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Parents’ trial raises debate about naturopathy for children

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[David and Collet Stephan, who are on trial for failing to provide the necessities of life to their toddler, arrive at court on March 10, 2016, in Lethbridge, Alta. THE CANADIAN PRESS / David Rossiter]

The ongoing court case for two Alberta parents charged with failing to provide the necessities of life for their toddler raises debate about the use of alternative medical care like naturopathy for children.

“Normally parents can make decisions that are not necessarily in the children’s best interests, but aren’t harmful to them,” Bernard Dickens, a professor of health law at the University of Toronto, tells Yahoo Canada News.

Determining when a medical decision is specifically harmful to a child — for example, denying medical care that could treat a serious condition, or undergoing a treatment that could have serious side effects without proven benefits — is the role of the courts in cases like these, Dickens says.

Alternative treatments are usually used in conjunction with more traditional therapies. But David and Collet Stephan of southern Alberta are in the middle of a criminal trial because they have been charged with failing to provide the necessities of life to their 19-month-old son, Ezekiel.

The toddler died of meningitis in 2012, and the Crown charges that his parents are responsible because they did not seek additional medical care for their son, instead relying on naturopathic therapies. The trial in Lethbridge is set to resume April 11.

It’s a situation that may become more common as the use of complementary or alternative therapies continues to grow. Alternative health practitioners like naturopaths, homeopaths, acupuncturists and chiropractors are increasingly popular with Canadians. A Health Canada poll from 2010 found that 73 per cent of Canadians had used natural-health products. And in 2013 University of Alberta researchers found that the use of complementary and alternative treatments was popular for children with chronic conditions.

“Most parents in the country would probably not have done what they did,” says Dr. Michael Rieder, chair of the drug therapy committee for the Canadian Paediatric Society, says of the Alberta case. “But there’s a lot of parents in the country who do have kids who use, or they are thinking about using, alternative medicine or therapy.”

Foster open dialog

“Parents have lots of reasons or choose alternate therapies, and some of them may be OK,” Dr. Rieder tells Yahoo Canada News. “But the biggest thing is that physicians need to know about them.”

Talk to all your child’s health practitioners about the therapies and treatments being used, he says, conventional or otherwise. That’s important in order to ensure that treatments aren’t going to cause contraindications, which can be harmful. Nearly 20 per cent of the parents in the University of Alberta study didn’t consult with a doctor or pharmacist about alternative therapies they were using along with conventional ones.

But it’s also valuable in order to maintain an overall open dialog between patients and practitioners, Rieder says, and to ensure that the patient’s worries are being addressed.

“You want to hear the parent’s point of view, because what you’re focused on may not be what most concerns them,” Dr. Rieder says.

The regulations for alternative therapies in Canada vary considerably by modality and location. For example, naturopathic medicine is regulated in Alberta, British Columbia, Manitoba and Saskatchewan, for example, but not in other provinces or the territories. And traditional acupuncturists are regulated in Alberta, British Columbia, Newfoundland and Labrador, Ontario and Quebec, and in some provinces and territories physicians, chiropractors, dentists, physiotherapists and/or nurses can perform acupuncture.

For physicians, taking a non-judgmental approach to alternative care may be the best way to foster openness from patients about what they are using, Dr. Rieder says.

“If you have an antagonist system then you can have this us-versus-them mentality,” he says. “The problem with that is, in my experience, is when you have that mentality the person who actually pays the price for it is the patient.”

But in addition to the responsibilities of the parents, medical professionals also have a responsibility to know when a child’s condition is outside of their scope of care, Dickens says.

“The limit is in what the professionals themselves can do, because one of the characteristics of professionalism is knowing how to do what you do but also knowing the limits of what you do,” Dickens says. That includes knowing when a patient should be referred to a different medical professional.

Ultimately, cases like the ongoing one in Alberta are determined case by case based on how the facts fall within the governing legal principles, Dickens says.

“You have to accommodate reasonable risk-taking, and the limits of that are hard to define in the abstract,” Dickens says. “So that’s why you deal with individual cases.”