In re Nikolas E.
Maine Supreme Judicial Court
720 A.2d 562 (1998)

- Written by Katrina Sumner, JD
Facts
Four-year-old Nikolas E. suffered from HIV. Nikolas’s parents were also HIV positive, and his sister had lost her life due to AIDS when she was four years old. Because Nikolas’s parents were divorced, he lived with his mother, who made medical decisions for him. Nikolas and his mother were under the care of a physician who alerted them to a clinical trial for treating HIV in children being conducted by another physician, Dr. John Milliken. Nikolas’s mother and sister had received treatment from this doctor before. Dr. Milliken recommended a new therapy called highly aggressive antiretroviral therapy (HAART). Nikolas’s mother opted not to pursue the treatment at that time, given her prior experience with the treatment her daughter was undergoing when the daughter died a painful death. Dr. Milliken filed a report with the referring physician and the Department of Human Services (the state) (petitioner) regarding the refusal of Nikolas’s mother and recommended that she voluntarily relinquish her parental rights and that decisions regarding Nikolas’s care should be taken from her. The state arranged for Nikolas’s mother to meet with Dr. Kenneth McIntosh, the director of an AIDS program at a children’s hospital and a Harvard professor of pediatrics. Dr. McIntosh explained that HAART was an experimental therapy. For this reason, Dr. McIntosh could not give any specific information on long-term side effects or benefits. Dr. McIntosh explained that because the United States Food and Drug Administration had hastened the approval of new AIDS medicines, the treatments were experimental, with studies being conducted even as medicines were being administered. Dr. McIntosh felt that Nikolas could benefit from the treatment, but he could not quantify the benefit or even speculate as to whether Nikolas would live longer as a result of the treatment. Although Nikolas’s mother declined the treatment, she remained open to it in the future and would comply now if the court ordered Nikolas to receive the therapy. The state filed a petition seeking custody of Nikolas so that he could undergo HAART. However, a trial court did not approve the petition. Nikolas’s guardian ad litem appealed the court’s decision and argued that Nikolas’s mother had placed Nikolas in a position of significant abuse or neglect.
Rule of Law
Issue
Holding and Reasoning (Wathen, C.J.)
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