Mount Vernon leukemia patient, 14, dies after rejecting transfusions

Seattle Times/November 28, 2007

By Carol M. Ostrom

A 14-year-old boy who refused blood transfusions in his fight against leukemia -- based on religious beliefs -- died Wednesday night in Seattle, hours after a Skagit County judge affirmed his right to reject the treatment.

Dennis Lindberg, of Mount Vernon, died around 6 p.m. at Children's Hospital & Regional Medical Center in Seattle, according to KING-5 television. As a Jehovah's Witness, Lindberg objected to receiving blood. Doctors had said he needed it to survive his cancer treatment.

In court Wednesday, Superior Court Judge John Meyer said that Lindberg, though in the eighth grade, was old enough to know that refusing blood transfusions might amount to a "death sentence," and that he had the right to make that decision.

Doctors at Children's diagnosed Lindberg's leukemia early this month and began giving him chemotherapy. Because such treatment destroys the body's ability to make red blood cells, transfusions were necessary, doctors said.

Lindberg's relatives disagreed about whether the boy should have been forced to get the transfusions. His aunt, who was his legal guardian and is also a Jehovah's Witness, supported his decision to refuse them. Through a hospital spokeswoman, she declined to comment after the judge's ruling.

Lindberg's parents, who live in Idaho, disagreed with their son and his guardian.

His doctors at Children's supported the boy's decision, Meyer said, although one doctor told the judge earlier that the boy's blood count was so low he could die overnight. The case came to court after officials at Children's reported it to the state, which went to court to force the transfusion.

Ethics experts and Jehovah's Witness officials said such a court case is unusual these days.

Most cases involving transfusions stem from surgical cases, and current policy at Children's is to inform parents that while the hospital will do everything it can to avoid transfusions, it will not let a child die for want of blood, said Dr. Doug Diekema, an ethics consultant there.

Years ago, courts routinely supported transfusions of children against the wishes of parents, Diekema said. While adults have the right to refuse any medical treatment, the courts ruled, that right doesn't extend to their children.

"The principle there is that parents can make martyrs of themselves, but they can't make martyrs of their children," Diekema said.

With an adolescent, the situation is much more complex, he said. "We all know that 14-year-olds change their minds; they become adults, and they have completely different belief systems. And that makes you nervous."

At the same time, 14-year-olds can have an "adultlike" decision-making process. And when the transfusion isn't a one-time emergency procedure but a long-term treatment, there's another complexity, Diekema said.

"Then the issue is: How can we effectively treat a kid when he's not going to cooperate?"

Diekema and Dr. Benjamin Wilfond, the hospital's director of pediatric bioethics, could not talk about Lindberg specifically. But such ethical and practical conflicts are the stuff of their professional lives.

Wilfond said most people instinctively want to do everything to save a young life. "But imagine if you heard a story about how this individual was strapped down to be given a transfusion, or tackled as he tried to leave the hospital," he added. "At 14, if you feel strongly about something, you're going to fight back."

Unlike the situation with very young children, "with adolescents, I think we find ourselves much more profoundly conflicted."

Wilfond said medical providers, along with parents, try to balance competing needs. "You're trying to respect their wishes, their evolving autonomy, balanced against wanting to protect them. Often, it's difficult to achieve both under all circumstances."

After the judge's ruling, Jim Nelson, chairman of the Jehovah's Witnesses' Seattle Hospital Liaison Committee, said Lindberg was a "very responsible young man who knows his mind and was very clear. He's a very brave young man, and he's standing firm for what he believes in."

Jehovah's Witnesses believe the Bible prohibits transfusions of blood, in part because blood is sacred, Nelson said.

And it doesn't mean the faith is "antimedicine," he added. "Jehovah's Witnesses do not have a death wish. We're not arguing a right to die."

When Lindberg became ill, his aunt took him to the hospital for treatment, Nelson noted Wednesday afternoon.

Material from The Associated Press and the Skagit Valley Herald is included in this report.

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