A 13-year-old boy's vow to resist chemotherapy by punching or kicking anyone who tries to force it on him will present doctors with a tough task if they can't change his mind.
A judge was due Tuesday to hear the results of his order that Daniel Hauser undergo a chest X-ray and his family pick an oncologist to be treated for Hodgkin's lymphoma.
Daniel and his parents stopped chemotherapy after one treatment and opted for "alternative medicines," prompting Brown County authorities to intervene. The cancer is regarded as highly curable with chemotherapy and radiation, but is likely fatal without it.
Daniel was scheduled for an X-ray Monday. His attorneys couldn't confirm he kept the appointment, and calls to the Hauser home rang unanswered.
"It can be very difficult to treat a 13-year-old boy who doesn't want to be treated," said Arthur Caplan, chair of the medical ethics department at the University of Pennsylvania. "I don't want to say it's impossible, but it makes it very tough on the doctors."
Last week, Brown County District Judge John Rodenberg ruled that Daniel's parents, Colleen and Anthony Hauser, were medically neglecting him.
Rodenberg said if a new X-ray showed a good prognosis, chemotherapy and possible radiation appeared to be in his best interest. Chemotherapy would not be ordered if the cancer was too advanced.
If chemotherapy was ordered and the family refused, Daniel would be placed in temporary custody. It wasn't immediately known where the boy might be treated or how medicine would be administered if he fights it.
Caplan said the medical community recognized a person's right to refuse treatments — but those rights didn't extend to incompetent people or children. Still, he said: "It is hard to treat someone who won't cooperate." Restraints could be used.
Officials at some Minnesota hospitals that treat cancer in children described several methods they would try to break through the boy's resistance.
Dr. Steven Miles, a professor of medicine and bioethics at the University of Minnesota Center for Bioethics, said a hospital may assign a companion to a child, or administer a sedative to relieve anxiety. Sometimes foster homes catering to medically ill children can help by providing a loving environment and education about what the child needs.
"The kid says he's not sick and the mom says she'll treat it if it's an emergency," Miles said of the Hauser case. "With cancer, if it's an emergency, it's too late."
Brian Lucas, a spokesman at Children's, said ethics experts met Monday to make sure everyone was up to speed on Daniel's case and plan for any possibility.
Caplan said he believes the judge made the right decision.
"This case falls, for me, squarely in the 'You've gotta get him treated' camp," Caplan said. "If it's not life and death, you might not push so hard. If it's not a proven treatment ... you wouldn't push so far."
But doctors may not have to follow the court order "if they feel it can't be carried out — if it's literally impossible to get a needle into this kid," Caplan said.