Faith or medicine?

A judge orders chemotherapy after a boy says no

Around the time of his 13th birthday last Oct. 1, Tyrell Dueck slipped while getting out of a shower. The next day, with his fight knee sore and swollen, his parents took the boy to a doctor. Medical examinations led to an unrelated but shocking discovery: a potentially lethal cancer in the boy's thighbone. It also set in train a jarring collision between medical science and Tyrell's Christian fundamentalist parents. Doctors say that Tyrell's only hope of survival lies in chemotherapy--and possible amputation of his leg. But according to testimony in a Saskatoon court last week, Tyrell and his parents--described by a psychiatrist as holders of "right-wing, fundamentalist, faith-healing" views--want him to go to a clinic in Tijuana, Mexico, for treatment built around large doses of vitamins and a special diet. After a three-day hearing last week, Justice Allisen Rothery ordered the boy to continue conventional medical treatment. Tyrell's father, Timothy, she declared, had persuad ed his son to place "his hopes for recovery on a cure that does not exist. This is simply cruel."

That did not settle the issue. Taken to a Saskatoon hospital by his grandparents following the judge's ruling, Tyrell submitted to a blood test, then walked out, telling reporters: "I'm still refusing treatment--I'm just not going to do it." Later that evening, after government officials ordered the Duecks' lawyer to get the boy back to hospital, his parents readmitted him. However, at week's end all parties declined comment on whether Tyrell was receiving treatment. Meanwhile, the Duecks launched an appeal against Rothery's judgment, a move that automatically suspended her verdict. The provincial court of appeal was expected to hear the case this week.

The dispute over medical treatment for the Grade 8 student raised troubling ethical questions over how far the state can go in protecting children against the wishes of their parents--and the child's own beliefs. It began almost as soon as doctors diagnosed him in November with osteogenic sarcoma, the same cancer that killed Terry Fox, the gutsy Marathon of Hope runner who died in 1981 at age 22. Confronted by the Dueck family's opposition to conventional medical techniques, Saskatchewan's social services department won a court order permitting the boy to live at home, but giving the department authority over health-care decisions. That allowed physicians to begin chemotherapy--until March 1, when Tyrell himself refused further treatment. The case went to court again, this time to decide whether Tyrell was competent to make his own medical decisions.

During the hearings, the fundamentalist beliefs and commanding personality of Timothy Dueck emerged as central issues. A tall and imposing man, Dueck, 36, works as a truck driver and lives with his wife, Yvonne, and the couple's three children-Tyrell has two sisters, one younger, one older--in Martensville, about 12 km north of Saskatoon. In the Dueck household, the court was told, Timothy Dueck is indisputably in charge. According to psychologist Josephine Nanson, the family "has a very traditional structure, with all the decisionmaking authority vested in the father. It would be very difficult for Tyrell to make a decision different from his father's."

Nanson and another child development expert who interviewed the boy agreed at the hearing that while Tyrell has the mental capacity to decide on his treatment, he possessed inadequate medical information on which to base a decision. Nanson said the boy believed the power of prayer, herbal remedies and alternative therapies in Tijuana would give him an 85- to 95-per-cent chance of recovery--and that he might not have cancer at all, but a "hormone tumour" related to his rapid growth over the past year.

According to the boy's oncologist, Dr. Christopher Mpofu, there is no such thing as a hormone tumour. Mpofu, whose own estimate was that Tyrell had a 65-per-cent chance of surviving with conventional treatment, said he tried to explain things to Tyrell--"but I've never been able to speak to him on his own. His father didn't want us to do that." Mpofu recalled the day when Tyrell announced that he would withdraw from chemotherapy. During a discussion with the boy and his father, said Mpofu, Timothy Dueck reminded his son that he had something to tell the doctor. "He said, 'Yes, Dad,' then he went on to tell me he didn't want any more treatment."

Although Canadian courts in recent years have frequently intervened to permit some medical procedures against parents' wishes, Bernard Dickens, a University of Toronto expert in medical law, notes that there is also legal doctrine which accepts that "mature minors" can be competent to make medical decisions for themselves. "Such decisions," adds Dickens, "must be free and independent--and when a child is strongly under the parents' influence, then objective medical evidence must weigh heavily in the balance." By week's end, one crucial piece of medical information that remained unknown was the extent to which the cancer in Tyrell Dueck's leg might spread as lawyers, doctors and his family struggled to decide his fate.

PHOTO (COLOR): Tyrell with parents Timothy and Yvonne Dueck: a belief in prayer and herbal remedies

~~~~~~~~

By Mark Nichols and Leslie Perreaux