Intended for healthcare professionals

Editorials

Alfie Evans and Charlie Gard—should the law change?

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1891 (Published 01 May 2018) Cite this as: BMJ 2018;361:k1891
Opinion: Alfie Evans and guerrilla warfare

Re: Alfie Evans and Charlie Gard—should the law change?

The issue in both clinical cases seems to be around what is and what is not acceptable or ordinary medical treatment in such cases. It is correct, as in a previous comment, that "The problem would not arise if access to high tech medicine and facilities were not available. To say that treatment was harming the child when the opposite - no treatment at all would do far more harm (in fact cause death) is not an argument."

With current poor knowledge about neurological pathologies, it would be rather complex to support scientifically one position or the other, but since there have been in the past situations where medicine has failed (so called biological miracles or unexpected recoveries are frequent rather than expected), the question is: who has the right to say whether a patient's life shall be prolonged days, months or years? The same wrong concept is applicable to other serious diseases, and seems more cynical when in newborns. People who have studied Classics know that in Greek towns (Sparta and Athens) and in Rome there was a sort of Rupe Terpea, a rock used to throw newborns with physical defects. But the real question remains who will take the decision for the parents? Would this be applicable also to some other pathologies as cancer patients who do not have treatment? Would it be applicabe to all Orphan Drug Teatments which are very costly and sometimes offer minimal improvement of the condition? My modest opinion is that parents shall consciously decide when suffering ends for the son/daughter, but the decision - to avoid excessively opimistic or pessimistic outcome - shall also be assisted by counselling from specialists.

As far as I read, the British law that was applied is more than old (16th century) and says that Govermental institutions shall decide about the care of a patient affected by an irreversible condition, irrespective of the parents.

However, in the specific case if some other Italian Hospital would take care of the asistance to the newborn, what's the problem? While ordering that Alfie shall not be moved?...... Pure cynicism!

An appeal to the British Government physicians and people: two cases in a few months seems too much. However, this drama happens in several other cases in other EU countries, without such ostentation of governmental medical and not medical institutions. Think that one day you might be the Charlie or the Alfie and this kind of dispute would not make you happy!

However, British specialists would had fear that another hospital in another country could (partially) solve the clinical problem, so the decision that it would be better to close the file with the word "death".

What about serious addicts where you know that the patient would never follow a rehabilitation programme? Why not give the addict an overdose (as it could happen normally at any time) and be finished?

The reason: this makes the difference between humans and animals!

Competing interests: No competing interests

07 May 2018
Paolo Alberto Veronesi
Researcher/PhD
Therapicon Srl
Via M. M. De Taddei 21- 20146 Milan IT