Sunday, 23 July 2017

Difficult ethical issues in Charlie Gard case

The news of death threats sent to staff at Great Ormond Street Hospital is disturbing. Whatever the opinion held on the issues surrounding the care of baby Charlie Gard, it has to be acknowledged that these are complex.

It would be easy enough to adopt the position that it should always be the parents choice to decide on the best treatment for their child, but this cannot always trump the legitimate concerns and responsibilities of doctors and nursing staff. It would of course be ideal if all choices on treatment, or of withdrawal of treatment and life support, could be made with agreement of both parents and doctors. But this cannot always be the case.

In the most difficult cases where there is disagreement about life support it will inevitably be decided by judges and through the legal process.

When the case was first heard I was asked as a medical ethicist to make a comment to the media. I chose not to do so because I could not know the full details of the case. This is true for most of us, and for many of those who chose freely to comment on it.

I can only comment in general terms, and not about a specific case. The facts need to be considered with compassion and understanding for all those involved - the medical staff and the parents, and of course baby Charlie.

We cannot expect doctors and nurses simply to provide treatment regardless of the overwhelming balance of probability that the treatment will cause more harm than it would relieve suffering. What we do understand about this particular case is that the treatment available in the USA has only a small chance of success.  Yes, that chance should be considered.

We might consider that any chance should be taken, but this would ignore the potential for needless suffering.

It is often said that the first rule in medicine is to do no harm. This is of course overly simplistic. It is often the case that treatment has both the potential for harm as well as for benefit. It is then a question of the balance of that benefit to harm.

These can be difficult to assess,  and the more so when dealing with the care of a baby. It is certainly the case that the progress in neonatal care and the improved outcomes would not have occurred if doctors had not pushed boundaries.

Whatever the 'rights' and 'wrongs' in the case of baby Charlie Gard, the staff at Great Ormond Street Hospital have legitimate concerns and are acting ethically in respect of their duties and responsibilities. They do not deserve to be threatened and abused.

Meanwhile our thoughts must be with the parents and with their baby. The parents, Connie Yates and Chris Gard are acting with great dignity and love for their child. They did not condone abuse and have also faced "nasty and hurtful remarks". They deserve to be heard and respected. So also do the doctors and nurses. Abuse of parents or doctors does not serve the interests of this baby, and it is unclear what the motives are of those behind the abuse.




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