Judge over-rules earlier decision on Charlotte Wyatt
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《英国医生杂志》
A high court judge in London last week lifted the declaration that he made a year ago that gave doctors treating a severely disabled 2 year old legal protection if they refused to ventilate her in the event of a life threatening emergency.
Mr Justice Hedley discharged the declaration because Charlotte Wyatt, who had her second birthday on the day of his judgment, had considerably improved and there might be circumstances in which it would be in her best interests to ventilate her.
Darren and Debbie Wyatt (pictured outside the High Court) will not be able to insist that doctors ventilate their child Charlotte in an emergency
Credit: CARL DE SOUZA/AFP/GETTY IMAGES
He refused the application by Portsmouth Hospitals NHS Trust for what he described as a "wholly novel" declaration that would give doctors "the last word" on her treatment.
But his judgment made it clear that her parents, Darren and Debbie, will not be able to insist that doctors ventilate her in an emergency. Doctors will not be required to take measures that would be "an affront to conscience."
The declaration made a year ago, that doctors would not be acting unlawfully if they refused to ventilate Charlotte in an emergency, was unusual because it referred to a future contingency. The trust, which is caring for Charlotte at St Mary's Hospital, Portsmouth, sought it because doctors hoped to avoid a last minute court battle over her treatment with her parents, who wanted all possible measures taken to try to save her life.
The judge said that the law was that a clinician could refuse to provide a treatment where he concluded "that a requested treatment is inimical to the best interests of the patient, and that his professional conscience, intuition or hunch, confirms that view. In those circumstances he may refuse to act and cannot be compelled to do so, though he should not prevent another from so acting, should that clinician feel able so to do."
Although Charlotte's improvement had defied expectations, the judge said she still had a "gloomy" medical prognosis. She had some of the capabilities of a 2 to 3 month old baby, gross and irreversible brain damage, and "the gravest chronic lung disease, described by two very experienced experts as the worst each had ever seen in a living child."
The judge said that the treating paediatrician, Dr K, whose identity is protected by court order, feared that the parents' views would have to prevail, but that was not the law. The position in law was that the clinician "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 so doing, 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."(Clare Dyer, legal correspondent)
Mr Justice Hedley discharged the declaration because Charlotte Wyatt, who had her second birthday on the day of his judgment, had considerably improved and there might be circumstances in which it would be in her best interests to ventilate her.
Darren and Debbie Wyatt (pictured outside the High Court) will not be able to insist that doctors ventilate their child Charlotte in an emergency
Credit: CARL DE SOUZA/AFP/GETTY IMAGES
He refused the application by Portsmouth Hospitals NHS Trust for what he described as a "wholly novel" declaration that would give doctors "the last word" on her treatment.
But his judgment made it clear that her parents, Darren and Debbie, will not be able to insist that doctors ventilate her in an emergency. Doctors will not be required to take measures that would be "an affront to conscience."
The declaration made a year ago, that doctors would not be acting unlawfully if they refused to ventilate Charlotte in an emergency, was unusual because it referred to a future contingency. The trust, which is caring for Charlotte at St Mary's Hospital, Portsmouth, sought it because doctors hoped to avoid a last minute court battle over her treatment with her parents, who wanted all possible measures taken to try to save her life.
The judge said that the law was that a clinician could refuse to provide a treatment where he concluded "that a requested treatment is inimical to the best interests of the patient, and that his professional conscience, intuition or hunch, confirms that view. In those circumstances he may refuse to act and cannot be compelled to do so, though he should not prevent another from so acting, should that clinician feel able so to do."
Although Charlotte's improvement had defied expectations, the judge said she still had a "gloomy" medical prognosis. She had some of the capabilities of a 2 to 3 month old baby, gross and irreversible brain damage, and "the gravest chronic lung disease, described by two very experienced experts as the worst each had ever seen in a living child."
The judge said that the treating paediatrician, Dr K, whose identity is protected by court order, feared that the parents' views would have to prevail, but that was not the law. The position in law was that the clinician "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 so doing, 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."(Clare Dyer, legal correspondent)