Page last updated at 14:15 GMT, Wednesday, 15 March 2006

Reaction to right-to-life ruling

The High Court has ruled doctors cannot switch off a ventilator keeping a 19-month-old child with a severe medical condition alive.

Experts give their reaction to the

decision.

DR VIVIENNE NATHANSON
Head of science and ethics, British Medical Association

"Such tragic cases are, fortunately, very rare. It is clear that both parties wanted the best for Baby MB, but differed on what was in his best interests.

"It is unusual for doctors and parents not to agree after they have spent time discussing and listening to each other's concerns.

"However, when an agreement cannot be reached, the only way forward is for the court to make a decision.

"We are sure Mr Justice Holman will have agonised over the decision but focused on what is right for the child."

DR MAX HUXHAM
Chairman, Jennifer Trust for Spinal Muscular Atrophy

"We are absolutely thrilled that the judge came out with the view that Baby MB should continue to be ventilated.

The technology now exists to prolong life but it is not necessarily always in the patient's best interests to do so
Dr Hugh Stewart

"This is what we have always wanted, and this is what usually happens with children with this kind of disease.

"I think this is a unique case, and hopefully it will be the only one that will ever come to court.

"Generally, with SMA the parents get on very well with their doctors. In this particular case it is likely that that relationship broke down at some point.

"Normally parents decide quality of life issues, and other such medical issues as a joint partnership between themselves and the medics - and that is the way it should be."

DR PETER SAUNDERS
Christian Medical Fellowship

"The court has made a wise decision. This baby, although suffering from profound muscle weakness, can still see, hear, feel, smell and taste - and should have normal intellectual capacity.

"Many competent disabled people are able to accept and live with that quality of life - even with the need for ventilation.

"Doctors worldwide are divided over whether or not invasive ventilation in cases of SMA type I is appropriate but the life expectancy and quality of life for these children has improved dramatically in recent years largely through more active treatment.

"In these circumstances, had the doctors been unhappy to continue treatment in the face of the parents' clear wishes then they should have been willing to refer the baby to others willing to consider continued ventilation."

ROYAL COLLEGE OF PAEDIATRICS AND CHILD HEALTH

"The RCPCH accepts this judgment as it helps to clarify what should be done in incredibly rare and difficult cases.

"This judgment is in accordance with the guidelines that we set in 2004 - 'Withholding or Withdrawing Life Sustaining Treatment', which was written in consultation with parents, patient groups and representatives of different religious beliefs, amongst others.

"We stressed then, and would stress now, that these decisions cannot be rushed.

"Each case involves an individual life and rigid rules cannot be imposed. In this case it was essential that there was a proper assessment of the child's quality of life.

"Paediatricians, along with parents and others members of the team caring for babies and children, sometimes have to make these difficult decisions.

"It rarely needs to go to court, but in this specific case, we have every sympathy with the parents and professionals involved."

DR HUGH STEWART
Medical Defence Union medico-legal adviser

"The case of baby MB highlights the particular difficulties doctors face when treating babies who are born with severe disabilities.

"The technology now exists to prolong life but it is not necessarily always in the patient's best interests to do so.

"In the vast majority of cases, parents and doctors agree on what course of treatment is in the child's best interests.

"But occasionally, as in this case, there may be a difference of opinion, for example where doctors believe that in their clinical judgement it is not in a child's interests to continue treatment but the child's parents want everything possible to be done to keep their baby alive.

"Parents wishes should always be taken fully into account and considered carefully, but the fact that parents wish treatment to be carried out does not require doctors caring for the child to carry out treatment that is not clinically indicated or is not in the child's best interests."

DR NEIL MCINTOSH
Paediatrician, University of Edinburgh

"I'm saddened for both the parents and the staff concerned. Clearly both had their own perspective.

"All they could do was go to court to try to sort it out from an independent body."

PROFESSOR JOHN HARRIS
Medical ethicist, University of Manchester

"All of the medics, including two on behalf of the family, felt it was not in the baby's best interests to continue living in the condition in which he is.

"But the judge decided it was in his best interests.

"We must hope, for the child's sake, he has got it right."

ROGER GOSS
Patient Concern

"It proves the law must change to require that all disputes between patients or relatives and their doctors over the withholding or withdrawing of essential life preserving care are resolved by an independent impartial authority.

"At present, this requirement only applies to cases of patients in a persistent vegetative state.

"The patient advocacy and disability movements will welcome this judgment.

"It is genuinely patient-centred. Though well-intentioned, doctors may take too mechanistically clinical a view of the benefits of survival versus its drawbacks.

"Mr Justice Holman decided that this was what medical opinion had done in the case of baby MB, despite unanimous agreement between eight consultants.

"They discounted the value of love, bonding and the right to enjoy some quality of life, however limited by one?s circumstances."



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