Great Ormond Street Hospital v Constance Yates, Chris Gard, Charles Gard (A Child, By his
Guardian Ad Litem), 11 April 2017  EWHC 972 (Fam)
a) Summarise the case briefly. Identify the interpretive issues in the case, indicating the reason for interpretation.
b) How has the judge/judges interpreted these issues? Explain.
c) How should the judge/s have interpreted the issues?
a) Identify the moral issue(s) in the case. Explain why you believe these are moral issues rather than any other kind of issue (the issue can be e.g. a legal issue in addition to being a moral issue).
b) Which moral theory/ies seem to you most likely to underpin the way the court has made its decision(s)?
c) Which moral theory ought the court to have used, and why?
In the case Great Ormond Street Hospital v Constance Yates, Chris Gard, Charles Gard, a baby boy was born in London. The infant boy had rare inherent disorder, mitochondrial DNA depletion syndrome (MDDS). The mitochondrial DNA depletion syndrome causes brain damage and failure of the muscles. There is no treatment of mitochondrial DNA depletion syndrome and it causes death in infancy. This Charlie Gard case converted debated because of disagreement of consultant team and parents on the question whether new treatment was in best interest of infant. In October 2016, baby was referred to Great Ormond Street Hospital (GOSH), a National Health Service (NHS) children’s hospital because of failure of thrive and low breathing. There Charlie was kept on ventilation and mitochondrial DNA depletion syndrome was identified.
The neurologist, Michio Hirano and Great Ormond Street Hospital decided to continue with the treatment to be directed in Great Ormond Street Hospital. Michio Hirano was requested to examine Charlie but Hirano did not come. Mr Hirano visited the hospital after having brain damage by Charlie. The hospital formed an opinion that more treatment may extend pain. The hospital discussed with parents for terminating the life support and rendering comforting caution. However, parents wanted more experimental treatment. In February 2017, Great Ormond Street Hospital took the permission of high court to overrule the decision of parents of Charlie. Further parents made appeal to the Court of Appeal. The court of appeal rejected the application made by parents of Charlie Gard. Later, Charlie’s parents made application in Supreme Court. The Supreme Court also rejected the application, and then they made appeal to the European Court of Human Rights. The judgement of the court was upheld at the each stage. The Great Ormond Street Hospital applied to the high court for a new trial.
On the second hearing, Mr Michio Hirano came to hospital to examine the condition of Charlie. Mr Michio Hirano said that it is not possible to continue experimental treatment because it is too late. The parents got ready to terminating the life support. The position of Charlie was maintained by Great Ormond Street Hospital. The condition of Charlie was weakened by January. The second hearing was conducted to examine the new evidences. Charlie Gard was transferred to hospice and ventilation was withdrawn. The next day, Charlie expired at the age of eleven months and twenty-four days.
There are some specific interpretive issues of the Charlie Gard case. The first issue was whether the choosing of an independent representative for infant baby Charlie Gard was not justified or this practice was not known to other authorities. The second issue was whether the decision of life-sustaining treatment was not in the best interest of infant Charlie Gard. The third major issue of case was right nature of the announcements made and the part of the test of best interest. The other issue of this case was coverage of best interest of the patient. The main reason for such interpretative issue was that the best interest of Charlie Gard was decided by various courts.
In April 2017, Charlie Gard case first came before the Francis J. On the question of whether it will be in the best interest of Charlie Gard to have the experimental treatment or nucleoside treatment, Francis concluded that it would not be in the best interest of Charlie. It is required to follow that it is legal and in the favour of Charlie Gard to withdraw the artificial ventilation. It is legal and in the best interest of Charlie for his handling clinicians to give him with comforting caution only. It is legal and in the best interest of Charlie to avoid experimental treatment or nucleoside therapy.
Further, on the rejection of appeal made by parents of Charlie, the case was presented to Court of Appeal. The court of appeal rejected the appeal made by parents. The court of appeal also denied the permission to make an appeal to Supreme Court. Parents of Charlie made an application to the Supreme Court. The Supreme Court rejected the application. Later, Charlie’s parents made an appeal to the European Court of Human Rights. The European Court of Human Rights made the application of parents disallowed.
Furthermore, the second hearing was prompted by a declaration of availability of new evidences in respect of treatment of Charlie Gard. The decisions refer to multi-disciplinary conference was held on 17 July 2017. At the conference, the opinion was made that there were need of scan to determine the position of Charlie that maintained was accurate by the Great Ormond Street Hospital. The MRI scan stated that infant had weakened to the stage where Charlie was beyond help. The parents of Charlie withdrew their disapproval to announcement. It had been concluded by Francis J that the parents are required to face the truth that the situation of Charlie cannot improve. It is in the best interest of Charlie to let him die. Francis said that it is very sad to confirm the statement made in April and now formally doing so. It was confirmed by Francis J that applications made by Great Ormond Street Hospital were directed by the welfare principle preserved in section 1 of the Children Act 1989.
It is required by the court to consider the best interest of Charlie Gard. The Francis J had the opportunity to convict the non-availability to the parents of permissible assistance and as at first instance to suggest the availability of the deliberation being a method by which disagreements may be conducted in the future. Francis J made an opinion that parents are required to know that they cannot done anything for their children out of their capacity. They should accept that they cannot save the life of Charlie Gard. The only remedy is to let the Charlie Gard die. On the application of Gosh, Francis J made a declaration that it is not legal and not in the best interest of Charlie to be kept on the artificial ventilation. It is also not in the best interest of the Charlie Gard to continue the experimental treatment or nucleoside therapy. Francis J made a view that deliberation must be attempted in all the cases so they both the parties of the case may understand the matters and position of each other.
Interpretive issues of the case
The case of Charlie Gard was heart-breaking case. Charlie Gard suffered from genetic disorder and the brain damage. The management of hospital wanted to terminate the life support. However, the parents of Charlie Gard did not agree to finish the lifetime support. They want to continue the experimental treatment in the United States. It was held by the court that it is not in the best interest of Charlie Gard. Charlie Gard should be allowed to die.
This judgement of honourable judge Francis J may be good. However, it is not correct to reject the rights of parent to treat an infant more by the experimental treatment. Central to the law as it relates to the medical cure of incapacitous patients in England and Wales is the requirement to make sure that any such treatment is the best interest of patient. It may appear unfair that parents of Charlie Gard are not permitted to make choices about his dealing. It is a consequence of wider system targeted at making sure that it is the interest of patients and not other’s interest, which command whether caution is provided. It is required solid proof that to do so would cause him harm. There were chances of further experimental treatment or an alternative treatment for Charlie Gard. The Charlie Gard case focuses on the issue of describing the best interest for Charlie and trying to determine it by the court system.
The judge is required to recognise the problem in knowing what establishes the best interest and be specifically careful about permitting the death. The judge was to make focus on the point of parental autonomy and right to decide on the behalf of their children. It was also required by the court to use the interpretation about the meditation. The judge or doctor cannot take terminate the life of someone. They have no right to take the life of someone. Charlie Gard had to keep with support life until infant expired due to his disease or sickness. The court might consider the point that whether doctors are the right people to decide what establishes quality of life. It was required by the court to think over the point that whether they are too much depend on the opinion of doctors made on the condition of Charlie Gard. The judge was required to ask for advanced care plan to give the better treatment to Charlie Gard.
Identification of moral issues of case-
In some cases where death approaches knocking at the door of life, conditions arise that are tough to give decision and even less simple to decide. From the moral point of view, many facets are exist which are required to be estimated.
The main moral issue was the desires of the parents, which must come first. Children are not considered as property. They are human being. They have their own individual rights. It is thinking of parents that they have right on their child. They think they can treat the children and matters of children as they wish. However, in United States, United Kingdom and some other places, if parents did not agree to give treatment or blood transfusion, then the doctors can take the necessary steps to save the life of children. The doctors can force for more treatment, therapy, or injections. Ethically the desires and welfare of children come first instead of desires of parents. In the situation where the doctors or medical consultants and the parents of children do not agree on the same topic or matter, then the issue may refer to the court. The court assigns a guardian for determine the best interest of the children. The appointed guardian will be responsible to decide the welfare of the children. The representations are required to be made by the parents and the doctors or medical consultants. The guardian makes efforts to consider the arguments. The guardian submits the report to the magistrate. The magistrate gives instructions on the legality of actions, directed by the guardian.
Interpretations of the judge
The second moral issue of the case was children’s right to life. Under the Human Rights Act, every person has right to life. The article 3 states that no person shall get tortured. No one is subject to inhuman or humiliating behaviour or sentences. It is the violation of rights of article 3 to terminate the life of Charlie without giving the treatment or caution or comforting care. The question was arise that every person has right to live but not if allowing the children alive is a miasma of suffering that is not possible to clarify. The other moral issue was action of hospital. The waited too long for the treatment of Charlie Gard. The treatment of infant was possible at earlier stage. The neurologist, Mr Michio Hirano did not came to examine Charli Gard at early stage. Mr Hirano came to hospital to examine Charlie after having the brain damage. It was the moral duty of Gosh to force the neurologist to come on early basis to examine Charlie.
As morality administers the private and individual interactions and law administers the society as completely dealing with communication between total strangers. Ethical problems such as this search their method to higher scopes of the court unexpectedly rarely, given the situations. Legal cases are still fewer than the medical cases they are constructed. This case of Charlie Gard was unique. The above-discussed issues are based upon value and beliefs of an infant. They cannot be considered as legal issues.
The case of Charlie raised the question that what is the moral status of parents and what is the moral status of the children in front of public. The Charlie Gard case was speciously depend on grounds of welfare. However, not all the aspects of the case are constant with the advancement of welfare of Charlie. There is a solid harmony in the medical and ethical literature in the United States, which is best interest of the patient, not the wishes of parents of children or desires of family of children or the personal partialities or preferences of doctors. This moral theory does not depend on parental autonomy or an effort to decide the desires of the patient. This moral theory of best interest depends on the concern for health and benefit of patient.
The legal decision for Charlie Gard was depend upon the assessment of the best interest of the Charlie Gard. This safety is significant in respect of infants and children because they are depended on their parents. The children are under the control of their parents and family but as a patient, children have their personal rights. The consequences are that parents may continue to be included in the choices made by their children. They do not have complete right to decline or to want the medical treatment for their children. It is in the best interest of children. The objective of medical treatment decisions made on the behalf of children. The central moral issue in the case is whether it will be best to render the new further treatment and continue concentrated care for Charlie Gard for some months more or to withdraw the artificial ventilation and permit the Charlie to die. This question raised that what will be risks and benefits of such two options.
How should judge have interpreted the issues?
Francis J gave the judgement to withdraw the artificial ventilation and let the Charli die because Charlie Gard would suffer and experience pain and disquiet from continuous caution. There was no surety that Charlie Gard would have advantage from the nucleoside treatment. It was also argued on the issue of this case that it was not sure that continued artificial ventilation in severe care is so terrible a life, which it would not be worth living. The doctors thought that it would not correct to continue to keep the Charlie Gard on the artificial ventilation. In this tragic case of Charlie, the judges in the court of appeal will seek the judgement that all the magistrates or majority of magistrates, think is accurate. Based on ethics, it is suggested that if the children are not so able to express their desires or wishes, then preferences should be given to the welfare of children. The benefit of children was the key factor of the courts. This moral theory of best interest supported the judgement given by the Francis J. The best interest standard is considered as an objective standard. When the values and beliefs of patients are not identical, the best interest is appropriate standard. The best interest standard is normally specified as reasonable person standard. This approach of court focused on the weakness of an infant because an infant can never say enough is enough.
It was not so easy for Francis to give the judgement in this case. It was quite confusing what is right or what is wrong for Charlie Gard, parents, and his family. The different moral theories to the children and parents made the claims. Francis J adopted the moral theory of best interest of infant. As per the above discussion, Francis J gave the judgement that Charlie Gard should not keep on artificial and ventilation. The judge permits the Charlie to die because it is in the best interest of Charlie Gard.
Many arguments raised on this case that parents of children have rights to make the decisions about the parents so that they can advance the children’s welfare. The judges were required to consider the moral theory of parental autonomy and reflective equilibrium. The further arguments recommended that children are the parental property. It is called as proprietarian accounts. The parents of children have basic right to choose the option for their children. The parenting has teleological base. The parenting is considered as good in itself. The Personhood is a procedure of unique ethically significant and ethically less significant. On the point of personhood, the person is not an ethically relevant property. The parent’s choice should have given priority. The desires of parents should come first. It is a duty of parents to decide what will be the best for welfare of the children. The judges were required to consider the moral theory of parental autonomy and reflective equilibrium.
The moral theory of reflective equilibrium states that it is not necessary that all the judges, doctors, and medical consultants are expert in specific matters. However, it is required that the judges, doctors and medical consultants should have proper knowledge about the related aspects. They should have broad mind. They are required to find issues and their solutions. The magistrates, doctors and other relevant consultants should apply logical methods to solve issues. They should have kind knowledge of these particular human rights. They are required to know the situation and handle the issues or matters in proper way. The judges must consider the sentimental of parents and family. The judge was required to know more about the advanced care treatment for the children. The court was required to take necessary steps to find out the alternatives for an infant so that Charlie Gard might survive. It was not required by the judge to depend only on the opinions of neurologists and doctors. They all were required to make more efforts until Charlie Gard die. This approach states that infant should not die. There must be chance of alternative treatment.
Articles/ Books/ Reports
Bester, J. C. Charlie Gard and the limits of the harm principle. Sydney: Ventura press, 2018.
Cummings, B. The medical remedies: Charlie Gard case. United Kingdom: Thompson Advantage Books, 2017.
Dressler, G. Ethical implications of medical crowd funding: the case of Charlie Gard. Australia: Pearson Australia, 2018.
Dyer, C. Law, ethics and emotion: The Charlie Gard case. London: Sweet & Maxwell, 2017.
Hirsch, D. Consent to medical treatment in cases of legal incapacity lessons from the Charlie Gard case. London: Bloomsbury Publishing, 2018.
John, N. The long struggle. Cambridge: Cambridge University Press, 2015.
Lagercrantz, H. observations on the case of Charlie Gard. Australia: CCH Australia Limited, 2018.
Lantos, J. The tragic case of Charlie Gard. London: Pearson Education Limited, 2017.
Paris, J. Approaches to parental demand for non-established medical treatment. London: Pearson Education Limited, 2018.
Savulescu, J. Is it in Charlie Gard’s best interest to die. Oxford: Oxford University Press, 2017.
Singer, P. Practical Ethics. Cambridge: Cambridge university press, 2011.
Smith, W. J. Culture of death: the age of do harm medicine. United Kingdom: Edward Elgar publishing, 2016.
Sokol, D. Charlie Gard Case: an ethicist in the courtroom. Australia: Pearson Australia, 2017.
Sullivan, D. The ethics of the Charlie Gard case. Oxford: Oxford university press, 2017.
Truog, R. D. The United Kingdom sets limits on experimental treatments: the case of Charlie Gard. United Kingdoms: LexisNexis Butterworths, 2017.
Wilkinson, D. and Savulescu, J. After Charlie Gard: ethically ensuring access to innovative treatment. Cambridge: Cambridge University press, 2017.
Wilkinson, D. Beyond resources: declining parental requests for futile treatment. Cambridge: Cambridge University Press, 2017.
Zimmerman, C. Family and civilization. Cambridge: Cambridge university press, 2014.
Great Ormond Street Hospital v Constance Yates, Chris Gard, Charles Gard, 11 April 2017  EWHC 972 (FamLegislations
The Children Act 1989
Arthur, C. (2017). “Charlie Gard: The facts,” [Online]. https://reaction.life/charlie-gard-facts/.
Harmon, A. G. (2017). “The case for Charlie Gard,” [Online]. https://imagejournal.org/2017/07/11/case-charlie-gard/.
PMC. (2017). “The Charlie Gard case: British and American approaches to court resolution of disputes over medical decision,” [Online]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5712473/.
 11 April 2017  EWHC 972 (Fam)
 Robert Truog, the United Kingdom sets limits on experimental treatments: the case of Charlie Gard (United Kingdom: LexisNexis Butterworths, 2017)
 Charle Arthur, (2017). “Charlie Gard: The facts” [Online]. Available: https://reaction.life/charlie-gard-facts/.
 Gred Dressler, Ethical implications of medical crowd funding: the case of Charlie Gard (Australia: pearson Australia, 2018)
 Neil John, The long struggle (Cambridge: Cambridge University Press, 2015)
 Dominic Wilkinson and Julian Savulescu, After Charlie Gard: ethically ensuring access to innovative treatment (Cambridge: Cambridge University press, 2017)
 David Sullivan, The ethics of the Charlie Gard case (Oxford: Oxford university press, 2017)
 Dominic Wilkinson, Beyond resources: declining parental requests for futile treatment (Cambridge: Cambridge University Press, 2017)
 PMC, (2017). “The Charlie Gard case: British and American approaches to court resolution of disputes over medical decision” [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5712473/.
 Brain Cummings, The medical remedies: Charlie Gard case (United Kingdom: Thompson Advantage Books, 2017)
 The Children Act 1989
 Denil Sokol, Charlie Gard Case: an ethicist in the courtroom (Australia: Pearson Australia, 2017)
 Julian Savulescu, Is it in Charlie Gard’s best interest to die (Oxford: Oxford University Press, 2017)
 John Lantos, The tragic case of Charlie Gard (London: Pearson Education Limited, 2017)
 Andrew G Harmon, (2017). “The case for Charlie Gard” [Online]. Available: https://imagejournal.org/2017/07/11/case-charlie-gard/
 Clare Dyer, Law, ethics and emotion: The Charlie Gard case (London: Sweet & Maxwell, 2017)
 Wesle J Smith, Culture of death: the age of do harm medicine (United Kingdom: Edward Elgar publishing, 2016)
 David Hirsch, Consent to medical treatment in cases of legal incapacity lessons from the Charlie Gard case (London: Bloomsbury Publishing, 2018)
 Peter Singer, Practical Ethics (Cambridge: Cambridge university press, 2011)
 John Paris, Approaches to parental demand for non-established medical treatment (London: Pearson Education Limited, 2018)
 John C Bester, Charlie Gard and the limits of the harm principle (Sydney: Ventura press, 2018)
 Hugo Lagercrantz, observations on the case of Charlie Gard (Australia: CCH Australia Limited, 2018)
 Carle Zimmerman, Family and civilization (Cambridge: Cambridge university press, 2014)
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