1. Shalo, Sibyl

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It's hard to find anyone who doesn't have an opinion about the Starchild Abraham Cherrix case, which was settled in August. The 16-year-old won his fight against the Accomack County, Virginia, Department of Social Services, which, based on a complaint from his original oncologist, sought a court order to force him to undergo chemotherapy for his Hodgkin disease. Cherrix, diagnosed a year earlier, had already undergone one round of treatment, which was unsuccessful and left him very weak and sick. Seeking to avoid another round, Cherrix and his parents traveled to Mexico, where he underwent an herbal treatment called the Hoxsey method. The settlement requires Cherrix to see a radiation oncologist who also practices alternative medicine, and the family must report his progress to the court every three months until he turns 18. (The parents won their case too, after being charged with being medically neglectful.)

Figure. The Cherrix ... - Click to enlarge in new windowFigure. The Cherrix family (Rose, Jay, and 16-year-old Starchild Abraham) in August, after the decision was reached allowing the teenager to refuse further chemotherapy. AP Wide World/Steve Helber

Some observers insist that Cherrix should be forced to have treatment because he will likely die without it and he's too young and immature to make such an important decision. Others feel just as strongly that the government shouldn't interfere with private, family, or individual medical matters.


What's a nurse to do? Suppose Cherrix had lost his case. Would officials have found a nurse to administer chemotherapy to a restrained, protesting teenager? Most nurses haven't found themselves in the middle of a situation like this. What does a nurse do when her job responsibilities are in conflict with her ethics, morals, or religious beliefs? A number of experts say that the most important thing to do is to speak up-and to do so early.


Mary McCabe, director of the Cancer Survivorship Program at Memorial Sloan-Kettering Cancer Center in New York City- and head of the center's ethics committee-says, "When health care providers feel that they're being asked to do something that they can't support ethically or that's against the wishes of the individual, it's always important for them to acknowledge their personal perspectives and the analysis that they've made."


McCabe says that ethics committees are institutions' best venue "for not just resolution, but identifying the issues and promoting respect for the individuals on any side of the issue."


Betty Ferrell, professor of nursing research at City of Hope Medical Center in Duarte, California, says that a hospital's ethics committee is also a venue for education.


"The nurse has the opportunity to hear medical data about the likelihood of the patient's responsiveness to the drug," she says. For example, she says, if a nurse understands that there's an 85% chance that a patient will respond to a particular drug, she might feel better about putting the patient through a stressful course of treatment.


The committee provides an opportunity for an interdisciplinary review of issues and the related science that may make the difference between a nurse feeling alienated by a conflict and feeling like part of a team dealing with it.


"Many times, there's no right way or wrong way, there's no good or bad," says McCabe. "There are nuances and different belief systems that come into play. There are shades of gray that not only make it complicated but require experts who can analyze the issue so people can discuss it in a neutral way and find some common ground."


"This isn't just an issue for oncology nurses," says Ferrell. "It's not just about chemotherapy. Critical care is where it occurs most of the time. And nurses need to ask the broader questions of what it really means to be a nurse."


Sibyl Shalo