What does the Wyatt judgement mean?

Charlotte's parents say she has made "remarkable progress"

The treatment of Charlotte Wyatt, the seriously ill little girl, has once again been considered in the High Court.

Charlotte, who has never left hospital, was born three months prematurely in October 2003.

She was only five inches long, and weighed just 1lb (0.45kg).

But Charlotte has survived against the odds and medical opinion, and is said to have made "remarkable progress" despite serious brain, lung and kidney damage.

There is an obligation on doctors to act in the best interests of their patient Daniel Sokol, Medical Ethicist, Imperial College

Her parents say Charlotte now smiles, reaches out to them and tries to talk.

However, at age two, she is at the same developmental stage as a two or three month old baby.

A court order was put in place last year saying doctors would not be acting unlawfully if they decided not to ventilate Charlotte artificially in a life-threatening situation.

Her parents, Darren and Debbie, have continually challenged that order, saying Charlotte's condition was improving.

Parents' wishes considered

In a judgement on Friday, which was also Charlotte's second birthday, Mr Justice Hedley said this order should be revoked.

However, this does not mean that Charlotte's parents have won their battle, and their daughter would be resuscitated whatever the circumstances.

It simply means there will be no court order in place.

Debbie Wyatt is pregnant with her fourth child

And it means that decisions in Charlotte's case will now be made in the same way as those in anybody else's - doctors will have to act in what they view as their patient's best interests.

The judge said they must act according to their conscience and the medical evidence available as to what is best for Charlotte.

And he stressed that her parents could not tell doctors what to do, although their wishes would be taken into account.

Mr Justice Hedley said: "I have tried to set out, in a way comprehensible to all, what I understand to be both the duties and also the limits on the duties of the treating clinician.

"He does not take orders from the family any more than he gives them.

"He acts in what he sees as the best interests of the child: no more and no less.

"In doing so, however, parental wishes should be accommodated as far as professional judgment and conscience will permit, but no further. It is vital that that is understood by all."

'Best birthday present'

Daniel Sokol, a researcher in medical ethics at Imperial College London said the court order had been lifted, but the judge has reinforced the validity of the existing medical guidelines.

He added: "Family members cannot demand or refuse resuscitation on behalf of other people.

"There is an obligation on doctors to act in the best interests of their patient.

"If they believe resuscitation is futile, and would not be in the patient's best interests, they are not obliged to perform it."

But he said that, in some cases, it might not be a clear decision, and doctors would have to evaluate the potential "benefits and burdens" to a patient of resuscitation, and the chances of the procedure being a success.

Mr Sokol said it was best if doctors and parents could agree between themselves what was best for a child, but if that was not possible, the courts were the right place for a decision to be made.

Pat Forsyth, a spokeswoman for St Mary's said the judgement had been clear that, if doctors are asked to act in any way against their conscience, they are not required to do so.

She added: "In practice, this means the paediatricians will continue to work with Charlotte's family - and hopefully agree treatment at all stages."

The doctors caring for Charlotte have said they are prepared to ventilate her in certain circumstances.

But Ms Forsyth said: "If there is a future disagreement, we have a very clear direction from the court that then doctors are not required to ventilate Charlotte when it's not in her best interests to do so."

Darren Wyatt said the court decision was "the best birthday present Charlotte could have had".

Both family and doctors will now focus on helping Charlotte to leave hospital and live at home.