Re Ryder [2020] NSWSC 895 (available on Caselaw) came before the Court on the application of a hospital and the Minister for Health, as the parents of a young boy did not wish t to consent to the next step in his treatment – six cycles of chemotherapy which were unanimously recommended by his treating doctor, supported by collegial consultation among other specialists in the field including from overseas, and by a formal second opinion.
The parents did not object to chemotherapy in and of itself. However they did not want to put Ryder through more chemotherapy when there is presently no detectable cancer in his body, motivated by their concern for Ryder’s quality of life.
The Court was therefore concerned with minimising the prospect of any microscopic cancer cells, which may have escaped from Ryder’s enucleated eye, becoming florid cancers in other parts of his body. The Doctor referred to this in his evidence as “distant (systemic) disease recurrence”.
Having regard to the best interests of the child, the court approved the treatment, saying at [28] – [30]:
While the Court feels deep sympathy and understanding for the emotional turmoil of the Parents, when faced with circumstances such as the present, the Court’s jurisdiction is not exercised by reference to the emotional wellbeing of the Parents, other than to the extent that wellbeing may have an impact upon the child. In this case, although what may come will be difficult and upsetting for the Parents, I have no doubt on the basis of how they have conducted themselves in these proceedings that they will see it through with the same fortitude and care for Ryder that they did during his earlier chemotherapy.
On the evidence, the issue is straightforward. If Ryder undergoes the proposed treatment, then there is, the Court accepts, only a 10 per cent prospect of a distant recurrence of Ryder’s cancer, that is to say a recurrence of the cancer in some other part of his body as a result of the travel of microscopic cancer cells from his left eye prior to its enucleation. The proposed treatment will be uncomfortable and will have side effects. However, I have also taken into account that it is likely, and much to be hoped, that his capacity to tolerate the proposed treatment will be better than it was during his earlier treatment.
On the other hand, if Ryder does not undergo the proposed treatment, there is a 40 per cent prospect of a distant recurrence of his cancer. It is not then simply a question of him suffering from a cancer. In that eventuality, any treatment will be longer and more toxic than the proposed treatment, including, depending on the site of the cancer, carrying significant risks to his long term health and development. To this must be added that, obviously enough, the treatment of a cancer has a lower chance of a successful outcome than dealing with microscopic cancer cells that have not yet developed into an active tumour.