Rebuilding trust

摘要

On July 25, 2007, the Child Protection Agency, Quebec, Canada, announced that it would not intervene in the case of Anael L'Esperance-Nascimento-a 3-year-o!d boy with cancer, whose parents withdrew him from chemotherapy against the advice of his oncologists. Although the consequences of this decision will become clearer in the coming months, these events raise questions about the appropriateness of state intervention and where the line should be drawn between parental and societal responsibility. Anael was diagnosed with a disseminated low-grade glioma in 2006 and was recommended several cycles of chemotherapy. After the insertion of a shunt-to help manage the hydrocephalus associated with Anael's cancer-symptoms diminished. Anael received the first cycle of chemotherapy, but his response to treatment was difficult to assess (because of the characteristic diffuse leptomeningeal thickening, seen with this type of glioma). Consequently his parents refused further treatment on the basis that it was too toxic, and they withdrew him from hospital. Anael's parents instead decided to use a non-evidence-based alternative treatment-a diet of raw vegetables and regular infusions of wheatgrass-developed by the Florida Hippocrates Health Institute (West Palm Beach, FL, USA). In a concession to the hospital, however his mother assured doctors that they could regularly examine Anael, and if the cancer progressed she would allow them to restart the chemotherapy regimen-a decision that could prove fatally inadequate.