion matter, given his age and (according to the county attorney) lack of maturity?

I’m not saying I have any answers. Part of me says it’s up to the kid, but another huge part of me is unnerved by the idea that a thirteen-year-old kid gets to make decisions like this… I remember the sort of crazy things that I believed when I was thirteen, and I find it hard to believe that he really understands that refusing treatment could very well kill him.

1. I have to wonder if some of the people who think he should not be allowed to make this decision would be perfectly okay with it if he was, instead, a she who was deciding to have an abortion. [↩]

2. There’s no timeline given, though I imagine it’s rather short. I mean, there’s a 100% chance that he’ll eventually die, regardless of whether he takes the treatment or not, barring the Second Coming.

   The untreated survival rate of Hodgkin’s Lymphoma is about 5% (source) after 5 years. So, there’s a 95% chance that this young man would be dead by the time he’s 18 if he doesn’t receive the treatment, but surely that’s not a 95% chance he’ll die immediately. A purely rational analysis might look at survival rates of individuals who don’t receive treatment until later stages of the disease, and wonder if he might be allowed to wait, to make the decision for himself when he’s matured a little more.

   [↩]

3. It’s not like chemotherapy is a completely harmless treatment; the source I cited above about the survival rate describes it as being pretty harmful in its own right. Does this influence their objections at all? I’m curious about their specific objections; they obviously aren’t opposed to any medical treatment, because they took the kid in originally. [↩]