When Doctors Overrule Parents

Do parents always know best?


On the evening news tonight was a story about the parents of a 3 year-old boy with acute lymphocytic leukemia, an aggressive cancer with a fatality rate of 100% if untreated. As deadly as the cancer is, 98% of children achieve remission within a few weeks of starting chemotherapy, and 90% of those who complete chemotherapy are ultimately cured of the disease.

Perhaps because so many of its victims are children, ALL is one of the most studied and best understood cancers. Treatment protocols are well established and widely accepted. There is no debate regarding the role of chemotherapy in treatment.

No debate between physicians that is. The parents of little Noah decided they knew better than his doctors about how to cure his cancer. They rejected medical advice, believing that a mixture of herbs and supplements were the answer for their son. To them, chemotherapy is toxic and harmful and too risky for their child. They took their son and ran to another state in order to avoid treatment.

The doctors notified the state child protection agency which issued an urgent order that Noah be found and returned to Florida to complete his medical treatment. He was located in Kentucky, taken from his parents and placed in the custody of his grandparents. His chemotherapy was restarted and his parents have filed suit to stop it.

It seems to me that parental distrust of the medical profession is on the rise, associated with an increased trust in alternative therapies unsupported by scientific study. I see this most commonly with vaccines, where hardly a month goes by that I do not have standard immunization recommendations challenged by a parent who “knows better.” Parental belief in the harm of vaccines can be incredibly strong. A former patient of mine recently moved her family to Colorado in order to avoid California’s mandatory vaccine law! She is now a militant anti-vaccine voice on social media.

As foolish and as deserving of public shaming these parents may be, there is one area in which they have  arguments that are valid. They argue that allowing physicians to overrule parental choice is a slippery slope that may lead to harm. Recent cases suggest their fears are not unwarranted.

There are some medical conditions where expert opinion is not as united or where treatment choices are not as clear. In some cases, such as in children with gender dysphoria, medical opinion appears to be driven more by political correctness than by science. (For example, although studies have shown that 75% of children who identify as transgender will ultimately identify as their biological gender, the American Academy of Pediatrics now recommends that all such children be supported in their transgender feelings.)

In spite of medical data calling into question the validity of transgender identity, doctors are forcing parents to yield to “expert” opinion. In British Columbia a father has been threatened with prison time if he refers to his biological daughter by her birth name. A father in Ohio lost custody of his child for refusing to consent to hormone therapy intended to change his 14 year-old daughter into a boy. He has been ordered to consent to counseling for his younger children so they can accept there sister’s transition.

Things are not always crystal clear with immunizations either. While the public health argument for mandatory immunizations for highly contagious diseases is compelling, there are a number of vaccines for diseases that can be avoided by other means. Hepatitis B and HPV for example, are typically sexually transmitted. While the vaccines are not harmful, should we force parents of young children to consent to their administration? Or punish them if they don’t?

While there are times when parents do not act in the best interest of their children, this does not mean that parents should be overruled in every such instance. If we wish to maintain trust in the medical profession, we should respect parents whenever possible, only overruling them when the risks to their child or to public health are extremely compelling.

If we fail to do so, we risk losing the trust of parents everywhere, and should not be surprised when some parents do not accept even our most clear and most emphatic recommendations