1. BIOETHICS – A REPORT
You will write a report on the Alfie Evans case
which will then be followed by an interpretation of the facts based on a number
of sources.
1)
watch
the video summarizing the course
of events of the case and take notes:
https://www.youtube.com/watch?v=H9YD-BFZxTs (
BBC news )
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2)
What is your immediate reaction to
what you have seen?
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3)
Read the article below about the
Hippocratic Oath.
In
what way has it the oath been
modified recently? Why do you
think this is? Which tenets of the oath are particularly relevant to the Evans case?
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A modern successor
to the Hippocratic Oath for physicians around the world has been approved by the World
Medical Association. This is the first revision in a decade
and reflects changes in the climate of medical ethics.
First of all, the
“Declaration of Geneva” is to be called, not an “oath”, but a “pledge”. The
most striking change is the emphasis on patient autonomy. A clause has been
inserted into the 2017 version which says, “I will respect the autonomy and
dignity of my patient”.A somewhat unusual new clause requires doctors to look
after their own health: “I will attend to my own health, well-being, and
abilities in order to provide care of the highest standard”.There is a new
obligation on physicians to share their knowledge for the benefit of their
patients and for the advancement of healthcare.
The current
Declaration of Geneva is used across the world by physicians. In many
countries it is actually part of the medical professional code and in some it
is legally binding. However, in other countries it is either not used at all
or has been adapted. The revised pledge is supposed to be a global ethical
code for all physicians. WMA President Dr Yoshitake Yokokura said:
“The life of physicians today is
completely different to what it was in 1948 when the original Declaration of
Geneva was adopted. Since then, the Declaration has become a core document of
medical ethics and a modern version of the 2,500-year old Hippocratic Oath.
We hope that the Declaration approved today will be used by all physicians
around the world to strengthen the profession’s determination to maintain the
highest standard of health care for patients.”
It is interesting to
compare the 2017 version with the 1948 version. In many respects they are strikingly
different.
1948: I will maintain the utmost
respect for human life from the time of conception
2017: I will maintain the utmost respect for human life.
1948: even under threat, I will
not use my medical knowledge contrary to the laws of humanity
2017: I will not use my medical knowledge to violate human rights and civil liberties, even under threat.
1948: I will maintain by all the means
in my power, the honor and the noble traditions of the medical profession; my
colleagues will be my brothers
2017: I will foster the honour and noble traditions of the medical profession
AS A MEMBER OF THE MEDICAL PROFESSION:
I SOLEMNLY PLEDGE to dedicate my life
to the service of humanity;
THE HEALTH AND WELL-BEING OF MY
PATIENT will be my first consideration;
I WILL RESPECT the autonomy and
dignity of my patient;
I WILL MAINTAIN the utmost respect for
human life;
I WILL NOT PERMIT considerations of
age, disease or disability, creed, ethnic origin, gender, nationality,
political affiliation, race, sexual orientation, social standing, or any
other factor to intervene between my duty and my patient;
I WILL RESPECT the secrets that are
confided in me, even after the patient has died;
I WILL PRACTISE my profession with
conscience and dignity and in accordance with good medical practice;
I WILL FOSTER the honour and noble
traditions of the medical profession;
I WILL GIVE to my teachers,
colleagues, and students the respect and gratitude that is their due;
I WILL SHARE my medical knowledge for
the benefit of the patient and the advancement of healthcare;
I WILL ATTEND TO my own health, well-being,
and abilities in order to provide care of the highest standard;
I WILL NOT USE my medical knowledge to
violate human rights and civil liberties, even under threat;
I MAKE THESE PROMISES solemnly,
freely, and upon my honour.
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4)
The Religious and legal Perspectives
Read the article below. Do you agree with the American or the European stance?
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Alfie Evans and Christianity
The case of Alfie Evans has resonated with Catholic
and Christian communities around the world. They see in his case a
fundamental conflict between the actions of the British legal system and
their religious belief in both the right to life and the right of parents to
determine a child’s medical care. Some religious activists have banded
together in support of the Evans family, calling themselves “Alfie’s Army,”
and regularly protest outside the hospital where Alfie is being treated.
In response to the outcry from the Catholic community, the Italian
government offered young Alfie citizenship, arranging for
him to travel to the Bambino Gesu hospital in Italy. Even Pope Francis, who met with Tom Evans in
Rome earlier this month, has weighed in on the case.
Moved by the prayers and
immense solidarity shown little Alfie Evans, I renew my appeal that the
suffering of his parents may be heard and that their desire to seek new forms
of treatment may be granted.
Pope Francis also tweeted out his sadness in response to the news of
Evans’ death:
I am deeply moved by the
death of little Alfie. Today I pray especially for his parents, as God the
Father receives him in his tender embrace.
But the swelling of support for Alfie has not changed the British
legal system’s mind. On Tuesday (April
24), justice Hayden ruled one final time that the family could not send Alfie
to Italy for treatment. Moving Alfie, he said, would only make him more
vulnerable to an infection and other dangers, for an outcome that would
certainly not help him live any longer.
Who has final say over an infant’s medical care?
Alfie Evans is not the first baby whose medical condition sparked
similar debates. Last year, Charlie Gard, a terminally ill British baby, died
in July 2017 a day after the
British High Court ruled that his life support could be withdrawn. Charlie’s
case had attracted the attention of world leaders from Pope Francis to US president Donald Trump.
Extreme medical cases like Alfie Evans and Charlie Gard illustrate the
moral dilemma of end-of-life care for sick children. It’s easy to understand
why the parents of sick children would cling to hope; as long as their
children are alive, they believe, there’s still a chance they might recover.
But the British legal system takes the view that, in some cases, keeping
children artificially alive only prolongs their suffering.
For outside observers, whether one sides with the parents or the state
often falls along national and cultural fault lines. American
conservatives are up in arms about
Alfie, and many other Americans may well feel the same way. David
French recently wrote in the
conservative National Review that, because of the “fundamentally
religious element to America’s founding,” the legal system would not consider
intervening to determine the course of Alfie’s medical care, which would be
left up to his family. He argues that Americans innately respect
parents’ rights and liberties above the state’s: “Raised against the backdrop
of American liberty, there are millions of Americans who understand this
reality almost instinctively, without knowing an ounce of constitutional
law,” he writes. “Their very spirit rebels against Great Britain’s actions.”
But European legal and political systems are based on the primacy of
the state’s authority in extreme situations like a dispute over a child’s
end-of-life medical care. That’s partly because European laws are informed by
human rights standards laid down in the United Nations Convention on the
Rights of the Child, which all European states are party to but the United States is not, as well as
other European treaties like the European Convention on Human Rights.
“In Europe, disputes over children’s medical care, including
end-of-life medical care, may result in a limitation of parental authority,
justified by the protection of the child’s rights and best interests, which
includes the right to have one’s dignity and physical integrity protected,”
Ton Liefaard, who holds the UNICEF chair in children’s rights at Leiden Law
School in The Netherlands, told Quartz.
Europeans themselves, meanwhile, are often divided along religious
fault lines. British neonatal ethicist Dominic Wilson offers a view into the
thinking behind secular support for the British legal system’s decision,
explaining that the goal is not to end Alfie’s life but to provide him with
palliative care. “Palliative care is not euthanasia,” he writes in a blog
post. “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.”
Whether one sides with the law or the rights of parents in this case,
it’s impossible not to feel compassion for Alfie’s parents. Writing about
Alfie’s father, Tom, in his ruling, justice Hayden laid out his understanding
of the issue. “His core dilemma, from which he struggles to escape, is that
whilst he recognizes and understands fully that the weight of the evidence
spells out the futility of Alfie’s situation he is, as a father, unable to
relinquish hope,” Hayden wrote. No parent could blame him.
https://qz.com/1264345/alfie-evans-life-and-death-highlights-the-vast-gap-between-the-us-and-europe-on-right-to-life/
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5)
Watch
this biased interpretation of the case. What is the expert’s reasoning
based on?
6)
Complete the text below by inserting
one word only in the gaps. Before doing so, read the text through at least once.
The tragic case of Charlie Gard will be
reconsidered by the High Court in London on July 13. ……………. its first ruling in April, baby
Charlie’s plight has attracted international attention, ……………. comments from the Pope and Donald Trump.
The case is significant for its poignancy
and its international profile, but
……………. legal significance arises from
the dispute between Charlie’s parents, Chris Gard and Connie Yates, and his
medical team. ……………. dispute includes their opinions on Charlie’s condition and
the likely benefits of an experimental medical treatment. ……………. disagreements
are uncommon, but when they arise there are a number of reasons why they need
an independent arbiter to ……………. the competing issues. Charlie suffers from a rare
and debilitating illness called encephalomyopathic mitochondrial DNA depletion
syndrome. ……………. a result of his
condition, Charlie has already suffered irreversible brain damage. His parents
……………. to take him to the US for an experimental treatment, called nucleoside therapy but both courts
and the doctors at Great Ormond Street Hospital have so far concluded that it
……………. be “futile”.
Charlie’s parents have the legal capacity
to consent to the treatment or to the withdrawal of treatment on ……………. of their child and some would argue
that the parents’ view should prevail. But as Lord Justice McFarlane stated in
the Court of Appeal:
It is well-recognised that parents in the appalling
position that these and other parents can find
……………. may lose their objectivity
and be willing to ‘try anything’, even if, ……………. viewed objectively, their preferred option is
not in a child’s best interests.
Equally parents and patients ……………. not be
left without the ability to review the expert decisions of medical
professionals. In this sense all power ……………. checks and balances even that
wielded by those with……………. but the best
of motives. The question ……………. becomes who is best placed to resolve these
competing but equally well-intentioned viewpoints?
Who decides and why?
As justice secretary, David
Lidington, recently said, the government has “no role to play” in the resolution of this case. ……………. the UK’s constitutional arrangements, government policy and the law all require that the courts are used to resolve ……………. disputes. No one is above the law
and the rule of law itself means that medical decisions are reviewable in the
courts. ……………., when doing so, the courts are not asked to find in favour of
either the parents or the medical team. ……………. are
they asked to consider what they would do as a parent or doctor. While they
will consider evidence from ……………. parties, the sole issue for
the court is to identify what is in the best interests of the patient.This
process ensures that medical opinion is rigorously tested and, where
appropriate, it provides legitimacy to the difficult decisions that doctors are
called ……………. to
make about life and death.For a liberal democracy it is crucial that all
evidence is heard in a public forum that is independent and impartial, subject
to an appeals process, and which regards the best interests of the patient as
the paramount consideration.
The next
hearing
……………. far the courts have concluded
that it would not be in Charlie’s best interests to undergo the experimental
treatment and that it would be in Charlie’s best interests, and therefore
lawful, for his life support to be withdrawn. Before the court……………. change this view, additional
evidence would ……………. to be produced that
undermined its earlier conclusion that the proposed treatment would be futile.
The purpose of the July 13 hearing is to explore ……………. such
evidence exists.……………. the case has been emotionally fraught,
evidentially it has been relatively straightforward as all the UK medical
experts, including an independent consultant paediatric neurologist instructed
by the parents, have agreed that the experimental treatment would have no
benefit. Even the US doctor offering to treat
Charlie ……………. that the
treatment had not been tested on Charlie’s exact condition. Mr Justice Francis summarised his evidence
as follows:
While there
was reason to be hopeful that the treatment might make a modest difference to
life expectancy, it almost certainly could not undo the structural brain damage
that had taken ……………..
If fresh evidence is now
produced that supports the treatment and that evidence is disputed by the
hospital doctors, the judge will have a much harder judgment to …………….. However, in a society that recognises the fundamental importance of the
individual citizen and their human rights, it is a task that properly ……………. to the courts and no other.
The Conversation , Nicholas Clapham, School of Law, University of Surrey
7)
Write a report on this case. Begin
with a brief summary of events. Then,
using the sources above, write your interpretation of the events and, in conclusion, judged on what you have
read, give your opinion.
Further reading : The Children Act, Ian McEwan
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