ความคิดเห็นทั้งหมด : 2

Should we pull the plug? Ethics Discussion


   Parents in fight to keep their baby alive
By Stewart Payne
(Filed: 28/08/2004)

The parents of a premature baby were yesterday preparing to challenge doctors who have said they will not resuscitate their child when it develops life-threatening breathing difficulties.

The hospital trust has supported the stance taken by its medical experts and said it will seek a court ruling if the parents insist on 10-month-old Charlotte Wyatt being resuscitated in an intensive care unit. Darren and Debbie Wyatt said they would challenge the trust if the matter goes to court.

Charlotte was born three months premature at St Mary"s Hospital, Portsmouth, weighing just one pound and measuring only five inches.

She has never left hospital, has stopped breathing three times due to serious heart and lung problems, and doctors say she would not survive in the long term because her lungs are so severely damaged.

When, as anticipated, she requires a ventilator again, the hospital has told the Wyatts it is prepared to keep her alive long enough for them to attend at her bedside, but insists it would be "against the child"s interests" artificially to resuscitate her.


Her parents spoke of their dismay at the hospital"s decision and described their daughter, who is now 18 inches long and weighs 10lbs, as a "fighter" who should be given every chance of life.

Mr Wyatt, 32, from Portsmouth, said: "The hospital is trying to get us to pull the plug, but I cannot do that. I would have to live with that for the rest of my life. I simply cannot make a decision to end Charlotte"s life.

"She has been fighting for 10 months and I"m not prepared to let her down. We need to be able to say we did absolutely everything in our power to help her.

"If the hospital tries to get a court order we will have to fight that. We still hope that one day Charlotte might come out of hospital. We have a feeling that she can pull through.

"Until we have no hope left we will keep fighting. The more she grows the more her lungs grow, and create more tissue.

"She may still suffer from lung disease, but science moves so fast that in years to come they may be able to do things for her they can"t do now."

Mr Wyatt, a chef, and his 23-year-old wife, have contacted Great Ormond Street Hospital in London to see if it would agree to care for Charlotte. Mrs Wyatt said Charlotte is now taking more notice of her surroundings and said she "really brightens up" when she sees them and their 20-month-old son Daniel. "We will never give up on her but it feels like the hospital are preparing to give up on her.

"I think she deserves better than that after all she has been through, and we will fight all the way to keep her going."

The views of medical staff at Portsmouth Hospitals NHS Trust are made clear in minutes of a meeting between doctors and the Wyatts. These state: "The trust would be prepared to go to the courts rather than send Charlotte to the intensive care unit. From past experience the court would agree with the doctors as they would feel that doctors cannot be forced to treat a child in a way they believe to be against the child"s best interests - despite the wishes of the parents."

Dr Joanna Walker, clinical director of paediatrics at St Mary"s Hospital, said: "When a child has a life limiting condition we work cooperatively with the parents and family always to act in the child"s best interests."

Doctors can decide to withhold treatment if they believe they are acting in the patient"s best interests and have discussed the decision with the patient or relatives.
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Daily Telegraph 30 September 2004 United Kingdom





Posted by : Phoenix , Date : 2004-09-30 , Time : 20:14:06 , From IP : 203.156.42.11

ความคิดเห็นที่ : 1


   Baby case "raises basic rules of humanity"
By Sally Pook and Nicole Martin
(Filed: 08/10/2004)

The judge given the task of deciding the fate of Charlotte Wyatt told the High Court yesterday that the case had raised some of the most fundamental principles that underpin humanity.

Mr Justice Hedley, who took 40 minutes to read the 21-page judgment before a packed courtroom, told Charlotte"s parents that he had given the case his "most anxious and closest attention".

"I am only too aware of my own limitations in making so momentous a decision," he said.

He began by stressing that his judgment lay in not deciding whether Charlotte should live or die, but how and when she should die.

"What is the role of the court in all this?" he asked. "Any civilised society must have the means by which intractable disputes, whether between the state and the citizen or between citizens themselves are to be resolved."

On the basis of medical evidence, the judge said it was clear that Charlotte experienced pain. "Whether she can experience pleasure, no doctor knows, though most doubt it," he said.

Although Charlotte"s parents, Debbie and Darren Wyatt, recognised the profoundly pessimistic medical prognosis, he said, they had not abandoned hope.

"They believe it is their duty to maintain life as they do not believe she is yet ready to die."

The baby, he added, had no ability to exercise a choice.

"Whilst the sanctity of her life and her right to dignity are to be respected, she can exercise no choice of her own.

"In those circumstances someone must choose for her. That is usually her parents but here it is the court.

"That choice must be exercised on the basis of what is in her best interests. It is the understanding and application of that concept that presents the true difficulty in this kind of case."

The judge said that despite being aware of his limitations in making a decision between these two opposing parties, a decision "there simply had to be". "This case evokes some of the fundamental principles that undergird our humanity," he said.

"They are not found in Acts of Parliament or decisions of the courts but in the deep recesses of the common psyche of humanity."

The judge told the court that he did not believe any further aggressive treatment, even if necessary to prolong her life, was in Charlotte"s best interests.

In reaching his decision, the judge said he had considered how, not if, Charlotte should die.

"As a society we fight shy of pondering on death. Yet inherent in each of us is a deep desire both for oneself and for those we love for a "good" death," he said.

"It seems to me therefore that in any consideration of best interests in a person a risk of imminent death is that of securing a "good" death.

"It would be absurd to try to describe that concept more fully beyond saying that everyone in this case knows what it means - not under anaesthetic, not in the course of painful and futile treatment, but peacefully in the arms of those who love her most."

He added that in making his decision he had seen not just a physical being but "a body, mind and spirit expressed in a human personality of unique worth who is profoundly precious to her parents".

"It is for that personality of unique worth that I have striven to discern her best interests. It is my one regret that my search has led to a different answer than that sought by these parents."

The judge added that it would not be right for him to part with the case without acknowledging "the dignity which these parents have shown in their sorrow or the commitment that they have shown to Charlotte".

"Their acknowledgement of the medical care Charlotte has received was a proper tribute to the treating staff and it is always refreshing to see a generous spirit displayed in adversity."

The judge ended by saying that although he had no doubt about the law, it left him "a little uncomfortable".

"The only way I can allay my discomfort is to remind myself in my consideration of Charlotte"s interests that Mr and Mrs Wyatt know her best," he said.

"In approaching the case in this way, I think I come closest to giving proper weight to their views whilst discharging the responsibility placed on the court."
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ผมชอบวิธีการที่ศาลอังกฤษจะต้อง "ให้เหตุผล" อธิบายต่อคนฟัง (หรือจริงๆแล้วต่อมโนสำนึกของตนเองด้วย) และในรายนี้ การแสดงความคิดเห็นต่อ Principle of autonomy และ humanity ในมุมมองของศาลนั้นชัดเจนและด้วยภาษาที่สวยงามมาก ดังนั้นทั้ง contents และภาษาน่าศึกษามากครับ




Posted by : Phoenix , Date : 2004-10-08 , Time : 20:14:48 , From IP : 203.156.40.130

ความคิดเห็นที่ : 2


   Doctors" dilemma: should they prolong a life just because they can?
By Celia Hall, Medical Editor
(Filed: 08/10/2004)

The added tragedy in the plight of Charlotte Wyatt is that her case had to go to court at all.

The decision over whether or not she should be allowed to die has been taken out of the hands of those who love her and know her best, her anguished parents and the doctors and nurses who have cared for and fought to keep her alive for almost a year.

Her case may be unusual but it is not unique. In 15 years at least four similar cases have been decided by a judge, but in many more, the decisions, no less painful, have been made in the privacy of the home, of doctors" offices and almost certainly in churches and chapels.

Charlotte"s case came to court because her parents did not agree with her doctors that it would be in her best interests not to resuscitate her again. The court has heard that the baby is severely handicapped and in pain.

That she is alive at all is a miracle. She was born three months prematurely, weighing one pound. This no doubt compounded her parents" determination that doctors should continue to strive to keep her alive.

"This is very tough. Her parents must have been told many times that they should not expect her to live, and yet she has," said Prof Margaret Brazier, the chairman of a new working party set up by the Nuffield Council on Bioethics to look into the problems around prolonging life in foetuses and newborn babies.

"There has been a whole series of cases that have gone to the courts in the past 23 years where patients and doctors have disagreed over a baby or very young child," said Prof Brazier, who is professor of law at Manchester University.

"These cases are always very private tragedies. Taking them to court only adds to the tragedy.

"We want to learn the lessons from those cases that have been resolved privately and see if we can find some sort of guidance that will help in the decision making for both parents and doctors in the future."

The first consideration for doctors is to do no harm. The second is always to act in the best interests of their patient.

Rob Williams, the chief executive of Bliss, the support charity for premature and sick babies and their parents, said:

"It must be the worst thing in the world to walk away and wonder if you have let your child down, if you have done everything you could for your baby. This must be real torture which probably never leaves you.

"There are no easy options here. Our view is that this is an area where there should never be rules. Every case is different.

"Ideally these decisions should be made in partnership. We do not want to be like Holland where there is a law that no babies are resuscitated if they are born at or before 25 weeks."

Ethicists feel that there will be more cases settled in the courts as science increasingly keeps tiny babies alive.

The question that doctors are increasingly asking of themselves is whether they should keep a baby alive just because they can.
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Posted by : Phoenix , Date : 2004-10-08 , Time : 20:20:10 , From IP : 203.156.40.130

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