{"id":41916,"date":"2018-04-24T09:01:53","date_gmt":"2018-04-24T08:01:53","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=41916"},"modified":"2018-05-14T10:39:47","modified_gmt":"2018-05-14T09:39:47","slug":"daniel-sokol-alfie-evans-and-guerrilla-warfare","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/04\/24\/daniel-sokol-alfie-evans-and-guerrilla-warfare\/","title":{"rendered":"Daniel Sokol: Alfie Evans and guerrilla warfare"},"content":{"rendered":"<p class=\"standfirst\"><span style=\"font-weight: 400\">The consequences of disputes, often, are contrary to the best interests of the children at the centre of them<\/span><\/p>\n<p><!--more--><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-38043\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/12\/daniel_sokol_2016-150x150.jpg\" alt=\"daniel_sokol_2016\" width=\"150\" height=\"150\" \/><span style=\"font-weight: 400\">Since December 2016, Alfie Evans\u2014who is nearing his second birthday\u2014has been treated at Alder Hey Hospital in Liverpool. He is terminally ill, with a severe and progressive neurodegenerative condition. In his High Court judgment of 11<\/span><span style=\"font-weight: 400\">\u00a0April 2018, Mr Justice Hayden remarked that \u201calmost the entirety of Alfie\u2019s brain (has) been eroded leaving only water and cerebral spinal fluid.\u201d \u00a0The medical experts agree that Alfie\u2019s condition is untreatable.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Mr Justice Hayden held that continued ventilation was no longer in Alfie\u2019s best interests and declared as lawful the withdrawal of ventilation and the provision of palliative care. Transferring Alfie elsewhere was also deemed irreconcilable with his best interests. Higher courts upheld that decision, rejecting legal arguments about the rights of the parents by stressing the paramountcy of the child\u2019s welfare and dismissing submissions of unlawful detention. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">On 23<\/span><span style=\"font-weight: 400\">\u00a0April 2018, with all legal routes seemingly exhausted, 200 or so protesters turned up outside the hospital. \u00a0At one point, dozens ran towards the main doors of the hospital only to be stopped by a row of policemen. Outside the hospital and on social media, protesters hurled verbal abuse at hospital staff: \u201ckidnappers\u201d, \u201cmurderers\u201d, \u201cexecutioners\u201d. \u00a0On Twitter, thousands returned insults to the protesters: \u201cungrateful\u201d, \u201cmorons\u201d, \u201cpathetic losers\u201d.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Although Alfie was a British citizen, under the jurisdiction of the High Court, the Italian government granted Alfie Italian citizenship that evening with a view, one assumes, to facilitate his transfer to Italy. \u00a0Alfie\u2019s lawyers lodged an emergency application hours later, which was dismissed by Mr Justice Hayden.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The amount of judicial, police, and NHS time spent dealing with this case must run to the thousands of hours. The NHS must also pay its lawyers, depleting its limited resources by six figure sums.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The whole situation\u2014full of inflammatory language, misinformation (how many commentators have actually read the judgments?), and delaying tactics\u2014is profoundly distasteful, but this circus is becoming the norm in &#8220;best interest&#8221; cases involving children, fuelled by social media and the public appetite for such stories. The creation, mainly through social media, of a maelstrom of opposition to the actions of the treating clinicians, with support from high profile figures such as the Pope, celebrities, and even governments, has become a strategy to pressure hospitals into submission. It is guerrilla warfare. Alfie\u2019s Army against the NHS. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">These ugly wars do shed blood. The consequences, often, are that the children at the centre of the dispute receive burdensome treatment for longer than they should, treating hospital staff feel victimised and demoralised, and hospitals in the future will think twice about taking cases to court for fear of damage to their reputation even when continued treatment is contrary to the child\u2019s best interests.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Ideally, brewing disagreements between parents and paediatricians should be addressed early on, with unresolved cases escalating to meetings with a clinical ethicist or hospital ethics committee. Once the matter reaches court, the \u201cwe are on the same side\u201d stance is replaced with an adversarial one, with lawyers on each side. Hence why the courts should only be used as a last resort, when nothing but judicial intervention will resolve the disagreement.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In the final pages of Saint-Exup\u00e9ry\u2019s <em>The Little Prince<\/em>, the pilot narrator stranded in the desert senses that \u201csomething extraordinary was happening\u201d to the Little Prince. He had to return to his star, but was unable to carry his heavy body. Worried, the narrator refuses to leave the Little Prince alone. That night, the Little Prince walks away unnoticed. The narrator manages to catch up with him. The Little Prince takes his hand and says \u201cYou will be sad. I will look dead but it won\u2019t be true\u2026\u201d. \u201cHere it is. Let me take a step alone.\u201d The narrator, full of grief, is unable to move. \u00a0A snake with \u201cgood venom\u201d bites the Little Prince\u2019s ankle, who stands still for a moment, without a sound, before falling softly like a tree onto the sand. <\/span><\/p>\n<p><span style=\"font-weight: 400\">For Alfie\u2019s parents, they will be saying their own goodbyes. Alfie must be allowed to make that final journey in peace and dignity, away from the chaos of the outside word, the chanting crowds, and tweeting masses.\u00a0<\/span><\/p>\n<p><i><span style=\"font-weight: 400\"><strong>Daniel Sokol<\/strong> is a medical ethicist and barrister<\/span><\/i><span style=\"font-weight: 400\">.\u00a0<i>Follow Daniel on Twitter: <a href=\"https:\/\/twitter.com\/DanielSokol9\">@DanielSokol9<\/a><\/i><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The consequences of disputes, often, are contrary to the best interests of the children at the centre of them [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/04\/24\/daniel-sokol-alfie-evans-and-guerrilla-warfare\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":41924,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-41916","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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