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This is a very sad and tragic case, and I have great sympathy for the extended family of Ezekiel Stephan, the 19-month-old who died of meningitis four years ago. In my opinion, there are many victims in this case.

The jury, apparently, agreed. Yesterday they returned a guilty verdict for Ezekiel’s parents, David and Collet Stephan, who now face sentencing for failing to provide the basic necessities of life to their son. It is reported that many of the jurors were crying when the verdict was given – clearly this was a difficult and emotional case.

Just the facts

As is often the case, there are different narratives of what happened, depending on your perspective. It is likely the jury had access to more facts than the public, and so their verdict, which was clearly difficult, needs to be taken seriously. Here are the basic facts as being reported:

In March of 2012 Ezekiel became ill with flu-like symptoms. His parents report that they thought this was a normal childhood illness and would pass. His mother reported to police that she thought he had croup. They treated him with natural remedies, mostly supplements.

Of importance is the fact that David Stephan is vice-president of Truehope Nutritional Support Inc., a natural remedies company founded by his father, Anthony Stephan. According to a police interview shortly after Ezekiel’s death, David Stephan said:

“Do we have a formal education? No. Are we educated in it? Absolutely,” he said. “Has it worked for us in every single scenario in the past before this? Yes.” “And then when he was sick there, we were giving him, above and beyond that, the olive root extract, which is an antifungal, antiviral, it’s a very powerful one,” he told Bulford.

Ezekiel was sick for 2½ weeks, during which time his parents treated him only with supplements. According to reports at one point they consulted a neighbor who is a nurse, and who told the parents Ezekiel might have meningitis. At one point Collet Stephan searched online for treatments for meningitis. She also consulted a naturopath, and picked up Echinacea as a treatment.

Ezekiel’s condition worsened until he became acutely ill, at which point his parents rushed him to the hospital. At that point they were giving him fluids through an eye dropper because he could not eat or drink. Also, he was so stiff from the meningitis that he could not sit in the car and had to be laid flat. Ezekiel was not breathing on arrival at the hospital. He was put on a breathing machine but never recovered, and was pronounced dead five days later.

Dueling narratives

Those defending the Stephans argue that they did what any parent would do, treat their child as if he had an ordinary illness until it became clear he was seriously ill at which time they sought emergency care. Some blame the Canadian system saying it was difficult to get a doctor’s appointment, and that the ambulance was delayed and did not have the proper equipment to intubate him.

They also go as far as to argue this is a witch hunt against the natural remedies community.

Critics of the Stephans argue that they unreasonably and irresponsibly delayed proper medical care for Ezekiel because of their misguided reliance on supplements and natural medicine. Clearly the jury, after hearing all the evidence, concluded that this latter narrative is closer to the truth.

During my medical education I have been on the receiving end of many parents with sick children, including children who ultimately died of meningitis. We see many children in the emergency room who are just a little sicker than a usual cold, perhaps lasting more than a day or two, or who are cranky or might be dehydrated. We rule out meningitis with a workup even in these mild and potentially early stages, because that is not a diagnosis you can afford to miss.

A child who is so stiff that they have to be laid flat is way past the point where they should have received definitive medical attention, in my opinion. This suggests that the Stephans waited longer than typical parents, until the severity of Ezekiel’s illness was undeniable.

Who’s to blame?

In tragic cases such as this there is often plenty of blame to go around. Clearly Ezekiel’s parents have the primary responsibility for his care, for providing the basic necessities of life, and a jury has now found that they failed to do so.

The prosecuting attorney had this to say:

“They definitely, definitely loved their son but as stated in our closing arguments, unfortunately sometimes love just isn’t enough,” Weich said outside court. “Parents still have to follow a standard of care as set by criminal law.”

The “standard of care” is a critical concept for any modern society. For me, that is what this case (and others like it) is really about.

The Stephans are also simultaneously victims. They consulted a naturopath, and naturopaths are licensed in Canada (and, unfortunately, in many US states). We have written extensively about naturopaths here, showing that they do not base case on a scientific standard. They use an eclectic variety of dubious and unscientific treatments, from homeopathy to “water cures,” that only seem to have in common that they are not based on scientific evidence.

Therefore, how much blame does Canada have for licensing a profession of, essentially, fake medical providers? Governments that legitimize such professions are failing in their duty to their citizens in the same manner that the Stephans failed Ezekiel. Ezekiel’s death is therefore on the heads of the naturopathic profession and the Canadian government as well.

There is also a much more diffuse blame, but still clear, on the entire alternative medicine community. The Stephans did not exist in a vacuum: they are a product of a cultural movement that seeks to legitimize what was considered health fraud just a generation ago. This is what happens when you abandon rigorous science as the basis of a medical standard of care, when you water down that scientific standard, try to subvert the proper functioning of medical science, and lobby for regulations that allow for pseudoscience and just plain bad science in medicine.

The Stephans are not an anomaly – they are a symptom of the intellectual bankruptcy and deception of the alternative medicine movement.

I am glad to hear a lawyer talk about the standard of care, but the irony of this statement is not lost on me either. Governments have been slowly abandoning the defense of the standard of care, and in a way it is hypocritical of them to condemn parents for doing what they have implicitly sanctioned.

Conclusion: Parents Nobody can ignore the basic standard of care

Given the facts as presented, I agree with the jury for convicting the Stephans. This case sets an important precedent: parents cannot ignore basic standards of care for the children under their charge because of their ideology. It doesn’t matter that you truly believe Echinacea can help with a serious infection (it can’t), you still have a responsibility to provide actual health care to sick children.

When such tragic cases occur, it is always my hope that they will help advance the discussion about what a standard of care in health care actually means, and everyone’s responsibility for upholding it. The public’s memory is short, however, and the alternative medicine propaganda machine is tireless.

Unfortunately, Ezekiel probably will not be the last victim of the lies and deceptions of alternative medicine quackery.

ADDENDUM: Orac has also discussed this case.