Why would physicians start chemotherapy in this patient?
Why would cancer specialists agree to give induction chemotherapy for acute myelogenous leukemia to a patient whom they knew could not survive the treatment? Such a decision, to proceed with intensive chemotherapy in a patient who is likely to die due to his refusal to accept blood transfusions, seems to me to be a splendid example of medical myopia, if not pretentiousness.
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The article has no useful facts and no direct information from the patient or physician parties.
Let’s assume for the moment that all of the facts about chemotherapy were spelled out. Most leukemia consent forms I’ve reviewed through the IRB process are 20 to 30 pages long and outline the course of care for 18 to 36 months describing all interventions, drugs, diagnostic procedures, side effects and complications that occur. Blood transfusions as a necessary part of care is spelled out explicitly.
So parents and patient sit down with the docs and review all this. (again, I’ve audited these processes; they are lengthy at several hours, and quite detailed, offering ample opportunity for questions. This is again reviewed with the family at several points in the first week to help fill in information lost due to their initial shock and surprise.) They know the chosen plan is a Hail Mary of a game plan, that with the constraints placed by them on the transfusion, all courses of action have a lower efficacy than if transfusion is allowed, and they wish to proceed with the plan chosen.
Once the patient is informed how can the medical team choose otherwise? If informed consent as a means to personal autonomy is to be respected as a right then our ability to refuse to honor the patient’s wishes unfairly burdens them with our imposed will; we risk denying them the respect of an autonomous individual.
I don’t think we are in a position to question the ethics or judgement in the manner of the editorialist of the article. If the consent was good (adequately informed, questions addressed, reaffirmed at intervals) then we cannot intrude on the decisions made by the patient and family.
A little honesty here:
A: Without induction chemotherapy the patient has essentially no chance of survival…period. Even with induction/consolidation chemotherapy in a patient who accepts blood products the odds are against and very likely an allotransplant would eventually occur (if possible). But none of us know the cytogenetics here.
B: Dr Hildreth wonders if certain questions were asked such as:
1. Did the doctors think Dennis Lindberg would survive his treatment without transfusions? Is that why they proceeded with his chemotherapy?
-I personally have seen a jehovah witness patient survive induction/consolidation treatment without blood product support. Scary as all heck and it is my personal record for a low hemoglobin on a survivor. But the point is the PATIENT DID SURVIVE.
2. Did they inform the patient that if he accepts chemotherapy without receiving any transfusions his risk of dying is much higher than normal, if not unavoidable?
-Come now. Any oncologist with half a brain is going to bring this subject up again and again under the circumstances. It is rather a question of the obvious and if the oncologist DID NOT bring it up, that oncologist shouldn’t be practicing…period.
3. Did they give Dennis the option to take a safer treatment, even though non-curative, in an attempt to palliate his illness without exposing him to the mortality of severe myelosuppression? If he was willing to die rather than violate his faith, did they consider alternative care that would help him to live out the rest of his life as he wished?
-None of us in cyberland know the answer to this question, but the fact remains less aggressive treatment is non-curative…period. This is a heartwrenching decision for a doc and family/patient to make for which the family and doc will have to live with. The simple fact is if the 14 year old did not undergo aggressive induction/consolidation chemotherapy he would DIE…period. Yes maybe less aggressive therapy would buy some time, but the patient would still die of his disease in the end. This kid was 14 years old. Even without blood product support, a little chance at survival is better than no chance. Dr. Hildreth playing monday morning quarterback and pontificating about what he would (or more appropriately would not have) done is meaningless especially in light of the fact he wasn’t there for any of the conversations or treatment. His only helpful statement on the subject is that was “ridiculous for me to speculate” (then he went ahead and speculated anyways). In the end a rather poor thread from Dr Hildreth on a specific situation he nothing about.
Sorry I forgot a word:
In the end a rather poor thread from Dr Hildreth on a specific situation he knows nothing about.
Re the Dennis Lindberg case, there was one or two news articles which hinted that the Ethicist and possibly one or more of Lindberg’s doctors that agreed with the position that Lindberg had the legal right to refuse transfusions.
Apparently, it was an unidentified “government official” that filed the petition for guardianship after the situation was already lost.
All this seems to indicate that Childrens Hospital supported Lindberg’s position, altho there probably were some doctors and employees who did not, personally.
SUMMARIES OF 600 JEHOVAH’S WITNESSES LAWSUITS & COURT CASES
The following website summarizes over 315 U.S. court cases and lawsuits affecting children of Jehovah’s Witness Parents, including 200+ cases where the JW Parents refused to consent to life-saving blood transfusions for their dying children:
DIVORCE, BLOOD TRANSFUSIONS, AND OTHER LEGAL ISSUES AFFECTING CHILDREN OF JEHOVAH’S WITNESSES
http://jwdivorces.bravehost.com
The following website summarizes over 285 lawsuits involving Jehovah’s Witnesses, including cases involving JW Employees who were injured while working and then died because they refused life-saving blood transfusions:
EMPLOYMENT ISSUES UNIQUE TO JEHOVAH’S WITNESS EMPLOYEES
http://jwemployees.bravehost.com
Jehovah’s Witnesses elders will investigate and disfellowship any Jehovah Witness who takes a blood transfusion,to say the issue is a ‘personal conscience matter’ is subterfuge to keep the Watchtower out of lawsuits.
Many Jehovah’s Witnesses men,women and children die every year worldwide due to blood transfusion ban.Rank & file Jehovah’s Witness are indoctrinated to be scared to death of blood.
FYI
1) JW’s DO USE many parts aka ‘fractions’ aka components of blood,so if it’s ’sacred’ to God why the hypocritical contradiction flip-flop?
2) They USE blood collections that are donated by Red cross and others but don’t donate back,more hypocrisy.
3) The Watchtower promotes and praises bloodless elective surgeries,this is a great advancement indeed.BUT it’s no good to me if I am bleeding to death from a car crash and lose half my blood volume and need EMERGENCY blood transfusion.
Know this,the reason that JW refuse blood is because of their spin on the 3000 year old Biblical old testament,modern medicine will eventually make blood donations and transfusions a thing of the past.When this technology happens it won’t vindicate the Jehovah’s Witnesses and all the deaths that have occured so far.
The Watchtower’s rules against blood transfusions will eventually be abolished (very gradually to reduce wrongful death lawsuit liability) even now most of the blood ‘components’ are allowed.
In 20 years there will be artificial blood and the Red Cross will go on with other noble deeds.
None of these changes will absolve the Watchtower leaders or vindicate their twisted doctrines
—
Danny Haszard born 1957 3rd generation Jehovah’s Witness
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