Family tragedy

District Court Judge James MacMichael made a thoughtful and appropriate decision this week over the fate of a 4-year-old boy who has HIV and whose mother refuses to subject him to further drug therapy. But the truly difficult decisions lie ahead for the court and for a family that has endured more than its share of tragedy.

Judge MacMichael denied DHS’ attempt Tuesday to immediately remove Nikolas Emerson from the protection of his mother and begin treatment with a combination of drugs that reduces the viral load associated with HIV and, eventually, the onset of AIDS. DHS can hardly be blamed for not wanting to wait until the child’s situation is dire. But given the Sept. 10 date for a hearing on a protection order, the boy’s current stable condition and the fact his sister died of AIDS after a painful course of treatment, perhaps traumatizing the family, there was likely no need for immediate action.

The law is fairly clear on what the court may do in cases such as these: In the instance of an immediate risk of serious injury, it can order treatment despite what a parent wishes. The question in this case might be how “immediate” the risk is to the child. More important to remember, however, is that the court can settle only legal issues; questions of the heart are beyond its purview.

The triple cocktail of drugs used to reduce the viral load in a person with HIV can produce side effects including nausea, diarrhea, vomiting, headaches and worse. If this family — any family — is to begin the course of treatment for a child, far better that it does so willingly and with the understanding that the discomfort produced by these drugs are far exceeded by the years they add to a life.

With AIDS, years matter. Not only has treatment improved significantly even since Nikolas’ sister suffered before her death, but the hope for a cure grows ever closer. Any child suffering from this virus deserves a chance to live long enough to be helped, and although not everyone who takes these drugs lives longer, most do.

It is impossible to say that a mother is wrong for trying to keep her child from pain. It is impossible for doctors and human-services workers not to step in. The state’s role in this sad and difficult story is to provide a compassionate persistence, to offer medical advice and education for the family trying to come to terms with this illness, to try to help both mother, who also is HIV positive, and son.

And if that fails, reluctantly, gently, it must take apart the family to try to save the child.