From: LexisNexis Print Delivery <lexisnexis@prod.lexisnexis.com> (TM)
Date: June 11, 2004 7:50:51 PM EDT
To: woeckner@Princeton.EDU
Subject: LexisNexis(TM) Email Request (1842:0:20362669)

                                                                         107ZMW


Print Request: Selected Document(s): 1

Time of Request: June 11, 2004 07:50 PM EDT
Number of Lines: 149
Job Number: 1842:0:20362669
Client ID/Project Name:

Research Information:


Note:
Terry, number 1


1 of 2 DOCUMENTS

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 17,20; ISSN: 0025-7435

CBCA-ACC-NO: 4721775

LENGTH: 2062 words

HEADLINE: The Tyrell Dueck dilemma [Parents insisting on alternative treatment
for their 13-year-old son results in boy's death]

BYLINE: Driver, Deana

BODY:

   In November 1998, a 13-year-old Tyrell Dueck was diagnosed with
osteosarcoma (osteogenic sarcoma). Physicians told the Saskatchewan boy
treatment would include chemotherapy and probable amputation of his leg.

   It was a difficult diagnosis to give and a shocking one to hear, but it was
only the beginning of a story that was to make international headlines
after Tyrell's parents, Tim and Yvonne Dueck, refused to allow their son
to undergo conventional treatments.

   Tyrell's parents wanted to seek alternative therapies in an American
Biologics clinic in Tijuana, Mexico instead.

   The issue went to court twice within the next few months and both times
Tyrell was ordered to undergo conventional chemotherapy treatments
immediately.

   Tyrell died in July 1999 after a battle fought against the medical
community, social services, court systems and his cancer.

   The past year has been one of the most difficult in the professional life
of Dr. Christopher Mpofu, pediatric oncologist at the Saskatoon Cancer
Centre and Tyrell's attending physician.

   But had it not been for teamwork and constant debriefings, the Tyrell case
would have taken a greater toll on the clinic staff, said Dr. Mpofu.

   ''It helped us both in terms of supporting each other but also in keeping
each other focused on the real issues and not on the emotional side of
things,'' he told the Medical Post.

   As physician responsible for the case, he chaired meetings with the Dueck
family and reported the case to the provincial department of social
services because of the danger to the child. He has no regrets about his
actions.

   ''I feel satisfied that we did what we had to do. We're obviously very
unhappy about the outcome,'' said Dr. Mpofu.

   Dr. Mpofu has discussed the case with other physicians and oncologists
across Canada, he said, and ''they all have been supportive of our stand.
They all feel we did what we needed to do, and from what they could tell,
we did it in a professional manner.''

   Dr. Mpofu said he acted within the laws of the province and the rules of
his profession while dealing with a very difficult situation.

   From the beginning, Tyrell's father Tim asked clinic staff not to question
Tyrell but to direct any comments or questions to Tim as a spokesperson
for the family, said the clinic staff.

   It was one of only a few times when such a directive has been given to
Saskatoon cancer clinic staff. ''There was never any direct dialogue with
Tyrell,'' said clinic social worker Debbie Arsenault. Tyrell would look to
his father to answer all questions, she said.

   ''Even when we did speak to him with his parents, he could never get a word
in,'' said Dr. Mpofu.

   Each time clinic staff tried to discuss the treatment plan with the Duecks,
the Duecks turned the conversation toward alternative therapies rather
than the conventional chemotherapy, clinicians have said.

   Dr. Mpofu said he offered to make arrangements for them to seek a second
opinion at another Canadian or American facility but the offer was
declined.

   Tim was unavailable when the Medical Post contacted the family in
September. His wife Yvonne spoke about the case from her perspective.

   She expressed frustration that she could not get a straight answer from the
doctors or social workers about who was responsible for sending the case
to social services.

   Dr. Mpofu disagrees with her perception. As attending physician, he said,
he spent a lot of time with the family and the clinic's social services
department's social workers to explain their obligation to report to the
department if there was a concern over a child's welfare.

   Clinic staff said they always talk with patients and families about
treatment options, potential side-effects and outcomes as well as their
reporting obligations in cases involving children.

   But they cannot determine the next step in the process, they said.

   ''It's our duty to identify our concerns to the social services department
and then it is the social service department's responsibility to decide
what they are going to do about it,'' said Dr. Mpofu.

   In the past eight years, the Saskatoon cancer clinic has reported only five
cases to social services and the Dueck case was the only one involving a
mature minor, said Arsenault.

   Tyrell underwent two courses of chemotherapy after the initial December
1998 court order by Justice M. Wright forced him into treatment against
his parents' wishes.

   When Tyrell told Dr. Mpofu in late February 1999 he did not want further
treatment, the matter went to court again to determine if he could make
that decision himself.

   Justice Allison Rothery ruled Tyrell was not a mature minor. She said
Tyrell's father was providing inaccurate information which could harm the
child and that Tyrell was not only incapable of making a decision against
his father's wishes but incapable of comprehending the consequences of any
decision.

   She ordered him to continue with conventional treatment without his parents
being present. The cancer clinic succeeded in having the order amended so
his parents could be present but not allowed to interfere with treatment.

   Dr. Donald Duncan, a child psychiatrist in British Columbia, testified in
the case as an expert witness for the Duecks, and told the Medical Post he
found Tyrell to be competent if given the right information. He said in
his opinion the judge ruled on the emotional rather than legal issue,
partly because of the abrasive personality of Tim.

   ''As a psychiatrist, or any physician, if I'm to decide whether my patient
is competent or not based on the decision they're going to make, that's
just inappropriate,'' he said.

   But as a person, Dr. Duncan is glad the judge ruled the way she did. ''The
judge's ruling was an attempt to save the child,'' he said. ''I understand
the emotional motive but I'm a little disappointed that they thought he
wasn't competent.''

   Dr. Duncan said Tim screened information from his son prior to the December
court ruling, but any parent would do the same with their child. ''As soon
as Tyrell was involved in the decision-making process, there was no
screening,'' he said.

   If Tyrell had been an outgoing child who argued for treatment and his
father a meek person who argued against treatment, the court's decision
probably would have been easier, said Dr. Duncan.

   For the Dueck family, the key issue in the case was one of choice, said
Yvonne. ''People don't realize we weren't out to change the world.''

   There are no guarantees when one takes cancer treatments. ''Until you have
a proven cure, you shouldn't have to go through it,'' she said.

   Yvonne said her family's religious beliefs should not have been the focus
of the case. ''It had nothing to do with our religion. This had to do with
what you had to offer him,'' she said.

   The Duecks belong to a fundamentalist Christian group and attend church at
Gruenthal near Saskatoon.

   Although she would not speak specifically against the cancer clinic
physicians, she said some doctors were almost callous in their diagnosis
and handling of Tyrell and the boy never gained respect for the medical
profession and conventional treatment.

   ''The biggest problem with Tyrell is he lost all his trust in doctors,''
she said. ''He had it in his own mind that doctors didn't care.''

   Some doctors were blunt and seemingly uncaring, said Yvonne. ''If it hadn't
been for the nurses that were basically like a second mom, it would have
been unbearable,'' she said.

   ''If you can help, help him, but don't force him,'' she said she told the
clinic.

   She blames the health-care system and a shortage of physicians for
contributing to the sometimes brisk treatment she said they received.

   ''That's bound to affect their approach to another person,'' she said. ''If
you can't and do not want to help him with compassion and enter into
another person's suffering, then you can't help him.''

   Tyrell chose to stop treatments when the pain and swelling returned while
he was undergoing chemotherapy, said Yvonne, and he was determined not to
lose his leg. He never complained about what the rest of his life might
hold and never expressed a fear to die, she added.

   ''There was just this peace about him throughout the whole thing, maybe an
acceptance to it, I don't know,'' she said.

   ''Maybe, for whatever reason, he just couldn't handle the fact of being an
amputee for whatever the rest of his life was. He made the choices,'' she
said. ''I know we carried it out the way he wanted it. He didn't want to
be on earth where he would be in a low quality life in wheelchairs and in
hospitals.''

   Dr. Mpofu disagrees that religion was not an issue; he said it was brought
up by the Dueck family on a number of occasions.

   ''Right from the beginning Mr. Dueck's position was he believed God would
look after his son. The church had already started to hold services and
prayers for him,'' said Dr. Mpofu. ''Even on the day Tyrell said he no
longer wanted to have the chemotherapy, the reason he gave was God had
healed him.''

   The cancer clinic incorporates various spiritual and religious beliefs and
practices as part of its patient therapy programs and coping mechanisms,
but the Dueck family's agenda was always to avoid conventional treatments
in favour of alternative therapies, said Arsenault.

   The cancer clinic allows patients to take complementary or alternative
therapies with their conventional therapy, barring contraindications, but
alternative therapies cannot be used instead of conventional treatment,
said Dr. Mpofu.

   Tyrell was taking herbal and other alternative treatments while undergoing
chemotherapy. ''We knew about those and we supported him using them,'' he
said.

   Some reports suggested Dr. Mpofu asked Tyrell if he wanted to continue
treatments after the December court ruling, but Dr. Mpofu said those
reports were in-accurate. ''Tyrell himself never objected to the
treatment. It was always his parents,'' said Dr. Mpofu. ''I didn't raise
the issue.''

   ''When they came on the visit, he told me that he no longer wanted
treatment--not because I asked him the question--but because he had been
prompted by his father. His father reminded him that he had something to
tell me.''

   The case affected other patients in the clinic who felt their suffering was
being minimized by Tyrell's battle, said Arsenault. She and others spent
many hours talking to parents and other child patients about their
feelings of ''anger and frustration.''

   Clinic staff tried to keep a cordial relationship with the Dueck family and
avoid any potential for mistrust and animosity.

   ''I think we did that,'' said Arsenault. ''Even after the court order came
down and Tyrell visited us again, we were able to discuss things ... it
was amicable.''

   Yvonne said at one point Dr. Mpofu gave up on her son, but Dr. Mpofu
strongly refuted that. ''In all our cases we try to work to maintain hope
for the patients and their families,'' he said.

   ''At the beginning, the hope is that we can cure their condition and for
the majority of children, that is the case. For cases where the
possibility of cure is very small, we still maintain hope that we can do
other things to make sure their life is as comfortable as possible.''

   When the cancer spread and Tyrell's probability of cure fell to 10%, Dr.
Mpofu said he left any further treatment options to the Dueck family.

   ''At all times, we are attempting to balance the treatment from the
potential side-effects,'' he said. ''We made the offer that we were still
available to see him to help with ongoing care or any other care that was
necessary but that was never taken up,'' he said.

   Test results in Saskatoon, which showed Tyrell's cancer had spread,
differed from those taken later by the American Biologics clinic in
Tijuana. Saskatoon doctors were not given access to the Mexico scans nor
were the Saskatoon results requested by the American Biologics
authorities.

   After Tyrell died, an American Biologics doctor said one of its doctors
recommended amputation but the idea was refused.

   Dr. Mpofu said that recommendation, which came weeks after his office made
the same recommendation, did not make him feel any better about the case.

   Deana Driver is a freelane writer living in Regina.


   JOURNAL-CODE: 0945

LOAD-DATE: February 25, 2000