Deur Tania Broughton, GroundUp
The Red Cross Children’s Hospital in the Western Cape. (Photo: GroundUp)
Staff attached to the Red Cross Children’s Hospital in the Western Cape were praised for their sensitive handling of the case where the parents of a six-year-old refused permission to amputate their child’s legs due to cultural and religious circumstances.
However, the High Court ordered that the parents’ rights cannot be interfered with, but ordered that intervention is necessary in terms of the Children’s Act.
Judge Mas-udah Pangarker, who heard the case, said she gave judicial approval for the operation.
Pangarker delivered her verdict earlier this month after the hospital submitted an urgent application. The application was not opposed by the parents.
The judge described the effort made by the staff to accommodate the parents’ wishes as “nothing less than admirable”.
This included allowing traditional healers to visit the child in hospital and give their advice on treatment. They also contacted the family’s cultural leaders in the Eastern Cape and asked the family’s lawyer for advice.
In her affidavit, Dr. Jessica Browne, the medical services manager, said the child suffered from septicemia, a blood infection that causes poor circulation.
The little girl – identified in the ruling as AD – was critical and in septic shock when she was admitted to hospital in January. She later developed gangrene in both feet.
The only treatment available was an amputation of the left leg below the knee and a Syme amputation (removal of the foot, leaving the heel pad for mobility) of the right leg.
Archive photo for illustration purposes only. (Photo: DSC Attorneys)
Browne said that because the sepsis can spread, it is essential that the surgery takes place as soon as possible.
However, AD’s parents refused to give permission, saying that they wanted to explore traditional medicine and healing because they believed it would cure her.
According to Browne, the parents said that it had to take place in the Eastern Cape and wanted AD to be fired. Her father indicated that he would not bring her back to the hospital.
However, at that time AD was on strong medication, including morphine, due to the severe pain in her feet.
After an “ethics meeting”, which included experts from the University of Cape Town, a decision was made in her “best interests” not to discharge her and after further discussions the medical team agreed to involve a traditional healer or cultural advisor in an attempt to accommodate and respect the parents’ wishes.
The staff invited a traditional healer of the father’s choice to assess AD. He said he was able to cure her with oral medications, topical creams and ointments.
However, the hospital made it clear that it could not allow traditional healing within its premises.
A second traditional healer, who is also a psychologist, was arranged by Paeds Pal to discuss the matter with the father.
Finally, the hospital’s clinical team, social workers and nurses met with the father again in late February “and emphasized the seriousness of his daughter’s condition”.
A second traditional healer then assessed Alzheimer’s disease. He said he would use oral traditional medication, which would cure her feet, but his plan might fail.
“As before, the problem the hospital faced was that traditional healing was not allowed on the premises,” said Pangarker.
Hospital staff then asked to speak with the parents’ cultural elders.
A doctor and social worker spoke to AD’s uncle who said he was aware of the situation, but “the family had no intention of changing their mind”.
The judge said she was informed on the day of the trial that the mother had finally agreed to the operation.
However, her father did not and he did not attend the court proceedings either.
The High Court in Cape Town. (Photo: Ashraf Hendricks/GroundUp)
Pangarker said Browne approached the court under the provisions of the Children’s Act because of the real and imminent risk to AD’s health and life.
“It was clear that if the infection were to spread further into AD’s right foot, the result would be an amputation below the knee instead of a Syme amputation. In those circumstances, AD’s mobility would be greatly impaired, if not completely.”
The judge said that despite the fact that the parents did not oppose the application, “it was a difficult and serious case that weighed heavily on everyone”.
“I was aware that the impact on the child, the parents and the rest of the family must have been profound and devastating,” she said, noting that applications waiving parental consent were rare.
Archive photo for illustration purposes only. (Photo: Unsplash)
She said that while the Constitution protects the right to religion, belief and opinion and to participate in a cultural life, AD also has the right to dignity, life and basic health care.
The hospital made every effort to respect the parents’ dignity and beliefs and obtain their consent for surgery.
“In my view, the hospital showed a level of sensitivity and respect for the family’s religious and cultural beliefs that was nothing short of admirable,” the judge said.
But none of the traditional healers who assessed AD offered a medically accepted alternative.
The law, read together with the Constitution, states that in all matters concerning minor children the best interests of the child are of paramount importance and that the High Court is the supreme guardian of all children.
“The urgent surgical intervention that was requested was the best medical treatment for AS in the circumstances. In light of the evidence, she would still, after rehabilitation and with the provision of prostheses and physiotherapy, be mobile,” Pangarker said and granted the order.
This reported originally appeared on GroundUp and is used with permission.