“Best interest” or “independent significant harm test”

A paper in the British Medical Journal has called for ‘new solutions’ to disputes between parents and doctors on medical care, in the wake of the Alfie Evans case.

Conflictive NHS hospital's decisions

So that they do not leave or so that they do not enter…

Two bioethicists have argued there are “strong ethical arguments” for changing the law; Professor Julian Savulescu, a philosopher, and Professor Dominic Wilkinson, a specialist in newborn intensive care, both teach medical ethics at the University of Oxford and have argued that the case showed there are problems with the current protocol.

Alfie Evans died in April, aged 23 months, after suffering from an undiagnosed degenerative brain disease. His parents had been locked in a prolonged legal dispute with Alder Hey hospital. Doctors believed further treatment for Alfie would be unkind and inhumane. The High Court ruled the hospital could stop providing life support, against his parents’ wishes; they’d wanted to move him to the Vatican-owned Bambino Gesù children’s hospital in Rome.

The two academics noted that in this case, as in other medical disputes (examples, Charlie Gard, Ashya King cases) courts based their decision on the child’s “best interests” irrespective of the parents’ wishes. However, in other areas of law, such as custody, courts can only overrule parents if there is a risk of “significant harm” to the child. The bioethicists say there are “strong ethical arguments” for changing the current law on medical disputes to an independent “significant harm” test.

The paper rejected the idea that parents could force medical professionals to give treatment against their will. But it argued that “independent mediation” has been shown to “de-escalate conflict” by trying to resolve disagreements before they come to court. They said it would be a “more stringent” standard for courts to meet if parents’ wishes were to be overridden (see HERE BMJ Journal article).

We approve this initiative because the concept “best interest” appears to be insufficient to Court decision making at the end of a life and more difficult to prove it. But the solution proposed by Savulescu of an independent ‘significant harm’ test is more consistent when courts decide to override parents’ wishes.

The change proposed by these renowned bioethicists, in our opinion is not sufficient but, is a step to find a solution.