We have previously blogged about the earlier decisions in this matter. Oshin Kiszko was diagnosed with medulloblastoma in December 2015 and underwent surgical removal of the brain tumour. His parents refused conventional post-surgical treatment, and in March 2016 the Family Court made an interim order authorising commencement of chemotherapy. In May 2016, the Family Court refused to order radiotherapy given the “absence of a consensus of qualified medical opinion”.

Oshin underwent two courses of induction chemotherapy, and responded well, but doctors said it would not be enough to save Oshin’s life. Doctors recommended high level dosage of craniospinal radiotherapy in addition to chemotherapy to give Oshin a realistic chance of survival, but his parents continued to oppose the treatment. PMH brought another application seeking orders requiring 3 cycles of consolidated therapy.

In deciding that palliative care was in Oshin’s best interests, Justice O’Brien considered:

  • The medical evidence of chance of cure (30-40%) and the long-term side effects of such aggressive treatment which were labelled by one doctor as “horrific” (risks included stroke, visual impairments, hearing loss, intellectual decreases);
  • The deterioration in his prospects over the last few months due to the delay in treatment;
  • The lack of unanimity within the PMH ethics committee;
  • The clear and deeply held views of Oshin’s parents; and
  • The risk to Oshin’s relationship with his parents if they continued to focus their energies on anything other than “solely on provision of support and love directly to him when he needs it most”.

Justice O’Brien said, at [101], that:

“The determination of best interests is not a precise science. It is multifaceted and complex. It is susceptible to very different conclusions being drawn by different people of equal compassion, sincerity and integrity. While the conclusion I have reached accords with the beliefs and views of Oshin’s parents, that is not to demean the beliefs and views of those who disagree, nor the integrity and motives of the doctors involved. There can be no question that they have been motivated at all times by their sincere beliefs as to what is best for Oshin, and by their commitment to fulfil what they regard as being their obligations to him. They have maintained that commitment in the most difficult of circumstances, and in the face of entirely unfair criticism.”

As well as orders requiring Oshin to undergo palliative care and all ancillary medical care and treatment, Justice O’Brien ordered that the parents be restrained from identifying or speaking negatively about any PMH staff or health professionals associated with Oshin’s care.

The decision is available here.