Tuesday 18 December 2018

How do doctors reach decisions in cases like that of Alfie Evans?

Judges have had to weigh up complicated issues in reaching their decisions

Alfie Evans cuddling his mother Kate James at Alder Hey Hospital, Liverpool. Photo: Alfies Army Official/PA Wire
Alfie Evans cuddling his mother Kate James at Alder Hey Hospital, Liverpool. Photo: Alfies Army Official/PA Wire

Eleanor Barlow

The court battle over the treatment of Alfie Evans (1) has seen his parents in dispute with medics treating their child.

Alfie was born on May 9, 2016. When he was a little over six months of age, he started to suffer from seizures or “jerking, seizure-like movements”. After catching a chest infection he was placed on life support.

Last December, court proceedings began, with Alder Hey Children's Hospital defending its position that continuing the life-support treatment is not in Alfie’s best interests.

Alfie's parents decided to fight for the right to fly him to Italy for treatment.

Alfie is in a semi-vegetative state from a degenerative neurological condition, which doctors have not been able to specify.

His parents recently lost their fight to take Alfie to Italy for treatment and they are now looking at bringing their little boy home.

In the past, judges have had to weigh up complicated issues in reaching their decisions in cases like that of Alfie's.

Here, experts answer some of the questions related to such cases.

Why would the decision to withdraw treatment from a child be made?

Professor Russell Viner, of the Royal College of Paediatrics and Child Health, said: “Every action and decision is taken in the best interests of the child, and decisions on care, including the withdrawal of treatment, are always made with the involvement of parents.

“We can’t comment on the specifics of the case, only the medical team treating Alfie, and the legal team, will know the exact details and they are bound by patient confidentiality.

“However, we feel it is important for the public to know that decisions to withhold or withdraw treatment from a child are not made lightly.”

In what circumstances does it happen?

According to the UK’s framework, treatment is withdrawn if it is unable or unlikely to result in the child living much longer, where it may prolong life but will cause the child unacceptable pain and suffering, or if an older child with a life-limiting illness repeatedly makes it clear they do not want treatment and this decision is supported by parents and doctors.

How often are decisions like this made?

In the vast majority of cases an equal decision is made to withdraw treatment and it is rare that there is disagreement

Prof Viner said decisions on withdrawing treatment from children are made “frequently”.

He said: “In the vast majority of cases an equal decision is made to withdraw treatment and it is rare that there is disagreement.

“The cases where this is a significant difference in view are the ones that grab the media headlines.”

Why is Alfie continuing to breathe after life support treatment has been removed?

Professor Dominic Wilkinson, consulant neonatologist at the John Radcliffe Hospital and director of medical ethics at the Oxford Uehiro Centre for Practical Ethics at the University of Oxford, said: “News reports have indicated that life support has been withdrawn from Alfie, and that he is breathing by himself.

“That does not mean that doctors were wrong, and it does not mean that breathing support should be restarted.

“The reason for stopping the breathing machines is simply that his serious condition is not treatable, and will not improve.”

He added: “Given the nature of Alfie’s condition, the doctors have wanted to provide him with palliative care, focused on his comfort, and focused on making his remaining time as good as possible.”

Is it euthanasia?

Prof Wilkinson said: “Providing palliative care is not euthanasia. It is about providing ‘intensive caring’ rather than intensive medical care.

“It does not end the child’s life. Rather, it supports the child, and the child’s family, for as long or as short as they remain with us.”

Press Association

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