The Case of Alfie Evans

The legal battle between Alfie Evans’s parents and Alder Hey Children’s Hospital has been one of the biggest medical controversies in Western media recently. This case has given rise to a storm of political and legal debate, with interest groups using tactless means to gain publicity.


Alfie was a two-year-old who suffered from a degenerative and terminal brain condition, and had been in a semi-vegetative state for over a year. After prolonged disagreement with Alfie’s parents over his treatment, the hospital applied to the high court in December 2017 to withdraw ventilation. Alfie’s parents lost cases in the High Court and the Court of Appeal, and were rejected by the Supreme Court and the European Court of Human Rights for appeals. On the 28th April 2018, Alfie died after the removal of life support for six days.


Alfie and his parents (Source: Save Alfie Evans)


This is a deeply saddening situation, with over 600,000 signatures supporting a petition calling for his release to a hospital of Alfie’s parents’ choice. Understandably, Alfie’s parents were determined to continue with Alfie’s life support. However, it is important to consider why the doctors and judges have decided to end life support for Alfie.




The legal debate


In summary, the grounds for which the High Court judged to end ventilatory support for Alfie consist of the loss his “basic sensory functions” from the degenerative disease; his complete dependence on the ventilation system for life support; and the lack of prospect for treatment or diagnosis, which I believe was the most important reason. Alfie’s parents appealed to move Alfie to an Italian hospital for further treatment, hoping that there had been a misdiagnosis. Although Alfie was granted Italian citizenship in light of this case, many medical professionals believe that such a transfer would be more damaging than beneficial for the child, especially since Alfie would not receive improved treatment elsewhere. According to Professor Dominic Wilkinson, a professor in Oxford University specialising in medical ethics, prolonged use of “invasive and intrusive forms of life support” can cause “pain and discomfort” for children. In this case, the judge focused on the situation that was most favourable to Alfie, ethically and medically, and palliative care has proven to be the most suitable and caring for Alfie’s needs, despite the immense pain and grief caused for his family.


This legal dispute highlighted the ethical dilemmas raised when a patient is unable to make their own decision or give consent, since the professional judgment of doctors may contradict the wishes of the patient's family. Although parents have a legal responsibility to consent to medical treatment for their children, enforced by the Children Act of 1989, doctors also have a duty of care towards their patients. This means that doctors should fulfil their professional obligation, otherwise they may become liable for injuries that arise from their medical negligence. In this case, both the Evans and the doctors are adamant that they represented the best interests of the child, therefore referral to the Court was the last resort.




Public controversy


Public condemnation of the hospital and the High Court judge has been unfair and disproportionate. The case has attracted attention from pro-life Christian lobbies, with the Christian Legal Centre (CLC) representing the Evans. Pavel Stroilov, a law student linked to the CLC, allegedly even advocated the decision to prosecute the Alder Hey doctors for murder. Furthermore, pro-life Facebook pages have posted a barrage of inadequate and nonsensical arguments, criticizing the “horrible” “UK health system” for “hand[ing] out death sentences”. Moreover, American anti-vaccination and gun-enthusiasts have blamed the British government for “stripping [people’s] rights” and “owning [people’s] children”; while foreign political and religious leaders, including Antonio Tajani (the European Parliament President), Andrzej Duda (the Polish President) and the Pope, publicly opposed the Courts’ decisions and proclaimed that Alfie “must be saved”. A German paediatrician may have even linked the case to the Nazi’s treatment of the disabled, commenting that Germany has learnt “because of [their] history, that there are things that you do not do with severely disabled patients.” Such a comparison is astonishing as the Courts did not withdraw Alfie’s life support because of his disability, but because of the further harm inflicted upon him. These groups are claiming to act in the interests of Alfie, making outrageous claims about the British government and consolidating misconceptions about the British legal system.


Tweet by Republican Senator Ted Cruz in response to the case.


Unfortunately, Alfie’s case has also been manipulated by some Republicans in the US to criticize the NHS, namely Ted Cruz, who tweeted: “It is a grim reminder that systems of socialized medicine like the NHS vest the state with power over human lives, transforming citizens into subjects”. Mike Huckabee, who twice unsuccessfully ran for the Republican presidential nomination, also claimed that “the British government is deciding it’s God and it is going to make the decision of life or death”, and that Alfie Evans was treated as “disposable and expendable”. Such statements are completely disproportionate and uncalled for, with no consideration for the courts’ reasoning behind their judgement. The NHS nor the Alder Hey doctors are at fault, as they were fulfilling their obligation in defending their medical opinion and advice. The suggestion that “parental rights are merely leased out by the state” is absolutely ridiculous - on the contrary, there have been no removal of Evans’ parental rights. Instead, the law has had to assess the degree of harm caused to Alfie by either the continuation or withdrawal of treatment.


It is dangerous that these people have cruelly latched onto this case for political attention. British law acts in the interests of the child, not the parents or doctors of the patient, nor political or religious concerns. Public individuals and groups should be much more respectful of the Evans’ privacy and grievance, and not exploit their pain to promote their ideology. Although the courts’ decisions to end Alfie’s treatment has led to his unfortunate passing, it is important to celebrate his life, however short, and incessantly support his parents through a difficult period.


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