Intended for healthcare professionals

Observations Ethics Man

Lessons from the Ashya King case

BMJ 2014; 349 doi: (Published 10 September 2014) Cite this as: BMJ 2014;349:g5563
  1. Aidan O’Brien, barrister, London,
  2. Daniel K Sokol, barrister and medical ethicist, London
  1. daniel.sokol{at}

Clinicians must try to reduce the risk of misunderstandings

On 28 August 2014 the parents of 5 year old Ashya King took him from Southampton General Hospital and boarded a ferry to France. He had been recovering from the removal of a medulloblastoma, a high grade paediatric tumour.

Ashya’s parents and doctors disagreed over his treatment. The parents sought proton beam therapy, arguing that it was less harmful than conventional radiotherapy.1 Peter Wilson, the lead paediatrician at the hospital, has since commented, “For this particular tumour, the reason why the proton beam was not deemed to be of any benefit is because you have to irradiate most of the brain and spine anyway.”2 Proton beam therapy is not routinely provided on the NHS in England, although a small budget exists to take children abroad for treatment.

If a child lacks competence to make treatment decisions, the responsibility falls to the child’s parents. Yet, the parents’ right is not absolute. Where their instructions seem to conflict with the child’s best interests, the doctors must seek the court’s authority to override them, save for grave emergencies. A court can invoke its inherent jurisdiction under section 8 of the Children Act 1989 to make “specific issue orders” or “prohibited steps orders.” …

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