Colin Newmark

Case of Colin Newmark: Refusal of Chemotherapy for Lymphoma[1]

At three years old, Colin Newmark developed an aggressive and lethal form of pediatric cancer known as Burkitt’s Lymphoma.  Colin’s doctors recommended that Colin be treated with a heavy regimen of chemotherapy, stating that chemotherapy offered Colin a 40% chance at surviving at least eight more years.  Without chemotherapy, he would almost certainly die within one year.   His parents decided that instead of allowing an uncertain and painful medical treatment, they would take Colin home and seek prayer-healing through their church. 

Should the state intervene and compel chemotherapeutic treatment for Colin?

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[1] Author: E.K. Salter, PhD (2013), based on court case Newmark v. Williams/DCPS, 588 A.2d1108 (1991).

John

John, a 32 year-old lawyer, had worried for several years about developing Huntington's chorea, a neurological disorder that appears in a person's 30s or 40s, bringing rapid uncontrollable twitching and contractions and progressive, irreversible dementia. It leads to death in about 10 years.

John's mother died from this disease. Huntington's is autosomal dominant and afflicts 50% of an affected parent's offspring. John had indicated to many people that he would prefer to die rather than to live and die as his mother had. He was anxious, drank heavily, and had intermittent depression, for which he saw a psychiatrist. Nevertheless, he was a productive lawyer.

John first noticed facial twitching 3 months ago, and 2 neurologists independently confirmed a diagnosis of Huntington's. He explained his situation to his psychiatrist and requested help committing suicide. When the psychiatrist refused, John reassured him that he did not plan to attempt suicide any time soon. But when he went home, he ingested all his antidepressant medicine after pinning a note to his shirt to explain his actions and to refuse any medical assistance that might be offered. His wife, who did not yet know about his diagnosis, found him unconscious and rushed him to the emergency room without removing the note. What should the care team at the emergency room do?

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-->http://depts.washington.edu/bioethx/tools/cecase.html

J.R.

            J.R. is a combative 21-year-old female who presents in the emergency room disoriented, with a fever, chills, and a cough.  J.R. is well known by the medical staff.  She has had three previous admissions with endocarditis and twice has left the hospital AMA.  On her most recent previous admission her mitral valve was replaced with a porcine prosthesis.  J.R. is HIV positive and has a history of prostitution and substance abuse.  She refuses counseling. On the 12^th day of her hospitalization, J.R. leaves AMA even after her physician warns that the bacteria in her blood is still active.  Two days later she returns to the ER and it is obvious her heart valve must once again be replaced.  J.R. demands another valve, saying it would violate her civil rights to be refused. Would it be wrong to refuse J.R.?

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*Crigger, Bette-Jane. Cases in Bioethics : Selections from the Hastings Center Report. 3rd ed. New York: St. Martin's Press, 1998.

Mrs. A

            At the age of 70, Mrs. A has been admitted to the hospital for the fifth time in as many years for treatment of respiratory difficulty.  The last time she was in the hospital she had nearly died  She has severe emphysema, and when she developed a cold, her deterioration was so rapid that only artificial respiration in the emergency room saved her life.  However, it proved very difficult to wean her from the respirator. She spent 4 weeks in the Intensive Care Unit and required constant care from the medical staff, principally Intern B.  After she was discharged, she remained short of breath even while watching television.

            Now, 5 months later, she has contracted another cold, but this time Intern B has managed to treat her without resorting to the ICU and the respirator.  During her illness, Mrs. A’s two sons have been in constant contact with the medical staff.  They have been anxious, agitated, and demanding.

            It is now 2 a.m. and Intern B is again called to see Mrs. A, who is becoming increasingly lethargic.  It is obvious that she is in respiratory failure, and will probably die before morning if she is not given a respirator. However, hospital policy requires that respirators be used only in the ICU, where the required supporting staff and facilities are available.  There is only one bed open in the ICU.  The residents like to save one bed for an emergency.  As Intern B approaches, Mrs. A’s sons are waiting. He knows their questions:  What’s wrong now?  What will you do?

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-->Crigger, Bette-Jane. Cases in Bioethics : Selections from the Hastings Center Report. 3rd ed. New York: St. Martin's Press, 1998.