Difficult decisions

The issue of parents refusing to allow children receive cancer treatment is back in focus

Between 100 and 150 children living in Ireland today will be diagnosed with various forms of cancer this year.

Dr Fin Breatnach, who established and developed the National Children’s Cancer Centre at Our Lady’s Children’s Hospital in Crumlin, says the lives of parents are thrown completely upside down on hearing a cancer diagnosis for their child. “It is absolutely horrendous for parents and from that moment on their lives will never be the same again.”

At the recent Dr Paschal Carmody trial in Ennis, Dr Breatnach revealed that “on a number of occasions” he has sought adjudication from the courts in instances where the parents did not want their child to receive cancer treatment where Dr Breatnach believed that the possibility for cure was significant.

Small number of cases

Elaborating on his revelation at the trial, Dr Breatnach said the number of instances where parents did not want their children to receive chemotherapy and radiotherapy was “very small” over his 36 years dealing with children’s cancer, stating that the number would be four in all.

Dr Breatnach said that in the few instances that he could recall where the High Court judge issued a care order to ensure that treatment took place, the children are today long-term survivors.

Dr Breatnach said paediatricians were occasionally faced with situations where Jehovah’s Witnesses refuse permission to allow a life-saving blood transfusion to be given to their child, that would almost invariably mean that chemotherapy could not be administered.

The cancer expert, who has retired from his role at Crumlin children’s hospital, said that whenever such cases went to court the judge inevitably ordered that the transfusion be given “and it is my belief that the parents involved were almost relieved that the decision was taken out of their hands to allow treatment take place”.

The issue of parents refusing to have very ill children receive cancer treatment has come to the fore once more. This follows a UK court last month ruling that a seven-year-old boy, Neon Roberts, can be given radiotherapy against his mother’s wishes. Neon has undergone two operations to remove a cancerous brain tumour and nodule but his mother Sally did not want him to have radiotherapy.

Doctors told the High Court in London that Neon could die without further treatment, but the survival rate for children with radiotherapy was 80-86 per cent. Summing up, Mr Justice David Bodey said: “One can’t enjoy a quality of life if one isn’t alive.”

Dr Breatnach said chemotherapy and radiotherapy can have severe immediate and long-term side effects for children and it can be a difficult decision for parents to make.

“It is a very difficult decision for parents as they reflect on the quality of life of their children and the potential side effects that may create problems further down the road. The severity of side effects, for exactly the same treatment, can vary enormously between one child and the next and unfortunately there is no way of predicting this. But obviously, if no treatment is administered, the child will not survive,” he said.

Despite the success of current treatments for the majority of childhood cancers, there are a small number of cancers for which no curative treatment is available.

“If you do not offer treatment for these cancers, then they will remain incurable,” Dr Breatnach said. “One must remember that as recently as 50 years ago, cure did not exist for the vast majority of childhood cancers.

“If the doctors at that time did not attempt to find cures or the parents of those children were not brave enough to allow experimental treatment to be given, then the overall cure rates for childhood cancer today of 80-85 per cent would never have been achieved.

“The hope for the future is that we will be able to move away from chemotherapy and radiation therapy and move to treatments which target the cancer with few effects on normal tissues. Such treatments are currently being developed, with some already in everyday use for specific cancers and showing great promise,” he said.