The judgment of the court which accompanies this press release gives the court’s reasons (1) for refusing Mr and Mrs. Wyatt permission to appeal against declarations made by Hedley J on 21 April 2005 relating to Charlotte’s treatment; and (2) for dismissing their appeal against the judge’s decision to continue the declarations at that point, rather than to wait until the circumstances arose which required an actual decision to be made.
This case has received a great deal of media attention, and the court thinks it very important that the public should understand both what the case is about, and what it is not about. The case is not, and never has been about the withdrawal of treatment from Charlotte in order to allow her to die. It is not about whether or not Charlotte should be subject to a “do not resuscitate” (DNR) policy. Nor is it about the level of care provided for her. Charlotte has been profoundly disabled from birth, but she has been kept alive by the devoted care and treatment she has received from the Trust’s nursing and medical staff. Without that care and treatment she would undoubtedly now be dead.
During the course of the hearing, the court was pleased that Mr. and Mrs Wyatt, through their counsel, were able to give a public and unequivocal acknowledgement of the outstanding care Charlotte has received. That acknowledgement was, in the court’s judgment, well made.
What the case is about is what should happen if Charlotte contracts an infection or suffers some other crisis which is likely to lead to her death, but which cannot be treated by drugs and thus requires her to be ventilated if she is to stand any chance of remaining alive.
The dilemma arises because amongst her other disabilities, Charlotte suffers from chronic lung disease of prematurity. As described by the consultant paediatrician in charge of Charlotte’s care in September 2004, her lungs are severely damaged because she was born prematurely, and in order for her to survive, she had to be placed in an incubator and ventilated immediately after her birth. This required pressurised gas to be blown into the lungs. That, in turn, caused damage to her lung tissue, resulting in scarring. The scarring reduced the ability of the lungs to exchange oxygen and carbon dioxide. The more premature the baby, the longer the period of ventilation required, and the more likely that such a baby will have chronic lung disease.
The medical opinion which Mr. Justice Hedley accepted in October 2004 and April 2005 was that it was not in Charlotte’s interests to be ventilated in the circumstances set out above. There were, in essence, two reasons for this view. They were, firstly, that the doctors thought the process of ventilation might itself kill Charlotte, and so deprive her of a peaceful death in the arms of her parents. Secondly, even if she survived ventilation, the process itself would be painful for her and it would not result in any improvement in her underlying condition: indeed, it might make it worse. Ventilation, therefore, at best would cause Charlotte additional pain and suffering, and would serve no purpose.
The court was entirely satisfied from the documents and from the submissions made by counsel that the Trust (acting, as it does, on behalf of the doctors and nurses who have devoted so much of their time and expertise to keeping Charlotte alive) did not invoke the court’s jurisdiction lightly, but did so because it thought it contrary to Charlotte’s bests interests to subject her to what it believed (and continues to believe) would be increased suffering for no commensurate benefit.
When the case came back before the judge in March 2005, Mr and Mrs Wyatt’s case was that Charlotte in the past few months had not only confounded the doctors by surviving, but that there were some improvements in her condition, notably a reduction in her reliance on an artificial supply of oxygen. They argued, accordingly, that since Charlotte’s life was not currently intolerable, ventilation which saved her life and could maintain her current state was in her best interests. The doctors did not agree.
In his April 2005 judgment, Hedley J found that there had been no change in Charlotte’s underlying condition, and that she remained a profoundly disabled baby. In particular, her brain had not grown to any significant extent. After a careful examination of all the arguments for and against ventilation, he decided for the second time that ventilation was not in Charlotte’s best interests, and he continued the declarations.
The Court of Appeal concluded that the judge was entitled to continue the declarations. The court was, however, unable itself properly to evaluate the latest information about Charlotte’s condition, and accordingly decided to accelerate the review of the orders which the judge himself had directed. That will, accordingly, take place shortly.
ENDS
