Runaway

The Daniel Hauser story, recently in the news, highlights some of the dilemma which burdens the treatment of serious mental illness. Dan is the 13 year-old Sleepy Eye boy whose parents “support his decision to” refuse chemo-therapy for Hodgkin’s Lymphoma, triggering a legal showdown with child-protection authorities.

Dan’s case stirs up familiar controversies: the efficacy of modern/western medical science versus alternative medicine; the right of an individual to refuse treatment; and the legal/moral criteria for over-riding such rights. I see both similarities and contrasts between Dan’s situation and the plight of adults with schizophrenia.

Untreated Hodgkin’s Lymphoma is likely fatal – schizophrenia rarely gets listed as the official cause-of-death, but untreated schizophrenia can totally destroy a person’s life. However, Hodgkin’s Lymphoma generally responds to chemotherapy, usually allowing the patient to live a long and happy life – schizophrenia generally responds to treatment (medication) which can be referred to as chemotherapy, which (in combination with the ideal support) allows the patient to live a long, happy and productive life. And chemotherapy for Hodgkin’s Lymphoma isn’t 100% successful, and has really nasty side-effects. The medications used to treat schizophrenia are also effective but has some horrible side-effects. The only difference is that treatment for schizophrenia is for a life-time.

Typically, in our legal tradition, a patient has the right to refuse treatment. But Dan, too young to vote, drink, or get married, doesn’t possess the legal right to consent to or refuse medical treatment, because we recognize that most 13 year-olds don’t possess sound judgment – and neither do people in the throes of untreated schizophrenia. Generally, the parents of a minor are granted the authority to make legal decisions on the minor’s behalf, and mostly, this seems to work, i.e., the parents consent and the patient receives treatment – no such presumption exists in the case of adults with schizophrenia, who generally retain their rights, despite the impaired judgment, and frequently refuse treatment.. But Dan’s parents “support his decision to” refuse treatment, raising the ire of civil authorities – just as adults with schizophrenia sometimes, but statistically infrequently, are involuntarily committed for treatment.

I find it ironic that public opinion strongly (though not unanimously) supports intervention by authorities to force treatment on young Dan, whereas, if he were 18 and severely impaired by schizophrenia, we would typically value his right to refuse above his right to receive treatment, thus making him an unnecessary burden to society for the next 50 years.