Parental Decision Vindicated
By “Awake!” correspondent in Canada
THE above headlines flashed to the world the dramatic story of a mother’s courageous battle to protect her baby from a risky and unnecessary operation.
The scene: a hospital in Kingston, Ontario, Canada. The time: 1:30 a.m., April 2, 1970. A doctor was getting ready to force a blood transfusion on a newborn baby girl. The mother, Mrs. Lynn DeWaal, one of Jehovah’s witnesses, pleaded with the physician to use the alternate, safe, light treatment, phototherapy. He angrily refused. Courageously the mother with the help of her family took the baby out of the hospital, though two doctors tried by force to detain them.
Many people have had occasion to change doctors or hospitals. Usually no one is much concerned. This time a real furore broke loose. The story blazed across Canada, the United States, to Central America, Britain and Europe. Newspapers, radio and television played up the drama. Headlines screamed about the baby being “snatched,” about “abduction.” Doctors made dire predictions. A minister of the provincial government announced that charges had been laid against the mother; later he said no charges had been laid. The police got out a search warrant. The Children’s Aid Society asked for a custody order; the judge refused to proceed without proper notice, and the Crown Attorney admitted that the mother had a right to remove the child.
And what was behind all the excitement? A baby girl, Eunice Devina DeWaal, who came into the world in the early morning of April 1, at St. Francis General Hospital, Smiths Falls, Ontario. She weighed 8 pounds 5 ounces. Later in the day she developed signs of blood incompatibility, which one of the doctors described as a “mild case.”
Mrs. DeWaal was obliged to leave the hospital at 6 p.m. the same day the baby was born in order to attend court to get a divorce from her husband who had left her. The hospital staff assured her that the child would be there when she returned. When she got back two hours later, the baby was gone. Upon inquiry she found out that the infant had been taken by the Children’s Aid Society to the Kingston General Hospital some sixty miles away. The young mother drove to Kingston accompanied by her parents and brothers. There she found that the baby had been placed without her consent in the hands of Dr. D. G. Delahaye, who had been prominent in several cases of trying to force blood transfusions on children of Jehovah’s witnesses.
Mrs. DeWaal discussed with Dr. Delahaye the condition of her baby, Eunice Devina. He reported that her bilirubin count had gone up to 18 milligrams per 100 milliliters. Since the baby was strong and active, this count alone was hardly an indication for exchange transfusion. Delahaye’s attitude left no room for discussion: “I am going to give that child a blood transfusion if I have to go to jail for it,” he declared. He was asked to consider the less-risky treatment of phototherapy, but this he flatly refused.
In face of such a difference of opinion, who should decide: the mother? or the doctor? Doctors can be right, also they can be wrong! Whose baby is it? Who will lose most by a wrong decision—the mother or the doctor? Who will be most deeply concerned to choose that which will be for the child’s welfare?
There are times, too, when medical decisions are made without the coolness and caution one expects from professional men. The Journal of the Canadian Medical Association carried an article admitting: “So often in the case of the Jehovah’s Witness the surgical team becomes emotional, confused and irrational . . . a great deal of intolerance exists toward members of the Jehovah’s Witness order.” Is a doctor who is ‘emotional and irrational’ likely to make the best decision for a child?
What are the determinative medical considerations that should have weighed in deciding on treatment for the DeWaal baby? Did her condition call for exchange transfusion or the alternative of phototherapy?
Professor Hans Keitel, a senior pediatrician at Jefferson Medical Centre and editor of the respected journal Pediatric Clinics of North America, analyzed the factors a physician should consider when faced with a baby who has a high bilirubin count. Under the heading “Failing to appreciate fully the risks of exchange transfusion” he admonished:
“The routine performance of an exchange if the bilirubin level rises to or approaches 20 mg. per 100 ml. in the first week of life is most unfortunate. [The bilirubin count of the DeWaal baby was at 18.] We must have the fortitude to tell parents the whole truth and to inform them of the uncertainties and the risks. Many believe it is far better to have a live child who has only a small chance of brain damage (if the bilirubin level does not rise over 25 mg. per 100 ml. for less than a day in the first week of life) than to risk the chances of a fatality.” (1965, Vol. 12, p. 210)
Mrs. DeWaal was one of those who wanted a “live child” and saw no need to risk an exchange transfusion (which could be fatal) when the bilirubin count was well below the recommended level of 25 milligrams per 100 milliliters.
While the risks of exchange transfusion are high, the phototherapy treatment (exposure to bright light or sunlight) requested by the mother comes well recommended in medical literature. It was described by Dr. J. A. Lucey in the medical journal Pediatrics, Volume 41, 1968, as “simple, inexpensive and safe.”
In insisting on the more dangerous procedure, was Dr. Delahaye being reasonable, or was this a sample of the ‘emotional and irrational’ behavior described in the Canadian Medical Association Journal?
Since the doctor declined to consider the wishes of the mother, it was decided to go elsewhere for treatment. Mrs. DeWaal was holding her baby. One of her companions said, “Come on, we’re getting out of here.” Dr. Delahaye grabbed the man’s jacket and replied, “Oh, no, you’re not!” A scuffle ensued. Two female members of the staff tried to wrestle the baby away from her mother, foolishly endangering the child and badly bruising the mother’s arm.
Still holding the baby, Mrs. DeWaal with the assistance of her brother got to the elevator (it was the seventh floor). As the descent was made, the alarm bells began ringing. How would she get past the guard on the main floor? As she stepped out of the elevator, the guard, excited by the bells, jumped into the same elevator to rush up to the seventh floor. Mother and baby slipped unhindered into a waiting car. Meanwhile Dr. Delahaye was striving to detain the men who were with Mrs. DeWaal, even struggling with them down the stairs and out onto the sidewalk to prevent them from getting into a second car that was waiting.
One might expect the warden of a penitentiary physically to restrain inmates from leaving, but this place was a hospital! The doctor was adding a new chapter to the record of medical decorum.
Now what would the authorities do?
Newspapers spoke of the baby as being abducted; the police were instructed to hunt for her. Questions were raised in the provincial legislature. John Yaremko, Minister of Social and Family Services, announced that a charge had been laid against the mother. An official in Mr. Yaremko’s department immediately denied that a charge had been laid. A warrant was issued to search the mother’s home; then the Crown Attorney ordered it canceled.
The Children’s Aid Society applied for wardship and complained when the judge would not make the order. Judge Garvin, being a man who believes in law, wanted to give the parents a fair hearing and refused to be stampeded. He recalled that the Supreme Court of Ontario had said in an earlier case of Jehovah’s witnesses that they were entitled to notice and a trial. Showing his due respect for the Supreme Court, he refused to act till proper procedures were put before him.
The Crown Attorney, C. J. Newton, commended the actions of Dr. Ashwell at Smiths Falls but also admitted: “The mother had an equal right to remove the child from the hospital.”
Faced with these crosscurrents of opinion, the Globe and Mail (Toronto) remarked: “Confusion clouded legal issues yesterday in the disappearance of a three-day-old baby.”
There was no need for confusion. The mother was within her rights. It was her child. People have a right to hire and fire doctors. This is basic in the doctor-patient relationship, and reasonable doctors are glad to respect it. Mutual trust is the basis of the relationship; official coercion has no place in it.
Similarly with hospitals. A hospital is not a prison. A patient, or parent of an infant patient, does not need the permission of the “warden” (doctor) in order to leave the hospital. In fact, some hospitals have been obliged to pay damages for interfering with patients who desired to leave.
It is customary in these cases for doctors to issue ominous threats that the child will either die or suffer brain damage without a transfusion.
What they fail to reveal to the public is that there is a standard pattern of retardation after transfusion, quite apart from the large number of fatalities (some estimate as high as 10 percent) from the exchange.
Medical World News, January 16, 1970, stated under the heading “Hazards of Exchange Transfusions”: “Infants who start life with erythroblastosis severe enough to require exchange transfusion never quite catch up with their unaffected peers.” Dr. Edward Schlesinger reported on tests given to children who had received exchange transfusion: “The greatest number of poor scores on both tests was concentrated in the group of children who had erythroblastosis fetalis treated by exchange transfusion.”
In the light of these adverse results the article said further: “Exchange transfusions seem to be on their way out as far as pediatricians are concerned.”
Dr. Ashwell, who had delivered the baby, issued the standard exaggerated threats. “The chances of this little girl living or not suffering irreparable brain damage are about the same as me winning the Irish Sweepstakes today,” he told The Telegram. This sweeping statement, however, developed something of a credibility gap when Ashwell was quoted further: “Quite honestly, I can’t simply describe the disease to you because I have only a slight grasp of it myself.”
Meanwhile, what did happen to Eunice Devina? The innocent focal point of so much controversy was taken by her mother to the home of some friends in another municipality. There she was given phototherapy treatment by a nurse of wide experience in the field. After five days under blue light, she made a complete recovery.
A doctor who examined her found that she was “active, developing well, and there is no evidence of abnormality.” At time of writing she is at home with her mother, happy, intelligent and normal in every way.
Dr. Delahaye seemed most unhappy about the case. In addition to the usual threats about the health of the child he accused the Children’s Aid Society of “laxity” in not trying to locate the baby; he accused the Supreme Court of Ontario of “ducking the issue.”
In an interview with The Telegram on April 3, he recounted another case involving a child of Jehovah’s witnesses, “suffering from leukemia. Before the doctor gave a transfusion its parents came to Kingston Hospital and took the child. Toronto doctors decided to abide by the wishes of the parents against a transfusion and ironically,” said Dr. Delahaye, “the child survived.”
Ironically, so did the DeWaal baby. Ironically, so has every other infant of Jehovah’s witnesses that has been removed from a hospital to avoid exchange transfusion. Not so ironically, six children of Jehovah’s witnesses in Canada have been taken from their parents, given forced blood transfusions and brought back dead.
On June 3, the mother, child and her legal counsel, appeared on television in Ottawa to explain what had happened and why. Though Dr. Delahaye had earlier announced concerning the baby that there is “a good chance it is dead,” Eunice Devina made it loud and clear that she was very much alive. Later the program was shown across Canada.
In view of the events of this case, one is reminded of law professor Howard Oleck’s commentary in Medical World News (Dec. 5, 1969) advising that medical relationships would improve “if physicians generally would stop acting as though they are somehow the anointed ones of God.”
Many good doctors do act with respect for parents, and this is to be commended. Such doctors are glad to have the balancing influence of parental decisions; it makes for good teamwork and a mutually beneficial relationship.
That parental decisions are not to be lightly cast aside becomes clear from the events herein related. Eunice Devina has been protected by a parent who felt obliged to disagree with a doctor. By her normal development, vigorous growth and contentment her mother’s decision has been vindicated.