The case of Oshin Kiszko: think before you judge

Oshin Kiszko suffered from Medulloblastoma (brain tumor), pictured with his Mother Angela Kiszko. Photo: Elle Borgward Oshin was described as a ‘fun-loving’, ‘supercharged’ child. Photo: Supplied

Oshin’s parents Angela Kizko and Colin Strachan pay their respects. Photo: Elle Borgward

Oshin’s mum Angela Kiszko fought for what she believed in. Photo: Elle Borgward

Hearts with personalised messages were hung around the Kiszko home on Thursday at Oshin’s memorial service. Photo: Elle Borgward

Six-year-old Oshin Kiszko’s parents made a harrowing choice to refuse consent for cancer treatments, the long-term physical and mental burdens of which they believed outweighed the chances of saving his life.

It led to a state-first Family Court case as Oshin’s doctors attempted to enforce those treatments.

They won, in the case of chemotherapy, but lost it in the case of radiotherapy, a treatment in which the consequences for a six-year-old’s brain development would have been more profound and also would have a diminished likelihood of succeeding given the time that – by then – had elapsed.

Whichever side they were on, all those who cared for Oshin – medical professional, family or friend – had heavy hearts on Thursday. Princess Margaret Hospital staff offered to attend the funeral. The lawyer who represented Oshin’s parents in court turned up to pay his respects.

An issue like this strikes at the heart of any parent, and as such ignited a fierce public debate. As such, it is important to understand the complex factors that led to this outcome.

The first factor was the breakdown in the relationships between the doctors at Princess Margaret Hospital and his mother Angela Kiszko. From the beginning they could not relate well. She thought them pushy and dismissive. It is reasonable to assume they thought her obstinate and lacking in understanding, though we have not been able to interview them, only rely on court affidavits and evidence.

Doctors mostly – and mostly rightly – enjoy something like hero-worship, at least in our culture, by the public and their patients. They are godlike and rarely questioned. It follows that they may not react well when their judgement is questioned by a parent they think is unreasonable, especially if they believe in their own hearts that the delay further explanation or negotiation will take, will put a child’s life at further risk.

When they are questioned, cases generally go to the Children’s Court, where doctors more often than not win, and cases go unreported.

It would be very challenging for a medical professional to remain patient and gentle as such a situation unfolds. And we cannot know what questions the doctors asked themselves before embarking upon the court action. It is certain they did not undertake it lightly.

​It should also be noted that PMH has, since this case, put into place a program aimed at improving parent-doctor communication.

Another factor was the strong beliefs of Oshin’s parents, Angela Kiszko and Colin Strachan, in quality of life over length of life and where it came from – primarily Angela’s history of farewelling close members of her family to protracted and painful battles with cancer. Her mother and her stepmother both had difficult deaths from cancer. This experience, whether comparable or not, understandably shaped Angela’s attitudes towards cancer treatments as much as anything else.

The third factor was Oshin’s personality and his parents’ attunement to it. Oshin was an exceptionally lively child and also held, since he was a toddler, a deep fear of doctors and medicine.

His parents repeated numerous times that they did not object to other parents’ choices to pursue treatment for their own children, and that they only believed treatment was not right for Oshin. They believed the process of such a treatment and its inevitable burdens, physical and intellectual, that would continue in the long-term, would traumatise him more than was humane to inflict on such a boy.

They wanted to protect him.

Whether they were right or wrong is not for me to say. I can only observe that their belief was genuine and passionately held; as was their love.

The final factor was the legal and moral grey area this case represented.

The very phrase, ‘a child’s best interests’, which each party to court proceedings had at heart, is shot through with grey.

It must call into question how one measures ‘best interests’ and we must recognise that its definition can only ever be subjective.

There was never significant medical disagreement in this case; even Professor Stewart Kellie of the Cure Brain Cancer Foundation in Sydney, a witness called upon by Oshin’s parents’ lawyer to support the argument not to enforce radiotherapy, acknowledged that it was primarily an issue of values, not one of a medical grey area.

Ultimately, it came down to the different practices and values of individual doctors; some, like Oshin’s, thought while there was life there was hope and any treatment burden was justifiable with there was a chance to save a life.

Others, including Professor Kellie, would not push parents to consent to radiotherapy on the brain of one so young.

Individuals, whether doctors or parents, all have their own values, and one is no more right or wrong than another, especially as no two cases are the same; something the Supreme Court judge acknowledged in making his own terribly difficult final judgement.

No one in this case should be harshly judged for following the advice of their gut. It is worth remembering that most of the time the shoe is on the other foot, with doctors often having to force parents to accept that throwing further treatment at a suffering child is pointless and cruel, and that the time has come to say goodbye.

Angela Kiszko and Colin Strachan decided to say goodbye before this point arrived.

But it is now time to let go of all the​ disagreement and the​ anger that has surrounded this case.

Oshin is at peace. Those who still have anger and fight should use it to fight these horrendous brain cancers that with brutal swiftness first transform, then claim forever, our loved ones.

Perhaps advances in research will lighten the burden of treatments in some cases almost as horrific as the alternative.

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