Do Parents or Doctors Have Final Say?

June 16, 2005 — -- It's never easy for a family to deal with the emotional decisions surrounding a child battling cancer, particularly when parents and physicians disagree about treatment plans. The treatment of 13-year-old Katie Wernecke's Hodgkin's lymphoma has sparked a debate over whether doctors, or parents, should decide the course of her care.

Child welfare officials in Texas have sided with Katie's physicians and removed her from the custody of her parents, Michele and Edward Wernecke, after they refused to allow doctors to proceed with radiation therapy for their daughter.

Hodgkin's lymphoma is a cancer of the lymphatic system, the network of small tubes filled with clear lymphatic fluid that crisscrosses the body and helps fend off disease. Treating this form of cancer, which has a very good cure rate, involves using drugs and X-ray radiation to kill the cancerous cells.

Katie's parents stopped getting radiation treatment for the girl when they believed that the cancer was gone from her body, because they feared that the radiation treatments would be harmful to the growing girl.

"While chemotherapy is sufficient to produce a remission, radiation is generally needed to prevent that cancer from coming back," said Dr. Daniel Sulmasy, chief of ethics at New York Medical College.

Radiation therapy can be hard on a child's growing body. Growing bones and developing reproductive tracts are particularly sensitive to the poisonous effects of radiation. Later in life, these children may have heart and lung problems, trouble with fertility, and may even develop a second form of cancer.

For this reason, The National Cancer Institute recommends that children with cancer be treated by teams of doctors who have the experience to balance the risks of radiation treatment with its lifesaving effects.

"Every case is individual," said Dr. Joanne Hilden, chair of the Department of Pediatric Hematology and Oncology at the Cleveland Clinic. "But there are very evidence-based treatments for Hodgkin's that all doctors go by. The treatment is really trying to spare people side effects while curing the disease."

The Werneckes are member of the Church of God, and have said Katie could not receive blood transfusions unless they came from her mother. Their lawyer, Daniel Horne, said religion was not at issue in the dispute over the girl's cancer treatment.