Misunderstanding and Hijacking the Alfie Evans Case

Misunderstanding and Hijacking the Alfie Evans Case April 30, 2018

Quilette’s “The Tragic Case of Alfie Evans” is a superb article. Read it. It pains me to see people on facebook and even on the threads here fundamentally misunderstand the Alfie Evans case and use it to further their agenda.

I advise you read the whole article, especially for you to hear about some of the American involvement in the case.

Here are a few excerpts:

Inevitably, as he lay dying many have been moved by his plight. In some quarters, this has unfortunately led to denunciations of the doctors, the judges, and the legal system. Ill-informed and prominent voices—from America, in particular—have variously blamed his death on secularism, or the NHS, or ‘government death panels.’ Others in the UK have called for an ‘Alfie’s law’ designed to give parents greater rights over the treatment of their children….

Before the case, the parents had engaged solicitors who commissioned several independent expert opinions, all of whom agreed with the doctors at Alder Hey that Alfie’s medical prognosis was hopeless and that Alfie’s brain had deteriorated to an extent that was “catastrophic and untreatable.”

One of the independent experts instructed by the family was Dr Martin Samuels, a Consultant Respiratory Paediatrician. He was asked in evidence about the fact that Alfie appeared on occasion to demonstrate “physiological changes” in reaction to movement, light, and sound. Three possible explanations were offered for this: “basic reflex; seizure related activity; association with discomfort.” It was unclear whether Alfie had sufficient consciousness even to suffer pain, but he certainly lacked any means of demonstrating it if he did.

Another doctor, identified in the judgment as Dr M, a Consultant Paediatrician specialising in intensive care medicine, put it this way:

I believe that it is unlikely that Alfie feels pain or has sensation of discomfort but I cannot be completely certain of this since Alfie has no way of communicating if he is in pain or discomfort. I believe that given Alfie’s very poor prognosis with no possible curative treatment and no prospect of recovery the continuation of active intensive care treatment is futile and may well be causing him distress and suffering. It is therefore my opinion that it is not in Alfie’s best interests to further prolong the current invasive treatment. It would, in my opinion, be appropriate to withdraw intensive care support and provide palliative care for Alfie for the remainder of his life.

Dr R, a consultant in paediatric neurology, was of the view that although it was unlikely that Alfie could be conscious of pain:

… as [he] is unable to communicate, it is important to consider whether, despite his inability to respond, Alfie may still have some awareness of pain and discomfort and this should therefore be kept to an absolute minimum considering that he might still be able to “feel” uncomfortable sensation I think it is unlikely that Alfie has any ability to be reassured by the voices and touch of his parents.

In short, there was a medical consensus that further treatment would be futile and carried at least a small risk that it would exacerbate any suffering Alfie was still capable of experiencing. Alfie’s case was not even like that of Charlie Gard where there was at least a proposal for experimental treatment. Even his parents accepted that no cure and no improvement was possible. Nor, in the main, did they dispute the medical evidence; indeed, their own independent doctors agreed with those at Alder Hey about Alfie’s prognosis.

The only real area of disagreement was about what should be done. The parents’ alternative plan was to transport Alfie first to Italy, where he would be kept at the Vatican Bambino Gesu Hospital. If that did not achieve its unexplained purpose, he would be flown to Munich, where he would be subjected to a tracheostomy and a gastrostomy and kept in the Paediatric Intensive Care Unit for 14 days while the parents were trained to manage a home ventilation system. It is unclear from the judgments whether the plan thereafter (assuming Alfie survived the journey) was to remain in Munich. In any case, as Lady Justice King put it in the Court of Appeal, “Mr Knafler [leading counsel for Mr Evans in the Court of Appeal] was unable to help the court to understand why the father’s proposal involved Alfie being transferred to both Italy and Munich.” 

Applying the ‘best interests’ test, the judges decided that to fly Alfie around Europe to various different hospitals, to conduct surgery—not for the purposes of effecting a cure, but simply to extend his life—was not in his best interests. Transport and surgery of the sort proposed were not without their risks and, if indeed Alfie was capable of experiencing pain, those risks included subjecting him to unnecessary distress….

Alfie’s case—like that of Charlie Gard last year—and the desperation of his young parents have been ruthlessly exploited by religious and political actors with dubious motives of their own.

An American based pro-life activist named Christine Broesamle contacted Mr Evans early in the year after she read one of his Facebook posts. Previously, her contacts had offered to fly Charlie Gard to Rome, and she said the same could be done for Alfie. She also arranged for German and Italian doctors to visit Alder Hey posing as friends of the family. One of those doctors falsely claimed to have seen Alfie’s medical records and, on this basis, he pronounced Alfie “fit to fly.” He further suggested that Alfie could be prescribed an anti-convulsant, a claim the court found to be “entirely contra indicated by his medical history.” This was a gross breach of professional ethics, which unsurprisingly did more harm than good to Mr Evans’s case.

The Evans family were also put in touch with an organisation called the Christian Legal Centre (CLC)—described in court as “a campaigning organisation” (it campaigns, inter alia, against abortion and gay rights)—which became publicly involved after the parents had lost the first two rounds of argument in the High Court and the Court of Appeal, and once the Supreme Court had ruled that it would not conduct a full hearing (although it did give a brief ruling without hearing oral argument). At that stage the parents’ legal options in this country would normally have been exhausted.

Associated with the CLC was a man called Pavel Stroilov, a Russian exile who has worked as an adviser to the current UKIP leader Gerard Batten. He is some sort of law student and wrote a letter in which he stated that:

[A]s a matter of law it is your right to come to [the] hospital with a team of medical professionals with their own life-support equipment and move Alfie to such other place as you consider is best for him. You do not need any permission from [the] Hospital or the court to do so.

This advice was flatly and unarguably wrong. One of the many rather mysterious things about the case is quite why the CLC needed to rely upon the legal advice of a law student when its own director, Andrea Minichiello Williams, describes herselfto Companies House as a barrister (although for some reason she does not seem to be listed on the Bar Council directory of practising barristers). Even if Ms Minichiello Williams’s own legal knowledge is a little rusty, she had at her disposal the services of a practising barrister, Paul Diamond, who for 10 years has been “standing counsel” to the CLC. As long ago as 2008, Mr Diamond, a sole practitioner who gives his address as a post office box in Cambridge, was paid £100,000 p.a. for his services, which would appear to be something of a waste of money if they relied on the word of a law student instead.

In accordance with the CLC’s legal advice, Mr Evans turned up at the hospital equipped with a foreign doctor and the staff of an air ambulance and asked to remove Alfie. There was some sort of confrontation with hospital staff, and the police were called. Back to court the parents went, now represented by Mr Diamond bearing a ‘habeas corpus’ application that can only be characterised as legally nonsensical—I suppose we can’t blame the law student for that, since it must have been Mr Diamond’s idea—which was inevitably struck out by both Hayden J.and the Court of Appeal. With remarkable understatement they described the application as “misconceived.” Far from helping the desperate parents, it is difficult to view the CLC’s involvement as anything other than exploitative.

The nadir of this circus arrived with the announcement that summonses had been served on doctors at Alder Hey Hospital, charging them with conspiracy to murder: a stunt with not even a veneer of legal respectability. Theoretically, such a course could have left Mr Evans vulnerable to being sued for malicious prosecution (although I am sure that the doctors at Alder Hey would not have pursued it), and any lawyer associated with it would be hauled before his or her professional regulator. It is inconceivable that a barrister such as Mr Diamond could have advised his clients on such a course, so it is safe to assume that the advice to issue the summonses came from Mr Stroilov the law student.

It would be absurd, and a victory for the most disreputable religious bigotry, for English law to take such a turn now. Instead, we should celebrate the fact that, on the whole, we are fortunate to have courageous and independent family court judges who follow clear and long-established principles of law. Of course their decisions are not always correct, but no good will come from tinkering with the fundamental principle of English law that moral dilemmas about the treatment of children can only be properly resolved—as they have been for over 150 years—by relying on the judiciary to listen to the evidence and then to decide what is best for the particular child involved. That is certainly not unjustifiable government interference in the rights of parents; it is upholding and defending the rights of the child.

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