Teen battles state over cancer treatment
By Harriet Ryan
Starchild Abraham Cherrix, 16, has refused chemotherapy and wants to use an herbal treatment.
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(Court TV) -- In Virginia, age 16 is old enough to drive a car, work a 40-hour week, stand trial in adult court, and marry.
Whether 16 is old enough to reject traditional cancer treatment is at the heart of a trial slated to begin next week on the Eastern Shore town of Accomac.
Starchild Abraham Cherrix, a 16-year-old suffering from Hodgkin's disease, has refused chemotherapy and radiation treatments ordered by his oncologist in favor of an herbal remedy prescribed by a Mexican clinic.
If Abraham, as he is known, were two years older, the decision would be his alone and no court could challenge his choice, no matter how medically unorthodox. But because he is a minor, social services authorities have intervened.
In the proceeding that begins in Accomack County Circuit Court on August 16, government lawyers will accuse his parents, who support Abraham's herbal treatment, of medical neglect for not ensuring their son receives chemotherapy and radiation. If they are successful, the judge is likely to give partial custody to the state and order Abraham into a hospital for treatment.
Although the right of states to compel medical treatment for gravely ill children over their parents' wishes is well established, Abraham's case is noteworthy because he has articulated strongly his own reasons for refusing conventional treatment.
"I should have the right to tell someone what I want to do with this body," he told USA Today last month. "I studied. I did research. I came to this conclusion that the chemotherapy was not the route I wanted to take."
Other cases often turn on a parent's religious beliefs, but the Cherrixes say that while they are devout Christians, their decision is based on Abraham's own negative experience with a first round of chemotherapy and his evaluation, seconded by his parents, of alternative treatments based on that experience.
"When Abraham mentioned that he didn't want to take radiation and that he wanted to try alternative treatments, I tested him and questioned him to make sure that was what he really wanted to do," Jay Cherrix said. "I researched it myself and saw that there were other options."
State authorities acknowledge the case is not an easy one and said they are concerned only with the teenager's health.
"One of the most difficult decisions of the Child Protective Services program requires balancing the rights of the parents with the health of the child," Anthony Conyers Jr., State Social Service commissioner, said in a statement about Abraham's case.
The trial comes as Abraham's health continues to deteriorate.
Although his lawyer says the lanky teen has gained weight and energy with the daily doses of herbs, including licorice, he acknowledged that tumors in Abraham's neck and chest are growing, albeit "infinitesimally."
Abraham was diagnosed with cancer a year ago after a doctor evaluating his complaints of exhaustion discovered growths in his neck. He began chemotherapy at a hospital in Norfolk, a two-hour drive from the Cherrixes' home on the island of Chincoteague.
The treatments left Abraham, who stands 6-foot-1, nauseous and so weak that his father had to carry him from the car to his bed.
"I watched Abraham go from 156 pounds to 122 pounds. I watched all of his hair fall out. I saw him cringing from pain in his jaw so bad that he couldn't eat. The heels of his feet hurt so much he couldn't walk. He had blisters in his mouth," said Jay Cherrix, who refers to his eldest son as "my little boy."
The chemotherapy initially seemed to work. His tumors shrank, and according to the Cherrixes, Abraham was cancer-free by the end of 2005. By February, however, the cancer was back.
Abraham's oncologist ordered a second, more intense round of chemotherapy and radiation treatment. Abraham balked.
"I think it would kill me the second time," he told the Associated Press.
Instead, he began searching for alternative treatments and decided on a sugar-free diet and a regiment of herbal supplements known as the Hoxsey Method. The treatment is controversial.
It is banned in the United States by the FDA, and a review by the National Cancer Institute several years ago of 400 patients who claimed they were cured by the method could not substantiate a single account.
Abraham and his parents, however, maintain they know people who have been helped by the treatment and were convinced by visits to a clinic in Tijuana.
"They were so overwhelmed with the kindness and professionalism of the staff and with the success stories of people they met there who had been cancer-free for 20, 30, 40 years. They felt they had found their place, their niche," said Sharon Smith, the family spokeswoman.
The Cherrixes asked Abraham's oncologist in Virginia to continue monitoring their son during the herb treatment, but the physician refused and instead alerted the Accomack County Department of Social Services.
After interviewing the Cherrixes and the doctor, authorities proceeded with charges of medical neglect, which, according to the Virginia statute, is "the failure by the caretaker to obtain and or follow through with a complete regimen of medical, mental or dental care for a condition which if untreated could result in illness or developmental delays."
In July, Abraham, his parents, the oncologist and seven other witnesses testified in a closed hearing in family court. The issue before the juvenile judge was whether the Cherrixes had neglected their son.
The couple did not fit the standard picture of mistreatment or disinterest. Rose Cherrix homeschools the five children, while her husband operates a kayaking business. They were at Abraham's side throughout his chemotherapy.
On July 21, however, the judge ruled that the Hoxsey Method alone constituted neglect. He gave social services joint custody of Abraham and ordered him to report to the hospital to begin chemotherapy within four days.
His parents immediately exercised the right of parties in family court to have their cases heard anew in a higher court. A county circuit court judge, Glen Tyler, stayed the lower court's order of chemotherapy until he could hear evidence.
In a trial expected to last two days, Tyler will hear from the oncologist, social services workers, a woman who claims the Hoxsey Method cured her ovarian cancer, and of course, Abraham.
In a previous hearing, the teenager recalled the debilitating effects of chemotherapy and his decision to pursue the herbal treatment. The judge can consider his opinion, but also disregard it because he is a minor.
According to Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, judges asked to compel medical treatment of a minor normally are guided by the standards accepted by the medical establishment.
"Courts decide based on what mainstream medicine says are the appropriate treatments. They are not interested in Mexican licorice-stick treatments," he said.
Courts also consider the rate of success of a treatment and do not order experimental or risky treatments.
The Cherrixes' defense plans to contest the efficacy of chemotherapy in Abraham's case, saying it is no guarantee of restoring his health. Stepanovich said he will call an oncologist to testify that Abraham's resistance to the first course of chemotherapy indicates additional courses may not help him.
Survival rates of those diagnosed with Hodgkin's disease are in excess of 80 percent, but the rates drop for those whose cancer returns after a first round of chemotherapy.
According to studies compiled by the American Cancer Society, the five-year survival rate for those who undergo a second round of chemotherapy and a bone marrow transplant is between one-third and one-half, depending on the treatment facility.
"It would be different if he had a broken arm or a heart ailment that could be rectified by surgery. There's medical treatment that could fix that problem definitively. In this case, he's got cancer and there's no definite cure. Chemotherapy is a treatment. It's not a cure," Stepanovich said.
Caplan, the University of Pennsylvania bioethicist, said it seems likely the judge will order Abraham back to the hospital for chemotherapy and radiation, but said "the reality-check question" is whether a tall 16-year-old can be made to cooperate.
"Are they going to shackle him? There is a physical reality that has to be grappled with here," he said.
Jay Cherrix echoed that skepticism. He said that while his family would comply with the order of the court, he has trouble imagining a doctor violating his son's wishes.
"I personally don't think there is a Dr. Mengele in the United States who would pump this stuff into a 16-year-old who didn't want that. I personally don't think we've reached that point in our civilization," he said.
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