Introduction
I was reading an article today on the BBC website entitled "Chinese actress' death sparks cancer treatment debate". It was about a 26 year old Chinese actress, Xu Ting, who was diagnosed with lymphoma (a type of cancer) who rejected treatment using chemotherapy/modern western medicine in favour of trying TCM (Traditional Chinese Medicine) alternatives. This was despite the urging of her followers to do the contrary.
This seems to have sparked an online debate of the sort that we sometimes see on whether this was irresponsible, unethical etc. There are also people now making this into a Western Medicine vs. TCM debate.
Missing the Point
Most of this debate seems to miss the point. It forgets that one of the principles of medicine (western, eastern or any other type) is autonomy of the patient. Except under certain exceptional cirumstances (e.g. emergencies, mental illness, lacking capacity, or children) patients must give their informed consent.
The Wikipedia article on the subject puts it quite succinctly:
"An informed consent can be said to have been given based upon a clear appreciation and understanding of the facts, implications, and consequences of an action. To give informed consent, the individual concerned must have adequate reasoning faculties and be in possession of all relevant facts."
As long as Xu Ting was able to give informed consent then her death, though tragic, is something that we must accept. I do not see any indication that at the time when she made here decision she was unable or uncapable of understanding her circumstances.
It seems precisely because she understood what chemotherapy entailed that she made the decision to initially refuse it.
If it later turns out that she was mislead by any of her medical practitioners - either medical or TCM then that is another matter.
This whole debate seems to indicate a problem in modern society and that seems to be that we forget about the "agency" of the individual.
Agency of the Individual and Personal Choice
Agency is a sociological concept which has it's roots in philosophy. Again from Wikipedia:
"In social science, agency is the capacity of individuals to act independently and to make their own free choices."
(For most intents and purposes - particularly in a medical context the words agency and autonomy can also be used interchangeably - unless you talk to a philosopher about it! )
Agency is absolutely essential in a free society and sadly something that is constantly being eroded. This is not just within the medical system but also within society in general due to another topic that irritates me a great deal which is the pervasive "nanny state" culture of modern society.
Right now it seems people are being dumbed down to the point that they either willingly allow the state to treat them like complete idiots or even worse the system just assumes that they are and does not even bother to ask them for their opinion.
Anyway the "nannying" trend in society is a major topic in itself and something which I might cover in a future post. Right now I will stick to it in a strictly medical sense. That is that:
I may think someone is making the wrong choice in opting to have TCM over chemotherapy but as long as they have made that choice using true informed consent I will defend that decision with every fibre of my being as should any other individual who respects freedom and liberty.
Vaccination
One exception to being able to give informed consent is in the case of children. In this case consent must be given by their parents/guardians. This brings us to the difficult issue of vaccination.
Let me first make it absolutely clear that I am 100% pro vaccination - the vast majority of scientific evidence is clear on that. Vaccinations are not without risk but normally the risk (as far as we know) is significantly less from vaccinations than from the diseases that they present.
That said it is a difficult subject for parents to make a decision on.
Most vaccinations are used for disease prevention and thus it is up to the parents to decide if they want their children to be vaccinated or not.
They have the right to refuse a treatment as long as it is not a life threatening situation - in that case it is understandable (though it may require a court to rule on it) if a medical professional or team provide treatments which go against their wishes.
This is not the case with most vaccinations though. If a parent decides that on balance they do not want to take a risk with a preventative treatment like this that is their right. I would strongly disagree with it - as would many others but that is what happens in a free society.
This is why I am uncomfortable with recent initiatives to criminalise parents who refuse vaccination for their children.
The solution to the problem of poor vaccination take-up is better education, more stringent research and better safety information. NOT forcing people or by extension their children to an unwanted medical procedure.
The one exception I can think of in relation to this is for post-exposure rabies vaccination.
In that case since vaccination is necessary to prevent death (and a horrendous one at that) - I think that compulsory vaccination of a child against a parent's wishes is acceptable (and would be backed by most courts).
An adult of course would have every right to refuse this vaccination for himself/herself in the same way that Xu Ting refused chemotherapy to treat her lymphoma.
Conclusion
I just wanted to re-iterate the point that I am in no way advocating using TCM or alternative therapies to treat serious life threatening illnesses over conventional treatments like chemotherapy.
Neither am I against vaccinations which I believe are an important tool of disease prevention and a major reason for the reduction in childhood illness and mortality that we have seen in the last century or so.
Most of the diseases that they treat create a heavy burden of illness, injury and death which we have lost sight of in most developed countries, paradoxically due to the success of vaccination programmes.
However, in any free society, we must always strike the balance between the needs of society and the rights of the individual. We must also be able to discuss these topics freely and without censorship.
You don't fight misinformation by gagging people.
I for one would be very afraid of a future where we were forced to take any kind of medical treatment against our wishes because if that started to happen any allusions to freedom would be gone.
Please have your say in the comments and I hope you enjoyed reading this.
If you like my work please follow me and check out my previous posts on science, photography and a variety of other topics @thecryptofiend - hope you enjoy.
Image credits: Top Image of Xu Ting is linked from the BBC article and originally from Weibo. All other images are from my personal Thinkstock account.