The Corner

Health Care

When Doctors Disagree with Doctors

(Pxhere)

Popular reaction to the Alfie Evans case in Liverpool has fallen into the well-worn grooves of the culture war. People assume that their response to any number of earlier high-profile medical controversies involving a clash between parents and doctors will do in this case too. The dispute at Alder Hey Hospital did start as a disagreement between parents and doctors, but then it became a disagreement between doctors and doctors.

Mind you, the pediatricians of Bambino Gesù in Rome have been professional and diplomatic. They point no fingers at Alder Hey. They merely offered to take the child and treat him after the Liverpool doctors had indicated their intent to remove life support. Alfie’s parents wanted to place him in the care of the Italian hospital. Alder Hey said no and refused to release him. The courts ruled in favor of Alder Hey and against the parents.

“Sometimes, the sad fact is that parents do not know what is best for their child,” Dominic Wilkinson, an Oxford neonatologist, tells CNN, defending the courts and Liverpool doctors while diverting attention from the immediate question that the present controversy raises: Confronted with divergent expert medical opinions, does not the patient or, as in this case, his proxy have the right to decide between them?

On the question of how best to care for Alfie, doctors disagree with one another, as doctors will. It’s why patients seek second and third opinions. Liverpool and Rome arrived at different treatment plans. “He has done his research well,” Justice Anthony Hayden said of Alfie’s father, Tom Evans, before blocking him from acting on the decision to which that research led him.

“Sometimes parents are right to rebel,” Jenni Russell writes in the Times of London, coming to her conclusion reluctantly but resting in it confidently:

Let’s remember, for instance, the case of Ashya King, the five-year-old whose parents removed him from Southampton Hospital when doctors insisted that innovative cancer treatment abroad would be a cruel waste of time. Three years later he is flourishing. Alfie cannot flourish but perhaps doctors are wrong to declare that the time for intervention is over. . . .

Alfie’s parents are not asking the NHS to do or spend more. They just want permission to take their son abroad. Since December, when Alder Hey first decided to end Alfie’s ventilator support, they have been fighting legal battles to transfer him to an Italian hospital which is prepared to keep him alive a little longer.

Alfie’s parents should want to transfer him there if only to deliver him, and themselves, from their now-poisoned entanglement with Alder Hey. Moreover, their relationship with Bambino Gesù sounds simpatico. The father now says he is talking with Alder Hey about taking Alfie home. Once the boy is free from the hospital and the National Health Service, their claim to veto power over his parents’ medical decisions for him could be hard to sustain, although no one can say whether the courts would still bar him from leaving the country, perhaps for the rest of his life, whether it be long or short. And in any case the prospect of an Italian air ambulance meeting him at his front door to fly him to the pope’s backyard in Trastevere any time soon would appear dim. Alfie’s next likely stop is home, not Rome. One step at a time.

Three days after doctors in Liverpool cut his artificial ventilation, he was breathing unassisted, his father reported. “Doctors are not omniscient in their assessments of difficult cases,” Russell notes.

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