ForumsWEPRAlfie Evans

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Ntech
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Ntech
193 posts
Shepherd

As this article is written, Alfie Evans, a two year old baby, is being held against his parents' will in a British hospital where they are denying him treatment and he is consequently dieing. Even though Italy and Germany have offered to treat Alfie and even have planes ready to save him, the British will not hear of it. More suspiciously, the British doctors allow no other doctors to see Alfie. What are they trying to hide? Why are they killing Alfie? Italy has announced that if Alfie dies in Britan, Britain will face charges of homicide. What a tragedy. This has to stop.

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Moegreche
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Moegreche
3,711 posts
Archduke

I'd like to push back a little on this intuition. But first, I think it's important to clarify some things.

the British doctors allow no other doctors to see Alfie. What are they trying to hide?

Are you sure this is the case? I mean, I'm sure Alfie has a specific team of doctors that will administer primary care. It's a bit too quick to suggest they're hiding something, though. This has a conspiratorial tone to it, and I'm not clear on what the suggestion here is. In any case, it's far too quick to suggest that doctors are trying to hide anything.

Why are they killing Alfie?

This is important, but they've decided to let Alfie die. This is an important distinction from a biomedical ethics standpoint. A doctor might kill her patient by, for example, administering cyanide. Or she might let her patient die by simply withholding treatment (e.g. removing breathers and feeding tubes).

Italy has announced that if Alfie dies in Britan, Britain will face charges of homicide.

Do you have a source for this claim? I couldn't find anything. It seems odd (read: impossible/incoherent) to charge a state with a crime like homicide. And the doctors couldn't be charged, since they're not the ones who made the decision.

Anyway, so the push back. This is a case that's (at least, superficially) similar to the recent Charlie Gard case. The key issue in both cases is what course of action is in the best interests of the child. It seems that Alfie Evans hasn't yet died despite being removed from life support. This brings up some important, related (but ultimately tangential) issues regarding whether they should have provided him oxygen to supplement his breathing and reduce distress.

But the bottom line, it seems to me, is that Alfie (like Charlie) is going to die very soon. And there's nothing that our current medical technology can do to stop that. Sending the child off to another country to go die isn't in his best interests. The argument here is supposed to be that Italy could help in a way that British doctors can't. As far as I can tell (and please correct me if I'm wrong here), that's just not the case. In other words, Italy doesn't have access to some medical procedure that's unavailable in Britain. The end result would be a prolonged suffering and eventual death, plus the stress of travel.

So, why make a dying kid suffer longer than is necessary? He's going to die either way, so why prolong his suffering?

Ntech
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Ntech
193 posts
Shepherd

Moegreche,

If the Brits really care about Alfie's best interests, why are they starving him? According to a German doctor that the parents were able to sneak in as a friend, Alfie has an undiagnosed illness that is not 'terminal.' In addition, the German doctor believes this is treatable. About the Italians holding the British to homicide, their ambassador to Britain made it clear that Italy would hold Britain responsible for the death of one of their citizens should Alfie die.

The bottom line is that we have no idea what disease affects Alfie so for you to say that Alfie is going to die and there is nothing we can do about it, is absurd. If you argue that we are trying to alleviate his suffering, why are we starving him? You're right: Italy doesn't have access to medical procedures not available in Britain BUT Italy is willing to try to save Alfie and Britain is not. Britain has given up on him and is refusing to let others have a crack at it. Britain is starving Alfie to "alleviate his pain."

The argument is not that Italy can help where Britain can't but that Italy is willing to help and Britain is not.

HahiHa
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HahiHa
7,932 posts
Viceroy

From what I have read, while the precise cause of Alfie's problem is unknown, the fact appears to be that most of his brain has been destroyed, leaving him in a vegetative state unable to live without artificial life support. Such a condition cannot be reversed, and so I understand the decision of his doctors to stop the machines. Letting him die with some dignity seems preferable as opposed to continue pumping a brain-dead infant body with air and nutrients for who knows how long.

nichodemus
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nichodemus
14,949 posts
Viceroy

Medical tort law has always been one that leads to high raging emotions because everyone, even the opposing side, will agree that the "moral thing" to do is to save the patient. The Courts have always had to make a hard and unpopular choice that will always lead to popular divide. It's very easy to just throw around words like murder and justice when these have no legal bearing.

It is good to always read the legal judgement to understand the full picture. It's not as if the Courts are actively out to kill people; they always make their judgement based on expert witnesses, in this case doctors. The judgements or summaries of all levels of the court are all out there.

High Court
Court of Appeal judgement - Couldn't find it on a public domain.
Supreme Court

The bottom line is that the judgements are all made with the aid of a wide range of medical experts. It is difficult to make a decision when there are conflicting medical opinions, but that burden is for the Court to make.

Furthermore one of the core reasoning that the Courts put forth is that any decision made should be based on what the Court thinks (Based on expert evidence) is in the best interest of the patient (Child here), and not what the parents feel is the best interests. This is quite cold to say, but this line of reasoning seems perfectly sound.

Ntech
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Ntech
193 posts
Shepherd

However, who is to say that Justice Mr. Hayden is qualified to judge based on this evidence? Surely Mr. Hayden does not hold a medical degree, and as such, his judgement is flawed for it is the product of an unknowledgeable point of view. Furthermore, there was one German doctor who believed that the illness was treatable. The doctors brought in to the case were all under the employment of the British governmental health care system and thus favored the diagnosis, and, if they had contradicted it, they would have contradicted their boss. Impartial doctors were not brought in, everyone consulted had ties to the government in some way. This is not justice, it mocks the principals of law.

HahiHa
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HahiHa
7,932 posts
Viceroy

It is my understanding that several medical experts had a good look at all the exam results and unanimously concluded that it was not treatable. That German doctor they "sneaked in as a friend", as you said above, and about which I have read nothing so far (does he even exist?), must either have some bit of information that noone else has, which sounds highly improbable, or his opinion is partial, which I consider more likely. I also think it sounds fishy that this purported doctor's line of reasoning, so far as you have portrayed it here, appears to be "No one knows what the illness is or what caused it, therefore it is curable". It is not the lack of diagnosis that is important here; what is important is that the child's brain was apparently irreversibly damaged, whatever the cause might be. I am reasonably sure that such a thing can be easily determined with medical scans, which should provide clear evidence. Has any medical evidence been published that shows that the brain was O.K.? I haven't seen any so far.

It is also my understanding that the doctors were only doing their job and are generally allowed to make their own decision without consulting with health care or government. You are basically claiming that the government actively forced several experts in the medical field to ignore and bypass all of their ethical values and guidelines and falsify records and testimonies, for... what? You haven't even provided any kind of motive for why a country would want the death of some child. It does not even begin to make sense.

nichodemus
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nichodemus
14,949 posts
Viceroy

However, who is to say that Justice Mr. Hayden is qualified to judge based on this evidence? Surely Mr. Hayden does not hold a medical degree, and as such, his judgement is flawed for it is the product of an unknowledgeable point of view. Furthermore, there was one German doctor who believed that the illness was treatable. The doctors brought in to the case were all under the employment of the British governmental health care system and thus favored the diagnosis, and, if they had contradicted it, they would have contradicted their boss. Impartial doctors were not brought in, everyone consulted had ties to the government in some way. This is not justice, it mocks the principals of law.

There are several problems with this argument.

Firstly it assumes that everyone part of the government is in on a monolithic conspiracy as well as subservient to the government's wishes. This is not backed up by facts at all; If judges were always supposed to bend to the will of the executive branch then why are there dissenting judgements every other day against the government in various legal cases? Surely judges would be "forced" to render decisions favourable to the government all the time? (This also assumes it is the government's interest to kill Alfie. But is it really? The political storm is already costing them). It also assumes that doctors very easily disregard their Hippocratic oaths when they come under a national medical system. Both these arguments assume that people do not have their own views vis-a-vis their employers which is quite wrong.

Secondly, the Courts have always acknowledged that the judges issuing the judgements are not medically trained. But there are two counters: They base their reasoning on extensive medical opinion such that their judgments aren't conjured out of thin air. Secondly the reverse argument can be made; Doctors are not legally trained and fit to make decisions that are equal parts law as well. [Here's a hypothetical: A man gets knocked down by a car and gets taken to a hospital. Because of a botched operation by a negligent doctor he dies. But is the cause the car accident or the doctor? Surely there are medical elements as well as legal elements here that would mean a doctor cannot decide the case.]

Thirdly, if all it takes is a single doctor's opinion to scupper every single judgement against the majority of mainstream medical opinion then a party simply needs to produce one expert that supports his view, no matter how far fetched. This has been recognised in the law as intolerable because it is inefficient.

Fourthly, as said earlier it's easy to talk about vague notions of justice. But is it justice to prolong the suffering of a child when most doctors agree there is nothing left to be done?

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