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Copyright 1999 Micromedia Limited
Canadian Business and Current Affairs
Copyright 1999 Maclean Hunter Ltd.
Medical Post

November 23, 1999

SECTION: v.35(40) N 23'99 pg 17,21; ISSN: 0025-7435

CBCA-ACC-NO: 4721788

LENGTH: 724 words

HEADLINE: Would an ethics consultation have helped? [Tyrell Dueck case]

BYLINE: Driver, Deana

BODY:

   The Dueck family did not have an official ethics consultation while he was
being treated at the Saskatoon Cancer Centre.

   Although some commentators, including a Saskatchewan Reform MP, say it
would have been a good idea, others say it would not have made any
difference in Tyrell's case.

   Physicians knowledgeable about this case generally agree the doctors at the
Saskatoon clinic acted correctly.

   The Duecks asked for a consultation with the Saskatoon District Health
ethics committee in mid-March 1999 but their court appearance clashed with
the consultation date and the meeting did not take place.

   The Duecks wanted the ethics committee to look into whether the family was
within its rights to decline chemotherapy, determine if the oncologist
should have respected their refusal for treatment in December and offer a
way for the situation to be ''amicably resolved,'' said their lawyer Owen
Griffiths.

   The family's request would have delayed further treatments and the clinic
was anxious to continue with therapy.

   When Tyrell refused treatment in February, ''we did consult with the head
of the two ethics committees here in Saskatoon--the district health board
committee and the university committee--and they gave us their opinion
that if the child was a mature minor he had the right to make the
decision,'' said Dr. Christopher Mpofu, Tyrell's oncologist.

   ''However, it wasn't in our power to make that determination.'' The issue
of capacity was a legal issue.

   ''The main thing that needed to be decided would never be decided by an
ethics committee,'' said Dr. Mpofu.

   Dr. Noel Doig, a retired family physician and chairman of the University
Hospital's ethics committee, said he and ethicist Dr. Harry Emson attended
an informal consultation which the cancer clinic administration convened
''late in the case, either just before or just after the judge (Allison
Rothery), made the ruling'' in March.

   ''The Duecks were not present. Dr. Emson and myself said we would not carry
on any formal discussion in their absence,'' he said.

   ''The ethics committee's function is to explain what the ethical principles
are to them to facilitate a formal discussion between parties...and to
some extent recommend what seems to be the correct ethical solution.

   ''But that recommendation is only in the form of advice, not in the form of
what you should or shouldn't do,'' he said. ''It's a question of
facilitation, not arbitration, not mediation.''

   The Saskatoon Health District is now formalizing the process for ethics
consultations, spurred in part by the Dueck case.

   Saskatchewan's Hospital Standards Act says a person cannot give consent for
hospital treatment unless he or she is 18 years old, or married.

   Physicians must report to social services any cases in which they believe
the best interests of the child are not being met. Physicians could be in
legal trouble if they do not report, said Dr. Doig. Parental consent would
have been needed for amputation, but could be overruled by a judge, he
said.

   Although the ethics committee did not meet with the Duecks, Dr. Doig was
familiar with the two main issues in the case.

   ''One is whether in fact a child of Tyrell's age is competent to make a
decision about his care. The second is the question of whether there is or
is not coercion on a child who is making a decision.''

   The judge ruled on one side of the issue in stating that Tyrell must
continue treatments, said Dr. Doig.

   ''The problem that arose, and this is a fundamental problem and one that I
have no solution to, is where do you find a surgeon who will in fact
amputate a leg of a 13-year-old who is saying, 'No, no, no?

Tim was portrayed by some as a domineering influential father, but his wife
Yvonne said in an interview that much of it came about because Tim was
responding to pressure. She said he was complimented on his handling of
the difficult situation.

   ''If you're looking for bad, you'll find it,'' said Yvonne, who is still
hurting from the picking apart of her family's values.

   ''I don't know how many fathers would actually do that and carry out the
wishes of what that son wants because this is his life, this is his
body,'' she said.

   An ethics panel likely would not have changed the decision of the Duecks,
said Dr. Duncan.


   JOURNAL-CODE: 0945

LOAD-DATE: February 25, 2000