On Friday, a massive cyber attack hit several nations in Europe and Asia, and disrupted the computer systems at multiple British hospitals. Patients were turned away as hospital staff couldn’t access the computers, and appointments had to be cancelled. The BBC reports that as many as 74 countries were affected, and security researchers believe all of the incidents are related.

The British public health system, National Health Service, advised people to only seek medical help at hospitals if it was an emergency. Ambulances were redirected to other hospitals. The screens on the hacked hospitals’ computers showed a message from the hackers each demanding $300 in Bitcoins within three days to unlock the information.

BREAKING: Multiple NHS trusts across UK under malware attack. Actual screenshot of the threat ppl are seeing: https://t.co/ZBm6a7ImwQ pic.twitter.com/7NVy8xvfyD

— Shaun Lintern (@ShaunLintern) May 12, 2017

The technique behind the attack is so-called “ransomware,” which basically is a type of software that infects a digital machine and locks its functions until a ransom has been paid. The name of this particular malware is “Wanna Cry,” also known as “Wanna Decryptor.”

36,000 detections of #WannaCry (aka #WanaCypt0r aka #WCry) #ransomware so far. Russia, Ukraine, and Taiwan leading. This is huge. pic.twitter.com/EaZcaxPta4

— Jakub Kroustek (@JakubKroustek) May 12, 2017

Several experts believe the cyber attack is linked to a hacker group called The Shadow Brokers–the same group that claimed in April that it had stolen and released malware created by the National Security Agency, NSA. It was not exactly clear what the groups’ motive was–it said it wanted to protest President Donald Trump, but also that it opposed the removal of Steve Bannon from the National Security Council.

The hackers also claimed they are “not fans of Russia or Putin,” but security experts said they could possibly be associated with the Russian government. One chief executive of a cyber-security firm, Jake Williams, said, “Russia is quickly responding to the missile attacks on Syria with the release of the dump file password that was previously withheld.”

Could we be seeing the largest cyber attack in history? Organisations in 74 countries now hit including FedEx and NHS #ransomware #WannaCry

— Lisa Forte (@lisaoncyber) May 12, 2017

Other companies that were affected include Spanish electric company Iberdrola, utility provider Gas Natural, University of Milano-Bicocca in Italy, Portuguese telecommunications provider Portugal Telecom, and FedEx. The largest telecommunications company, Telefonica, was also hit, but the attack reportedly didn’t affect any customers. It seemed to be a new kind of ransomware, and it spread fast. Some said it seemed to be a worm–a malware program that spreads by between computers, like a virus.

In Britain, the NHS is facing criticism for not doing enough to protect its computer systems against attacks like these. The hacker group became known two months ago, and Microsoft released a program that could protect against its malware. But not all NHS computers installed it. Ross Anderson from Cambridge University is one of the critics. “If large numbers of NHS organizations failed to act on a critical notice from Microsoft two months ago, then whose fault is that?” he said.

Emma Von Zeipel

Emma Von Zeipel is a staff writer at Law Street Media. She is originally from one of the islands of Stockholm, Sweden. After working for Democratic Voice of Burma in Thailand, she ended up in New York City. She has a BA in journalism from Stockholm University and is passionate about human rights, good books, horses, and European chocolate. Contact Emma at EVonZeipel@LawStreetMedia.com.

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The human trafficking industry involves 20.9 million people and $150 billion dollars each year. One new class at the University of Kansas School of Law is looking to lower those horrifying numbers. Led by KU School of Law Clinical Associate Professor and Director of KU School of Law’s Medical-Legal Partnership Clinic Katie Cronin, KU’s Human Trafficking Law and Policy course requires law students to work on real human trafficking cases and provide resources to attorneys, police, health care workers, and victims of human trafficking.

For example, Marci Mauch, one of Cronin’s students, devised training materials to help police and hospital staff recognize patterns consistent with human trafficking victims. According to the materials, signs that someone may be a human trafficking victim include avoiding eye contact, being unaware of their location, letting somebody else speak for them, having certain illnesses such as STIs, and having injuries that do not match their stories. Cronin came up with the idea of teaching hospital staff how to identify victims after learning that human trafficking victims often end up in emergency rooms.

Other examples of projects devised by Cronin’s students include working on the visa application of a human trafficking victim–the application most likely could not have been filled out by the victim as it was hundreds of pages long and required a certain level of expertise. Other students worked on the creation of a manual for attorneys working T visa cases–a visa afforded to victims who turn their human traffickers into authorities. Yet another worked on the creation of a Know Your Rights brochure for victims served by the Willow Domestic Violence Center.

“It’s sort of shocking how many areas of the law human trafficking does impact,” Cronin said in an interview with KU News Service. “Immigration attorneys can provide services to foreign national victims, and even those law students that go into corporate work can help their corporate clients to make sure that their supply chains remain free of human trafficking.”

The University of Kansas is not the first law school to expose its students hands on to human trafficking cases. For example, Boston University School of Law’s Human Trafficking Clinic offers its students the opportunity to provide legal representation for human trafficking victims and assist attorneys in shaping public policy. Columbia Law School’s Sexuality and Gender Law Clinic regularly prepares reports on human trafficking cases, while the George Washington University Law School and the University of Southern California Gould School of Law clinics directly litigate human rights cases in court.

Still, KU School of Law is unique in its efforts to attack human trafficking at the “nexus” of medicine and law. Director of KU’s Anti-Slavery and Human Trafficking Initiative (ASHTI) Hannah Britton said to the Lawrence Journal-World:

All of these survivors need immediate legal assistance… The problem is that this is a hidden population because it’s a criminal activity… Most victims are very scared to come forward because they are fearful of arrest or deportation. They’ve been isolated, and the traffickers are very skillful at creating fear.

Cronin and her students are doing good work creating much needed avenues for victims to overcome these fears.

Hyunjae Ham

Hyunjae Ham is a member of the University of Maryland Class of 2015 and a Law Street Media Fellow for the Summer of 2015. Contact Hyunjae at staff@LawStreetMedia.com.

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Like anything with a life, survival is a germ’s end game. When it faces a challenge, it will adapt. Some germs adapt alarmingly well to the challenge of modern medicine. They’re called superbugs because they’ve evolved to survive the challenges we throw at them, including antibiotics.

Do we have a counterattack against these superbugs? Let’s find out.

Superbugs in the News

Superbugs have been making headlines lately. Here’s what’s happening in case you missed it.

CRE Outbreaks

CRE stands for carbapenem-resistant Enterobacteriaceae, a type of bacteria resistant to carbapenem antibiotics. CRE resists nearly all antibiotics and can cause death in about 50 percent of infected patients because most people who become infected are already sick and have weakened immunity. Most recently, CRE killed two people in an outbreak at the Ronald Reagan UCLA Medical Center in Los Angeles and one person in a Charlotte, North Carolina hospital.

A duodenoscope, a device that drains fluids from the pancreatic and biliary ducts, stands out as the main suspect in the UCLA outbreak. Duodenoscopes probe the body, making infection easier for hitchhiking germs, especially superbugs like CRE. The particular duodenoscope implicated in the UCLA outbreak boasts an intricate design that unfortunately makes it difficult to clean properly even through reprocessing, the multi-step sanitation process designed for reusable devices. So this particular model of duodenoscope picked up some potent CRE that withstood reprocessing and infected several patients.

C.difficile Infections on the Rise

C. difficile infections happen when the harmful bacterium Clostridium difficile (C.diff) overpowers the otherwise harmless and helpful bacteria living in the intestines. Antibiotics kill bacteria, including the good kind that help fight off C.diff, so sick people who have taken antibiotics for long periods of time become especially vulnerable to C.diff. Since C.diff resists antibiotics, once good bacteria succumbs, zero defenses stand between it and the multiplication that causes deadly intestinal infections. C.diff preys on the sick and spreads wildly through hospitals. It ranks as one of the three most common infections acquired in hospitals and still cases are growing. Confirmed C. difficile infections doubled from 2000-2009 according the Centers for Disease Control and Prevention.

In Short, Superbugs Threaten Hospitals

As you can see from the cases above, superbugs thrive in hospitals where sick people with weakened immune systems squeeze together in close contact. Our usual sanitation tricks don’t stop them. Even when healthcare workers practice sanitation that could kill the flu virus, these superbugs stick around, hiding out in bathrooms, hospital beds, and on medical equipment. Since superbugs resist antibiotics, once the inevitable infection does occur, it’s extremely hard to fight and could lead to death. For example, CRE kills almost half the people it infects.

Public health officials working on the UCLA outbreak have sprung to action to contain the spread. They’re finding people who might have been exposed to CRE via use of the potentially faulty duodenoscope. They’ve issued warnings about the devices so other hospitals don’t run into similar problems.

But after two deaths in California and one in North Carolina in 2015 so far, many have asked: how can we prevent superbug outbreaks in the first place?

Preventing Superbug Outbreaks

To fight superbugs, experts recommend combating the antibiotic resistance that produced them in the first place, becoming better at monitoring and controlling them, and developing innovative techniques for prevention and control.

Combating Antibiotic Resistance

The CDC’s report Antibiotic Resistance Threats in the United States, 2013, inspired government action that fights the antibiotic resistance that produces threats likes superbugs. Their recommendations include prevention, tracking, changing antibiotic use, and developing new drugs and diagnostics.

In actual practice, the CDC has encouraged hospital antibiotic stewardship programs, which combat overprescribing and incorrect prescribing of antibiotic drugs. The programs push for evidence-based assurance that antibiotics are necessary and effective for the condition in question. For example, in antibiotic “time-outs,” doctors revisit the need for antibiotics after receiving diagnostic lab results. Often antibiotics are prescribed as a precaution while waiting for medical tests, but this practice encourages doctors to reassess the need for the drugs with medical test results in hand. These programs are voluntary, and so far California is the only state that requires antibiotic stewardship programs by law. Experts, including President Obama’s science advisers, are pushing to make stewardship programs a requirement for hospitals and nursing homes that want to receive Medicare payments.

Additionally, President Obama’s FY 2016 budget shoots to double federal spending to fight antibiotic resistance that would help move the National Strategy for Combating Antibiotic Resistant Bacteria along.

Read More: Are We Doing Enough to Prevent Antibiotic Resistance?

Monitoring the Spread of Superbugs

Tracking is crucial to understanding where superbug infections might happen and what efforts might be needed to control them.

One recommended control measure requires all patients admitted to hospitals be screened for CRE. CRE squats in the guts of many people, but only creates problems when they’re weakened by sickness or too many antibiotics. Knowing who carries CRE would help control potential problems before they happen.

In terms of general tracking, there’s no requirement that state health agencies track and monitor antibiotic-resistant bacteria, but luckily, many of them do. According to an Association of State and Territorial Health Officials survey of antibiotic resistance-related state health agency activity, about half of them collect surveillance data about occurring infections. Federal requirements could lead to all states performing valuable surveillance activities.

Implementing Innovative Practices

Superbugs challenge our sanitation practices and antibiotic use. The race is on to develop new techniques to fight them so we can replenish our defenses instead of relying on old practices. Here are a few new interventions considered for fighting superbugs. Warning…don’t read this while eating.

• Fecal transplants: Nope, that’s not a typo. This procedure is exactly what it sounds like. Fecal matter is collected from an ideal donor and placed into the gut of another individual whose population of good bacteria might have been compromised through antibiotic use. In the case of C.diff, a fecal transplant can replace good bacteria that keep infection at bay. It might seem strange, but the procedure has proven 90 percent effective at curing C.diff infections. These unorthodox transplants work better than many other cures.
• Sanitizing robots: A concentrated hydrogen peroxide solution poses a threat to superbugs. It can be toxic to humans, so at Johns Hopkins University Hospital they’ve enlisted impervious robots to help them sanitize hospital rooms. After a human technician seals the room, a bot blasts the air with 35 percent hydrogen peroxide solution that reaches every inch of the room, even cracks and crevices. A second bot dries up the room so no residue remains. This results in a completely pristine hospital room, medical equipment and all.

• New antibiotics and alternative therapies: Superbugs grow accustomed to existing drugs and we haven’t created new ones that shock their systems. This is partly because 99 percent of living species (plants and fungi) that produce promising new antibiotics will not grow in lab conditions. If they can’t grow in a lab, scientists can’t study them to make them into medicine. Recently, scientists tapped into this 99 percent horde of potential antibiotics by tricking the microbes into thinking they were in a natural environment by stuffing dirt in between two membranes. The extracted antibiotic is known as Teixobactin and has proved successful in battling antibiotic resistant MRSA and TB in mice. It hasn’t been tried on humans yet, but the methods scientists used to grow “ungrowable” cultures in laboratory conditions hold promise for the future.

Antibiotics are also overused in agriculture to treat animals raised in conditions that lead to persistent infection. Hyun Lillehoj, an avian immunologist at the Beltsville Agricultural Research Center, has discovered promising new treatments for diseases affecting poultry that would render antibiotics unnecessary. She’s found promise in using food supplements, probiotics, and phytochemicals to enhance a bird’s natural immunity and ward off infection in the first place.

On a sweeter note, Lund University found promise in the lactic acid bacteria hiding in honey bee stomachs. Lactic acid bacteria contains antimicrobial properties and has proven effective in fighting resistant MRSA. Honey processing kills the good bacteria, so store-bought honey has no antibiotic properties. The researchers reintroduced the natural bacteria into honey and used it on horse wounds. All horses were healed when no other antibiotics or steroids had worked.

Legal Challenges of Superbugs

Superbugs involve a liability hotbed because they’re changing the rules. Healthcare professionals adhere to strict rules and protocols proven to prevent the spread of infection. Unfortunately, following those rules doesn’t prevent the spread of infection from superbugs. So when something goes wrong, who is liable? The new proliferation of superbugs presents a legal problem without precedence. Courts will look at whether a hospital has taken reasonable actions to promote safety, unfortunately with a lack of history in the case of antibiotic resistance laws, what actions might be considered reasonable are not yet clear. Upcoming decisions might afford more clarity.

California Congressman Ted W. Lieu requested a hearing from the Committee on Oversight and Government Reform (OGR) to discuss the sterilization issues with duodenoscope that led to the UCLA CRE outbreak. Family members of affected patients are also filing suits against the manufacturer of the duodenoscope that led to their infections, citing grievances like negligence and fraud. Decisions in these cases could influence future arguments.

Are superbugs under control?

As alarming as recent superbug growth might be, so far the situation is under control. However, the outbreak and C.diff growth calls attention to the need to prepare our defenses for the growing threat of superbugs. Antibiotic resistant germs prey on the weak, making hospitals and nursing homes vulnerable targets for devastation.

The government and medical professionals have jumped on the case with their efforts to combat antibiotic resistance, stop the spread of superbugs, and develop new treatments. While antibiotic resistance presents a challenge, consider how antibiotics themselves have been around for less than a hundred years. While their invention was considered a medical miracle, we surely have more miracles up our sleeves to get past this new challenge.

Resources

Primary

CDC: Lethal, Drug-Resistant Bacteria Spreading in U.S. Healthcare Facilities

FDA: Design of Endoscopic Retrograde Cholangiopancreatography (ERCP) Duodenoscopes May Impede Effective Cleaning

U.S. National Library of Medicine National Institutes of Health: Clostridium Difficile Infection: New Insights Into Management

CDC: Vital Signs: Preventing Clostridium Difficile Infections

California Department of Public Health: The California Antimicrobial Stewardship Program Initiative

CDC: Core Elements of Hospital Antibiotic Stewardship Programs

USDA ARS: Alternatives to Antibiotics in Animal Health

Additional

Network for Public Health Law: Superbug Prevention and Hospital Liability

Kaiser: UCLA Bacteria Outbreak Highlights the Challenges of Curbing Infections

USA Today: Dangerous Infections Now Spreading Outside Hospitals

International Business Times: Drug-Resistant Bacteria A ‘National Security Risk’

US News & World Report: Patients File Lawsuit Against Medical Scope Maker in Hospital Superbug Infection

Washington Post: New Class of Antibiotic Found in Dirt Could Prove Resistant to Resistance

CNN: Superbug Cases Reported in North Carolina; One Dead

Food Safety News: The Search For Alternatives to Antibiotics

Food Safety News: White House Wants to Nearly Double Funding for Antibiotic Resistance Fight

Nature: A New Antibiotic Kills Pathogens Without Detectable Resistance

ASTHO: State Strategies to Address Antimicrobial Resistance

Ashley Bell

Ashley Bell communicates about health and wellness every day as a non-profit Program Manager. She has a Bachelor’s degree in Business and Economics from the College of William and Mary, and loves to investigate what changes in healthy policy and research might mean for the future. Contact Ashley at staff@LawStreetMedia.com.

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In most cases, the law grants people autonomy over their own bodies, including a constitutional right to consent to or refuse medical treatment; however, for teenagers, that right is curbed by their parents, who have the right to control medical procedures in most cases until that child turns eighteen. There has been a lot of news lately where teens are fighting back against their parents over medical treatments, procedures, and even appointments. Read on to learn more about this issue, including mental health, substance abuse, and physical problems.

Parent – Child Medical Care

Traditionally when a teenager, child, or infant goes for medical treatment, including routine check-ups, parents are welcome in the room. Many doctors’ offices allow the parent in, while some do so only if the child says the parent can come in. This is especially true in more sensitive appointments. In most cases, a child’s parents or guardians are the ones who know the most about the child.

According to the University of Washington School of Medicine:

Parents have the responsibility and authority to make medical decisions on behalf of their children. This includes the right to refuse or discontinue treatments, even those that may be life-sustaining. However, parental decision-making should be guided by the best interests of the child. Decisions that are clearly not in a child’s best interest can and should be challenged.

The concern that a parent could make a decision that isn’t in their child’s best interest has led to some cases where children and teenagers start to fight back against their parents when it comes to medical care.

What are age of consent laws?

Doctors of all kinds, from dentists to ophthalmologists, have grappled for years with age of consent when it comes to mature adolescents. In a 2013 Pediatrics article, the authors stated:

It is well understood in the medical community that adolescents’ aptitude to make rational, responsible decisions changes over time and that older teenagers and young adults have substantially similar cognitive capacities.

According to Doctor Will See You Now, this question of maturity, and the automatic assumption of parent’s rights, endures as the general background rule that will apply in the majority of court cases regarding treatment of teens. The site points out that most frequently, parents are “free to sort among alternatives and elect the course of treatment based on his or her assessment of the child’s best interests.” This rule applies to any patient below the age of majority, 18 in most states, although in a small number of states, such as Delaware (19), Mississippi (21), and Nebraska (19),  it is higher. In Arkansas, Nevada, Ohio, Utah, and Wisconsin the age of majority varies due to high school graduation dates. Some health insurance plans also have rules associated with their policies.

Those who are evaluated to have a maturity over their physical age, however, have been deemed “mature minors” in some court cases. That concept, as psychologically valid as it is, is cloudier when it comes to state laws, which vary widely in their “mature minor” stances, including the ages at which one becomes a “mature minor.” SeverFew U.S. courts have already defined the term, and a few more will be tasked to evaluate it in coming months. Seventeen states do have some form of concession to the standard parental consent requirement, ranging from written exceptions from psychologists to emancipation rights. Most often, the exceptions are requested by minors seeking an abortion without parental consent or knowledge.

These rules have become increasingly open to exceptions aiming to protect minors’ privacy and bodily integrity, safeguard the public health, and respect older minors’ adult-like autonomy and decision making ability.

Sensitive Categories of Treatment: Exceptions to the Rule

All states have some exceptions to parental consent when it comes to medical care for minors. It can become public health issue if young people are scared to get medical treatment because they have to tell their parents about them. These include procedures like testing for STDs–something that all 50 states and D.C. allow minors to do without having parental permission.

In many states, but not all, minors can also give their personal consent without their parents’ input regarding reproductive health services, with regard to contraceptive services and prenatal care, as well as drug and alcohol abuse treatment and outpatient mental health services. However, there usually is a minimum age for this kind of care without parental consent–usually early teens. These laws also don’t preclude parents from being able to require them to submit to treatment.

Abortion

One specific area of concern when it comes to minor medical care is abortion. Most states require parental consent for a minor to receive an abortion, although Supreme Court precedent allows a pregnant minor to receive an abortion under certain circumstances, such as “if she is sufficiently mature or if it would be in her best interests mentally and physically.” “Tests of maturity can include questions about good grades or extracurricular activities, as well as other less-defined queries that would allow judges to see a young person’s thinking process and understanding of the procedure,” said Doriane Coleman, a law professor at Duke University. The law is pretty inconsistent state-by-state, however, in some states, another relative could be allowed to be present at the abortion, in others a young woman could go to court to fight for her right to have the medical procedure.

Substance Abuse

When it comes to substance abuse, some states allow minors to consent to treatment. However, the laws usually also require that minors have to receive treatment if their parents consent to it on their behalf. Allowing minors the option to consent is is an attempt to make sure the treatment sticks–after all, a person who consents to treatment or requests treatment is more likely to follow through and at least stay in the program until the end.

According to the Doctor Will See You Now:

For doctors, the issue is that even if a minor is empowered by state law to give consent, they still need to ensure that the minor is intellectually and emotionally capable of giving informed consent. Thus, even if there is no age limit under state law or the age limit is very low, at times doctors may find it is inappropriate to allow a minor to consent to his own care if he is too immature or otherwise incapable of understanding the procedure’s risks, benefits and alternatives.

Payment, Confidentiality, and HIPAA

Additionally, the Doctor Will See you Now points out:

The fact that some minors can consent to their own health care and treatments in certain areas does not always mean that they actually have a right to confidentiality with respect to that care. Under the Health Insurance Portability and Accountability Act (HIPAA), practitioners are basically required to follow state law regarding confidentiality for minors, and they are given discretion over parental notification when state law is silent on the issue. Most parents will find out eventually, whether it is from HIPAA or the patient’s own volition.

Particular federally funded programs also have certain confidentiality laws. For example, services subsidized by Title X, the federal family planning funding program, have to be provided confidentially, per federal law.

Case Study: Cassandra C.

The Connecticut Supreme Court ruled recently that the state was well within its rights to require a young woman named Cassandra C. to continue undergoing chemotherapy treatments even though it wasn’t what she wanted. Her mother wanted her to do whatever she thought was best.

Because of the nature of the case, and concerns about Cassandra’s wellbeing, the case has been featured in the national news. Unfortunately, Cassandra spent every day in isolation from other patients and was under constant supervision. “She hasn’t been convicted of a crime, but it’s kind of like she’s in jail,” said Joshua Michtom, an assistant public defender and Cassandra’s lawyer. “It’s an especially lousy way to go through chemo.”

Court Orders

There are very rare situations in which the court becomes involved, because parents aren’t acting in the best interests of their children. In addition, there are cases like those outlined in the novel My Sister’s Keeper, where parents seek to have a minor child donate an organ to a sibling, or to undergo any other significantly invasive medical procedure for the benefit of another child.

Conclusion

Medical decision making by and on behalf of children and teens is a subject that is ethically, mentally, physically, and legally complex. State laws vary considerably, and they often have vague standards and language. Children should generally be involved in medical decision making to the extent of their abilities. It is not only a teaching moment, but it is also a way to create autonomy. In the case of a conflict between a minor’s wishes and a parent’s wishes, however, everyone needs to proceed with caution, especially in life or death cases. As such, it is usually wise for them to seek the advice of legal counsel and, in some cases, to proceed to court for a judicial order authorizing the proposed course of treatment.

Resources

Primary

District Court of Appeal of Florida, First District: DEPT. OF HEALTH v. STRAIGHT, INC.

Eastern District Court of Pennsylvania: Parents United for Better Schools v School District of Philadelphia

Additional

The Doctor Will See You Now: Doctor-Patient Confidentiality: How Do We Define It and When Should We Waive It?

Journal of Health Care Law and Policies: Medical Decision Making by and on Behalf of Adolescents

Journal of Pediatric Psychology: Involving Children and Adolescents in Medical Decision Making: Developmental and Clinical Considerations

Guttmacher Institute: Minors and the Right to Consent to Health Care

Philly: Should Teens Get to Say “No” to Life-Saving Medical Treatment?

Pediatrics: The Legal Authority of Mature Minors to Consent to General Medical Treatment

Editor’s Note: This article has been edited to credit select information to the Doctor Will See you Now, and some portions have been edited for clarity. 

Noel Diem

Law Street contributor Noel Diem is an editor and aspiring author based in Reading, Pennsylvania. She is an alum of Albright College where she studied English and Secondary Education. In her spare time she enjoys traveling, theater, fashion, and literature. Contact Noel at staff@LawStreetMedia.com.

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Let us examine a scenario; parents go to a hospital to treat their child’s cancer and after seeing the debilitating effects of chemotherapy, opt to end the treatment. The hospital, however, sees the child’s cancer as curable and uses the court system to attempt to force their patient to continue treatment. Which party has the law on their side, the parents of the child or the hospital?

This seemingly hypothetical situation has become a real debate between an Amish couple in Ohio and the Akron Children’s Hospital. Parents, Andy and Anna Hershberger, have decided to stop the chemotherapy treatments of their 10 year old daughter, Sarah, who is battling Leukemia. The couple originally consented to the chemotherapy of Sarah in May 2013 but put an end to the treatment in June 2013. The parents saw the effects of the treatment as more harmful than helpful and opted to use natural herbs and vitamins rather than radiation to rid the girl’s body of the cancer.

While it is the belief of Mr. and Mrs. Hershberger that chemotherapy was actually killing their daughter, it is the moral and legal obligation of the hospital to make sure that the young girl received proper care. As explained by Robert McGregor, Akron’s chief medical officer, the hospital believes that the girl will die without the chemotherapy treatment. “We really have to advocate for what we believe is in the best interest of the child,” explained McGregor.

This is where the law stepped in, as the hospital went to court in order to force Sarah’s continued chemotherapy treatment. Judges appointed an unaffiliated third party, or “court guardian” to the case, Maria Schimer who is an attorney as well as registered nurse. Along with guardianship came Maria’s power to make all medical decisions regarding Sarah’s continued treatment. With this decision, the Amish family went into hiding about four months ago and has refused to reappear until the guardian is removed. Maria Schimer recently requested to be dropped from this case as she can no longer reach Sarah and her family.

The Hershbergers are currently fighting to obtain the right to make health care decisions for Sarah after the legal guardian is formally removed from the case. These parents are appealing the decision that allowed Maria Schimer to step in and make medical decisions for their daughter in the first place. The couple feels that assigning this guardian has infringed upon their constitutional rights and are appealing under the Ohio Health Care Freedom Amendment, approved in 2011. This amendment prohibits laws that force Ohioans to, “participate in a health care system.” This appeal is the first time that the court has been forced to determine the scope of this amendment, which has previously been seen as a symbol against President Obama’s health care overhaul.

The representing attorney to the Hershberger’s, Maurice Thompson of the libertarian 1851 Center for Constitutional Law in Ohio also helped draft the Ohio Health Care Freedom Amendment. Thompson feels that this case is a significant issue under said amendment because the Ohio Health Care Freedom Amendment is in place to preserve the rights of parents and children to choose their health care free of compulsion and prevent forced health care. “Allowing an uninterested third-party, one that has never even met the family or the child, to assert an interest in an exceedingly important parental decision will completely undermine the parent-child relationship,” argues Thompson.

Though the case of the Hershberger family has not yet been decided, it is most likely going to face multiple challenges. This stems from the fact that though the Ohio Health Care Freedom Ammendment was approved, it did not prevent the implementation of the Obama’s new federal health care law. This is because a state amendment does not have the ability to nullify a law. This situation could harm Ohio’s ability to enforce its specific laws and amendments to a case such as this. It is also questionable as to whether this amendment can extend to the point of protecting the Hershberger family’s case, which will be up to the court system as they decide on the full scope of the amendment.

The bigger picture of this case becomes, is it the right of the parents or the right of the hospital to determine the medical future of a child? While the Akron Hospital, versus the Hershberger family case is one of the most recent, there are other similar situations in which parents have lost the custody of their ill children to decisions made by the hospitals treating them. Fifteen year old Justina Pelletier was taken from her parents and placed into the custody of Boston Children’s Hospital in February 2013. This event occurred due to a dispute between Justina’s parents and the hospital, when her diagnosis changed from a mitochondrial disorder to a mental illness. After the change in diagnosis, the Pelletier family threatened to withdraw their daughter from the hospital in order to seek a second medical opinion. Once a child is labeled with a mental disorder, it is within the hospital’s power to call child protective services. In this case DCF labeled the parents behavior as insolent and abusive. The parents were stripped of their custody and the state of Massachusetts forcibly been treating as well as detaining Justina since that time. Based on the current ruling, it looks as if Justina will not be fully released until she is 18 years old.These two extreme cases can seem terrifying in the eyes of parents, and rightfully so. It seems that the hospitals often have the final say in the treatment of child patients rather than the parents.

While both sides of this scenario, the hospitals and the parents, seem to be looking to protect the child’s best interests, it becomes hard to draw a line between who is correct in their judgements. If parents are fully informed about treatment options as well as their risks and decide that the risks do outweigh the benefits, it should be within their ability to opt out of treatment as the child’s legal guardians from birth. However, this becomes complicated with the consideration of some parental religious beliefs that could bar the child from receiving potentially life saving treatment. On one hand, due to custody under the hospital or a third party guardian, a life can be saved, but on the other religious beliefs may be compromised. This medical debate does not have an all encompassing answer.

At what point, does it become ok to take over the custody of a child without the consent of their parents, or is it ever ok? To each his own, what is your opinion?

[The News- Herald] [Fox News] [Police State USA]

—

Taylor Garre (@TaylorLynn013)

Featured image courtesy of [Randall Pugh via Flickr]

Taylor Garre

Taylor Garre is a student at Fordham University and formerly an intern at Law Street Media. Contact Taylor at staff@LawStreetMedia.com.

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