Ethical Dilemma in Pediatric Leukemia Treatment: Parental Rights vs. Child’s Welfare

QUESTION

2019 case- Ethical dilemma/Leukemia
A Florida judge ruled that a 3-year-old boy with leukemia must begin receiving chemotherapy
treatments despite the objections of his parents, who would prefer he be treated with CBD oil,
alkaline water, and mushroom tea.
The child, Noah McAdams, was diagnosed with acute lymphoblastic leukemia in April at Johns
Hopkins All Children’s Hospital. His parents, Taylor Bland-Ball and Joshua McAdams opted to
go against his doctors’ advice and pursue a homeopathic approach to the illness.
But Hillsborough County Judge Caroline Tesche Arkin ordered Wednesday that the child, who is
currently in the custody of his grandparents, must receive proper medical care as part of the first
phase of his chemotherapy treatment. (Under Florida law, a court can make medical decisions for
a minor if they are deemed to be a victim of “medical neglect.”)
The parents’ lawyer, Michael Minardi, confirmed in an email that the judge had ordered them to
“continue with the first phase of chemotherapy.”
But Minardi said that the child will also be able to “use alternative treatments” during this phase
of chemotherapy, including medical cannabis.
“It could have been worse,” McAdams, the child’s father, said after the ruling, according to
the Tampa Bay Times.
Right now, the parents and their attorney are working on appealing the decision.
Minardi told the News that “the court will make a determination of phases two and three of the
chemo at a later date,” adding that the McAdams and Bland-Ball were “not happy with the
requirement that the child undergo chemotherapy.
McAdams and Bland-Ball initially agreed to the hospital’s treatment plan for their son, but after
nearly two weeks at the facility they decided to seek a second opinion.
“The hospital’s governing body was disorganized and the doctors were not pleasant or
professional to us,” McAdams said during his testimony. “It seemed like doctors were
disappearing on us and just passing down Noah’s information secondhand.”
Noah underwent a total of two rounds of chemotherapy, according to McAdams and Bland-Ball,
who said his blood tests showed no signs of the cancer.
This prompted the parents to use homeopathic remedies, including CBD oil, alkaline water,
mushroom tea, and more, to help with Noah’s condition.
When Noah’s parents failed to take him to a third scheduled chemotherapy appointment on April
22, 2019, authorities were notified.

Hillsborough County police issued an alert on Facebook for a child “who is believed to be
missing and endangered.”
On April 29, 2020, the boy was later found in Kentucky, and both McAdams and Bland-Ball
were accused of possible child neglect.
Acute Lymphoblastic Leukemia, commonly diagnosed in children, has a 90% cure rate for
patients who follow the common treatment plan of up to two and a half years of chemotherapy.
But as Dr. Bijal Shah of the Moffitt Cancer Center told the News, “It’s going to be almost
universal that the leukemia will come back” if treatment is stopped early. Shah also said that just
because leukemia becomes undetectable, that doesn’t mean that it is cured.
Shah also cast doubt on the parents’ alternative approach to treatment, saying, “I’ve seen
[patients] try to do vitamin C therapy, silver therapy, marijuana, stem cell therapy in Mexico,
blue-green algae, sugar-free diets — you name it.”
“This has never worked for my patients,” he said.
The parents have used Facebook as a way of providing updates on the court proceedings.
On Tuesday, Bland-Ball talked about Noah’s mental health and said he’s been tremendously
affected by the experience.
“We saw him yesterday. He was pale, terrified, wouldn’t even speak, wouldn’t even walk,” she
said. “And he’s just absolutely traumatized anytime a doctor gets near him.”
In the same video, Bland-Ball said that she and McAdams weren’t denying treatment; they were
instead “looking for a better treatment that has less side effects and less issues.
Parents had lost custody
The ruling also granted Bland and McAdams unsupervised visitation with their son, who was
removed from their custody on April 30.
A dependency court judge ruled that Noah would remain in state custody but could live with his
maternal grandmother.
CNN reached out to Hillsborough CPS, which is overseen by the Hillsborough County Sheriff’s
Office. Crystal Clark, a spokeswoman, told CNN, “The Child Protective Investigations Division
does not and cannot comment on its investigations due to confidentiality per Florida Statute. The
case is still active and our Criminal Investigation Division is working with the State Attorney’s.
TAMPA, Fla. — Months after a judge removed a young Tampa boy from his parents’ home for
their refusal to get him chemotherapy to treat his leukemia, Noah McAdams has been fully
reunited with his family.

His mother, Taylor Bland, announced Sunday on Facebook that Noah was “all the way home.”
The family’s attorney confirmed to 10News that Noah was returned Sunday afternoon. The
lawyer said all parties had agreed to reunification and expressed no legal objection to her motion
to get the family back together. A formal hearing will be held at 8:30 a.m. on Dec. 16.
Under Florida law, when a court determines it to be a situation of life or death, the state can
mandate medical treatments for a child. That’s what happened to Noah after his parents took him
to Kentucky for alternative treatment — causing him to miss a chemo appointment and sparking a
missing child alert.
“We have a long road of therapy for Noah ahead of us, due to all the trauma he has endured from
being separated from his loving parents,” Bland wrote in a social media post.

Passport Leukemia-
Read the story and watch the video:
https://youtu.be/EQNkJL6zqOw
Answer the questions: Reflection
Think of the principles of beneficence and nonmaleficence
==> Do you feel the parents have the right to refuse medical treatment for their child even if it may
cost the child possibly his life?
Or
==> Do you agree with the state and with the verdict of medical neglect in this case? Do you think the
judge made the right decision by taking Noah away from his parents and mandating he receive
chemotherapy?

ANSWER

Ethical Dilemma in Pediatric Leukemia Treatment: Parental Rights vs. Child’s Welfare

Introduction

The case of Noah McAdams, a 3-year-old boy diagnosed with acute lymphoblastic leukemia, raises a significant ethical dilemma regarding parental rights, the child’s welfare, and the role of the state in medical decisions for minors. This case has ignited a debate centered on the principles of beneficence and nonmaleficence, ultimately questioning whether parents have the right to refuse medical treatment for their child even if it may jeopardize the child’s life or if the state’s intervention, as mandated by the judge, was the correct course of action.

The Parents’ Perspective

Noah’s parents, Taylor Bland-Ball and Joshua McAdams, initially opted for a homeopathic approach to treat their son’s leukemia, which included CBD oil, alkaline water, and mushroom tea. Their decision stemmed from concerns about the side effects and potential harm associated with chemotherapy. They believed they were acting in Noah’s best interest by exploring alternative treatments that they perceived as less invasive and harmful.

The State’s Perspective

Under Florida law, the state can intervene in medical decisions for a child if they are deemed a victim of “medical neglect” in situations where treatment is considered life-saving. In Noah’s case, the court determined that chemotherapy was a necessary and effective treatment, and the parents’ refusal to continue with it could potentially result in his death.

Ethical Considerations

1. Beneficence: The principle of beneficence emphasizes the duty to promote the well-being of the patient. In Noah’s case, medical professionals overwhelmingly supported chemotherapy as the standard and effective treatment for acute lymphoblastic leukemia, which has a high cure rate when treated properly. From a beneficence perspective, the state’s intervention can be seen as a necessary step to ensure the child receives the best available care and has the highest chance of survival.

2. Nonmaleficence: Nonmaleficence involves the obligation to do no harm. While Noah’s parents may have genuinely believed in the alternative treatments they chose, the medical community had concerns about the effectiveness and safety of these approaches. From a nonmaleficence standpoint, the state’s decision to mandate chemotherapy can be seen as an effort to prevent harm to the child by ensuring he receives evidence-based treatment.

The Judge’s Decision

The judge’s ruling to mandate chemotherapy for Noah and remove him from his parents’ custody was based on the assessment that the child’s life was at risk due to the parents’ decision to pursue alternative treatments. This decision aligned with the principles of beneficence and nonmaleficence by prioritizing Noah’s well-being and minimizing potential harm.

Conclusion

In situations where parental choices may endanger a child’s life, a delicate balance must be struck between parental rights and the child’s welfare. The case of Noah McAdams underscores the complexity of such ethical dilemmas. While respecting parental autonomy is important, the state’s responsibility to safeguard the child’s health and well-being is paramount, as guided by the principles of beneficence and nonmaleficence. In this context, the judge’s decision to mandate chemotherapy can be seen as a measure to protect Noah’s life, although it is not without controversy and ethical nuances. Ultimately, the ethical debate in this case highlights the challenging decisions faced by healthcare professionals, legal authorities, and society at large when it comes to the welfare of minors in critical medical situations.