THE BRAIN SURGEON’S VERDICT

Alfie Evans’ death is a tragedy. But those who accuse doctors of murder are guilty of ignorance and cruelty, says a former top brain surgeon

You cannot terrorise those trying to help their patients

THE news was as tragic as it was inevitable. Alfie Evans, the 23-month-old boy whose rare degenerative brain condition sparked a long legal battle over whether his life support should be withdrawn, lost his fight for life yesterday.

Alfie’s parents, who fought so hard for their son, should be allowed to grieve in peace. Nobody can blame them for refusing to accept the inevitability of his death. But their grief and despair have been hijacked by mob sentiment, provoked by extremists acting as provocateurs to stir up hatred against the very people who had done so much to help him.

As a senior neurosurgeon, I am not only familiar with matters of life, death and the terrible burden of deciding where the boundary between the two might lie. I know, too, about the vast kindness, endless dedication and humanity of my colleagues in the Health Service who must be protected from the sort of vilification – and even death threats – we have seen in recent days.

Who can forget the grotesque sight of the baying mob, who last week attempted to storm Alder Hey Children’s Hospital, where Alfie was cared for until the end by a skilled and committed team of doctors and nurses?

Police were called to guard staff and other patients from the protesters. Alfie’s father, Tom Evans, threatened to take out private prosecutions for murder against three doctors who had so diligently cared for his son.

Those who have distastefully sought to make political capital from this tragic episode include pro-life campaigners, libertarians who think the State has no place in deciding when treatment should be withdrawn, advocates of quack medicines and even the rabble-rousing former American congressman Joe Walsh, who tweeted last week: ‘Why does an American need an AR-15 [a type of gun]? To make sure what’s happening to Alfie Evans never happens here.’ Does he seriously suggest that Alfie’s doctors and nurses should be murdered with assault rifles?

The mob shouted ‘Save Alfie Evans’ while attacking those who spent nearly two years trying to do precisely that.

FOR all their efforts, Alfie could not be saved. All that could be done was to arrange the best palliative care so his young life could end with dignity and without undue discomfort. I watched the Alfie Evans case with great personal interest. My own son came close to dying from a brain tumour when he was only a few months old but was saved by surgery.

I later became a paediatric brain surgeon myself and cared for many children, some with terrible brain damage or fatal, malignant tumours.

I loved my patients and I learned of the overwhelming force of the love we have as parents. But I also learned that children sometimes die, however hard we struggle to keep them alive, and that some children’s brains can be so damaged that they are not capable of a meaningful existence.

The question of what constitutes a meaningful existence is dreadfully difficult, especially if a child with severe brain damage can only survive by being kept on life support, as was the case with Alfie.

It is probably the hardest question in medicine, and best dealt with by agreement between doctors and parents. And if the relationship between the parents and doctors breaks down – a rare but deeply tragic occurrence – the decision must be made in a court of law.

How else is the problem to be resolved? With assault rifles? By a howling mob?

Those who rail against the supposed injustice of Alfie’s treatment would do well to read the lengthy judgment of Mr Justice Hayden, who presided over the High Court application for the hospital to be allowed to take Alfie off a life-support machine, a decision that ultimately brought his short life to a close.

The 23-page document describes in painstaking detail how the hospital and its doctors bent over backwards to accommodate the wishes of Alfie’s parents. Some of the details are distressing. Alfie was first diagnosed with encephalopathy – a condition in which the brain is steadily destroyed – when he was just six months old. His condition grew inexorably worse until he became unresponsive and his only physical reactions were spasms.

A brain scan carried out on February 2 confirmed the progressive destruction of the white matter of Alfie’s brain which, doctors said, appeared ‘almost identical to water and cerebrospinal fluid’.

The diagnosis of specialists from Alder Hey – which the judge acknowledged as ‘worldclass’ – was reviewed by specialists from Great Ormond Street, Munich and Rome. They agreed Alfie’s condition was incurable and that he was in a semi-vegetative state. Every care, in other words, was taken at every stage.

With all the specialists agreeing that treatment was futile, the only dispute was over how long he should be artificially kept alive – a decision in which the court weighed Alfie’s needs and his quality of life.

Last week, the judge refused the family’s request to take their son for treatment in Rome and criticised an adviser of theirs – law student Pavel Stroilov, who is linked to the pro-life Christian Legal Centre – as a ‘fanatical and deluded young man’ whose legal advice had come close to contempt of court. Such is the nature of the people deriding our medical profession in such destructive terms.

Those in the screaming mob accusing doctors and nurses of murder had no idea as to how Alfie’s condition could be treated. They had no understanding of the nature of catastrophic brain damage and what it can mean.

This is not an argument about the medical profession playing God. Instead we are talking about long hours of dedicated labour and expertise which must take precedence over mob sentiment.

BY ALL means campaign for your beliefs, but you have no right to terrorise the doctors and nurses who are doing their best to help their patients – work which is difficult enough as it is. And why frighten the other sick children in the hospital? How can you possibly justify that?

Yes, the case of Alfie Evans was horribly difficult, but the rule of the mob has no part to play. The people who took part in the demonstrations outside Alder Hey should be ashamed of themselves.