How do medics reach decisions in cases like that of Alfie Evans?

Alfie Evans Credit: Press Association Images

The court battle over the treatment of Alfie Evans, who died on April 28, saw his parents in dispute with medical staff caring for their child.

Judges had to weigh up complicated issues in reaching their decisions over whether the family should be able to continue seeking to continue treatment.

Alfie's life support was withdrawn after his parents lost a final appeal, and he died several days later.

Here, experts answer some of the questions related to such cases.

  • Why would the decision to withdraw treatment from a child be made?

Professor Russell Viner, of the Royal College of Paediatrics and Child Health, said: “Every action and decision is taken in the best interests of the child, and decisions on care, including the withdrawal of treatment, are always made with the involvement of parents.

“We can’t comment on the specifics of the case, only the medical team treating Alfie, and the legal team, will know the exact details and they are bound by patient confidentiality.

“However, we feel it is important for the public to know that decisions to withhold or withdraw treatment from a child are not made lightly."

Alfie's parents Kate James and Tom Evans. Credit: Alfie's parents Kate James and Tom Evans
  • In what circumstances are decisions to withhdraw treatment taken?

According to the UK’s framework, treatment is withdrawn if it is unable or unlikely to result in the child living much longer, where it may prolong life but will cause the child unacceptable pain and suffering, or if an older child with a life-limiting illness repeatedly makes it clear they do not want treatment and this decision is supported by parents and doctors.

  • How often are decisions like this made?

Prof Viner said decisions on withdrawing treatment from children are made “frequently”.

He said: “In the vast majority of cases an equal decision is made to withdraw treatment and it is rare that there is disagreement.

“The cases where this is a significant difference in view are the ones that grab the media headlines.”

  • Why did Alfie continue to breathe for several days after life support treatment was removed?

Professor Dominic Wilkinson, consulant neonatologist at the John Radcliffe Hospital and director of medical ethics at the Oxford Uehiro Centre for Practical Ethics at the University of Oxford, said the fact that Alfie continued to breathe on his own did not mean that doctors were wrong.

Speaking before Alfie's death, he said: “The reason for stopping the breathing machines is simply that his serious condition is not treatable, and will not improve.”

He added: “Given the nature of Alfie’s condition, the doctors have wanted to provide him with palliative care, focused on his comfort, and focused on making his remaining time as good as possible.”

Alfie was being treated at Liverpool’s Alder Hey Children’s Hospital Credit: Alfie is being treated at Liverpool’s Alder Hey Children’s Hospital
  • Is withdrawing life support euthanasia?

Prof Wilkinson said: “Providing palliative care is not euthanasia. It is about providing ‘intensive caring’ rather than intensive medical care.

“It does not end the child’s life. Rather, it supports the child, and the child’s family, for as long or as short as they remain with us.”