Aboriginal Girl Passes Away

[xcon2run]

In case you haven't heard, Mikayla Sault (the young aboriginal girl who refused chemo for alternative therapy) just passed away. Incredibly sad story, especially given how young she was. I'm sure this is going to re-ignite the debate we've all seen over the news in the past few months.

 

Interested to hear your thoughts here as well.

 

http://www.cbc.ca/news/aboriginal/makayla-sault-girl-who-refused-chemo-for-leukemia-dies-1.2829885

[A-Stark]

As much as I think the mother was monstrously irresponsible here and quite literally let her daughter die... I can't really come around to thinking that taking the girl away from her family would have been the right decision either. 

 

Very sad. She clearly relapsed and a stroke secondary to hyperviscosity. 

[xcon2run]

Yes I agree with your viewpoint. Once of my colleagues mentioned how you can really think of it as either 1) Do you want what works? or 2) Do you want to protect your beliefs/culture? Personally I side with point 1 but still, I feel tremendously for that poor mother. 

[rmorelan]

Yes I agree with your viewpoint. Once of my colleagues mentioned how you can really think of it as either 1) Do you want what works? or 2) Do you want to protect your beliefs/culture? Personally I side with point 1 but still, I feel tremendously for that poor mother. 

 

I can certainly understand why have a couple of centuries of betrayal it would have hard for some from that culture to actually trust western medicine - trust anything really. What remains of their culture is often all they really have left, and loosing that after all this time would be something very difficult to decide. Plus regardless of how effective it is the idea of us marching in, taking by force and "poisoning" one of their children is not going to go over very well. 

 

It is a truly awful situation.

[amichel]

Yes I agree with your viewpoint. Once of my colleagues mentioned how you can really think of it as either 1) Do you want what works? or 2) Do you want to protect your beliefs/culture? Personally I side with point 1 but still, I feel tremendously for that poor mother.

Her parents are Christian ministers. Which, in my opinion, weakens the cultural belief argument somewhat. As does the fact that their alternative was a white guy in Florida.

[xcon2run]

Her parents are Christian ministers. Which, in my opinion, weakens the cultural belief argument somewhat. As does the fact that their alternative was a white guy in Florida.

 

I wasn't going to bring up the old Hippocrates clinic but I'm glad someone did haha. 

[LeBronto2019]

Isn't it still possible to be Christian and still have beliefs associated to Aboriginal culture? They have such a rich history and multitude of practices, and maybe their perspective on health stems more from their cultural heritage than religious. Not mutually exclusive topics, of course, but there is a chance that there was enough distinction between culture and religion that it could be due to that. 

[rmorelan]

Isn't it still possible to be Christian and still have beliefs associated to Aboriginal culture? They have such a rich history and multitude of practices, and maybe their perspective on health stems more from their cultural heritage than religious. Not mutually exclusive topics, of course, but there is a chance that there was enough distinction between culture and religion that it could be due to that. 

 

by this point everything is grey on grey. I mean there were dozens if not more Aboriginal cultures all intermingled.

[amichel]

Isn't it still possible to be Christian and still have beliefs associated to Aboriginal culture? They have such a rich history and multitude of practices, and maybe their perspective on health stems more from their cultural heritage than religious. Not mutually exclusive topics, of course, but there is a chance that there was enough distinction between culture and religion that it could be due to that.

Yes. Of course it is. Which is why I used the word weakened, not negates. Also, they stopped chemotherapy because the girl supposedly had a vision of Jesus. Which, again, makes it seem less of a cultural decision.

 

I understand (academically) the fear Aboriginal people must have of children being taken away by the system. But for a nearly 100 percent cure? It seems wrong to me. Especially since, for the reasons I've outlined, the cultural beliefs reasoning seems very weak to me.

[Chamilt]

Although I think the family and the girl ultimately made the wrong decision. I believe not just aboriginal cultures but any culture or person should reserve their autonomy and the ability to make their own decisions. I know she was only 11 and her ability to appropriately make this decision was likely impaired and greatly influenced by her parents as well as her family and friends. Not to mention the quack in Florida (I'll leave it at that).

 

But, personally I wish to have the right to have a DNR when I am sick or refuse treatment that I may not believe will benefit me. No different than Jehovah witness' refusing blood transfusions, even when it will save their lives. Or if I'm a noncompliant diabetic who doesn't take my insulin. Bottom line we have to respect peoples choices. Our job as physicians/future physicians isn't to push treatment onto people (such as has happened in the past) but to present them with all of their potential options and subsequent risks. And we may give our professional opinion on what we believe is the best option. 

 

Also, I think it's really sad that most people have made this an "aboriginal" issue and think the are ignorant and dumb for choosing alternative/natural therapy. I know just as many or more rich, white folk that continuously choose ridiculous therapies over conventional medicine, much to the detriment of their and their families health. 

 

This whole issue is about autonomy and choice, not culture, race or religion.

[amichel]

Although I think the family and the girl ultimately made the wrong decision. I believe not just aboriginal cultures but any culture or person should reserve their autonomy and the ability to make their own decisions. I know she was only 11 and her ability to appropriately make this decision was likely impaired and greatly influenced by her parents as well as her family and friends. Not to mention the quack in Florida (I'll leave it at that).

 

But, personally I wish to have the right to have a DNR when I am sick or refuse treatment that I may not believe will benefit me. No different than Jehovah witness' refusing blood transfusions, even when it will save their lives. Or if I'm a noncompliant diabetic who doesn't take my insulin. Bottom line we have to respect peoples choices. Our job as physicians/future physicians isn't to push treatment onto people (such as has happened in the past) but to present them with all of their potential options and subsequent risks. And we may give our professional opinion on what we believe is the best option.

 

Also, I think it's really sad that most people have made this an "aboriginal" issue and think the are ignorant and dumb for choosing alternative/natural therapy. I know just as many or more rich, white folk that continuously choose ridiculous therapies over conventional medicine, much to the detriment of their and their families health.

 

This whole issue is about autonomy and choice, not culture, race or religion.

You make some good points. I just don't think an 11 year old is capable of making that decision, and I don't think parents should be allowed to make decisions that endanger their children. If it were a more iffy treatment, fair enough. But it's not.

 

Also, I think it's the family that made it an "aboriginal issue", not everyone else.

[xcon2run]

You make some good points. I just don't think an 11 year old is capable of making that decision, and I don't think parents should be allowed to make decisions that endanger their children. If it were a more iffy treatment, fair enough. But it's not.

 

Also, I think it's the family that made it an "aboriginal issue", not everyone else.

 

I agree with your standpoint. Of course it's not JUST aboriginal people, but the way her mother frames the issue certainly makes it seem that way. I just don't see how this situation is any different then a Jehovah's witness family refusing blood for their child. Both are refusing treatment for their children that will most likely pass away if the treatment is not given.

 

I don't care where you are from or what religion you believe in, any issue that puts a child in jeopardy who doesn't know any better and is too young to make their own decisions should be investigated and *hopefully* prevented. Let them grow up then see what they believe. Better to be on the safe side.

[Chamilt]

You make some good points. I just don't think an 11 year old is capable of making that decision, and I don't think parents should be allowed to make decisions that endanger their children. If it were a more iffy treatment, fair enough. But it's not.

 

Also, I think it's the family that made it an "aboriginal issue", not everyone else.

 

I agree with you that an 11 year old is likely not competent enough to make a decision that is life and death and yes it is a highly effective treatment and curable illness. And as I said I think they made the wrong decision.

 

I guess I kind of got carried away with the autonomy issue as a whole, not just in children. 

 

I agree the family likely used an aboriginal angle, but it was the media that presented it that way. Mainstream media sucks, lol.

[rmorelan]

I agree with your standpoint. Of course it's not JUST aboriginal people, but the way her mother frames the issue certainly makes it seem that way. I just don't see how this situation is any different then a Jehovah's witness family refusing blood for their child. Both are refusing treatment for their children that will most likely pass away if the treatment is not given.

 

I don't care where you are from or what religion you believe in, any issue that puts a child in jeopardy who doesn't know any better and is too young to make their own decisions should be investigated and *hopefully* prevented. Let them grow up then see what they believe. Better to be on the safe side.

 

what is interesting is we have overriding that before (we being the courts). Parents don't get to absolutely decide these things - that is why this case was so interesting. The expectation was there would be an override here as well.

[A-Stark]

I'm not happy that the media is credulously repeating the family's claim that her fatal stroke was caused by the chemo. 

 

It was caused by her disease. 

[Chamilt]

Or can we just look at this in a positive way.   

 

Darwinism?

 

[amichel]

Or can we just look at this in a positive way.

 

Darwinism?

 

Ew... Too far I think.

[Leon]

what is interesting is we have overriding that before (we being the courts). Parents don't get to absolutely decide these things - that is why this case was so interesting. The expectation was there would be an override here as well.

 

Yup I definitely see this becoming an ethics seminar for next year's class. I think this outcome was inevitable with the withdrawal of chemo. And given the complex factors involved, I'm not sure if there is necessarily a right or wrong path here. I just wish the media was more balanced with their reporting, but of course they never are.

[xcon2run]

Yup I definitely see this becoming an ethics seminar for next year's class. I think this outcome was inevitable with the withdrawal of chemo. And given the complex factors involved, I'm not sure if there is necessarily a right or wrong path here. I just wish the media was more balanced with their reporting, but of course they never are.

 

As we all know, the media likes the little guy/girl. I think an override would be expected yes (based on previous cases) so that's why I'm so surprised the judge did not. It certainly is a landmark case and I'm curious where it goes from here...

[Leon]

As we all know, the media likes the little guy/girl. I think an override would be expected yes (based on previous cases) so that's why I'm so surprised the judge did not. It certainly is a landmark case and I'm curious where it goes from here...

 

My understanding is that the ethnic origin of the girl (being Aboriginal) made the case exceptional from any other. Ie. if her ancestry was not Aboriginal, the ruling would likely have gone the way most of healthcare expected. But her ancestry allowed the usage of a clause in the law that led to this outcome. Still, this is going to be a long and ongoing debate for sure.

[NLengr]

I'm not happy that the media is credulously repeating the family's claim that her fatal stroke was caused by the chemo.

 

It was caused by her disease.

 

I noticed yesterday when I listened to the editor of the Turtle Island newspaper (local aboriginal newspapers for the area the town is in) talk on CBC about the case, there were multiple mentions about how chemotherapy "poisoned" the child and "killed" the patient. It was pure idiocy.

 

This case should have been about one thing and one thing only: was the child capable of comprehending the decision she made, and it's consequences, and therefore was capable to make a decision regarding.

 

All this stuff about aboriginal rights and traditional medicine becomes moot if she was capable of deciding to withdrawal from chemo. It seems like the social workers involved believed she was capable from what I have read.

[NLengr]

My understanding is that the ethnic origin of the girl (being Aboriginal) made the case exceptional from any other. Ie. if her ancestry was not Aboriginal, the ruling would likely have gone the way most of healthcare expected. But her ancestry allowed the usage of a clause in the law that led to this outcome. Still, this is going to be a long and ongoing debate for sure.

That was the other similar case that was ruled on in Ontario court a couple months ago, not this one.

 

See here:

http://www.cbc.ca/news/canada/hamilton/news/stress-over-chemo-court-fight-uncalled-for-family-of-aboriginal-girl-1.2834674

 

That's the case that was much more disturbing to me. It needed to be appealed by the crown due to legal precedent ramifications IMO. I don't think it was though.

[bruhh]

You have to put cultural beliefs and reality on two scales and see which one outweighs the other. I would do my best to convince that the medical treatment is effective, if unsuccessful then I will have to concede and let them carry on with their culturally molded beliefs. It is their life for which they make decisions for. I am in no authority to make decisions for someone else. The most important thing here is that the beliefs we have forwards curative mefical treatment is as strong as their belief for herbal/religious treatment. So it's not easy to overrule their judgment because of our own opposite beliefs. Maybe they'd rather die than succumb to using Western treatment methods. Then so be it!

[ploughboy]

Entire case boils down to whether or not Mikayla was competent to make medical decisions.  Ignore the rest of the media jabber.

 

I've known 11-year-olds who were totally competent, and I've know 25-year-olds who couldn't be trusted to tie their own shoes without supervision.  Never having met Mikayla I can't comment any more than that.

 

Sad case all around.

[evans]

All this stuff about aboriginal rights and traditional medicine becomes moot if she was capable of deciding to withdrawal from chemo. It seems like the social workers involved believed she was capable from what I have read.

 

There's also the issue of an informed decision. Her upbringing in this case might have greatly influenced her decision and made her believe that her alternative treatment would be effective in curing her, and that chemotherapy would poison/sicken her.