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Charlie Gard

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  • edited July 2017
    GOSH’S POSITION STATEMENT
    HEARING ON 13 JULY 2017
    1. Charlie is a beautiful, tiny baby afflicted by one of the cruellest of diseases. His
    depletive genetic disorder leaves him with no muscle function at all now and deprived
    of his senses, unable to breath and, so far as can be discerned after many months of
    encephalopathy, without any awareness. At the moment, he is on a low dose of oral
    morphine. Before that was started quite recently, all of those caring for him at GOSH
    hoped very much that Charlie did not experience pain. They did so in the knowledge
    that if he did not, it was because he had no experience at all because he was beyond
    experience.

    2. In one respect, Charlie is immensely fortunate and that is in having parents of great
    fortitude and devotion. All at GOSH wish to pay tribute to their dedication to their only
    child and their tireless pursuit of a cure for him. The hospital feels certain that they have
    done all that they have for Charlie out of love and because they could not have done
    anything less even if they had wanted to.

    3. Great Ormond Street is a children’s hospital. It looks after some of the sickest children
    in the world and seeks to improve the quality of life of each. Many of the patients seen
    make enormous strides and for some there is a cure. But for some, there is a cloud
    without a silver lining. As an institution and as individuals, GOSH and its staff strive
    to forge relationships of trust and understanding with all families the better to support
    its child patients in difficult times.

    4. It is only very rarely that there develops between GOSH and a child’s parents a dispute
    which requires judicial resolution and to the hospital’s immense regret, that has
    happened in Charlie’s case. All at the hospital have given anxious thought as to why
    Charlie’s situation, which though desperate is not, sadly, exceptional has developed in
    such a contentious way.

    5. Looking back over the months since the end of March, the hospital perceives that there
    has been one important agreement and two important disagreements. Those caring for
    Charlie and his parents have agreed about Charlie’s current lack of quality of life. When
    he gave evidence to the High Court in April Mr. Gard said this: “He’s not got a quality
    of life. I’m not going to stand here and say he’s fine. He’s not got a quality of life but
    that’s not what we’re fighting for. We’re fighting for a chance to give him the treatment
    that he needs to possibly improve.”

    6. As to the disagreements, one is a difference of opinion about the risks, benefits and
    ethics of providing four compound nucleoside treatment for Charlie after a time when
    his brain had become profoundly affected by his genetic disease. The other has been a
    more fundamental and unbridgeable divide of principle.

    7. Charlie’s parents fundamentally believe that they alone have the right to decide what
    treatment Charlie has and does not have. They do not believe that Great Ormond Street
    should have had the right to apply to the Court for an independent, objective decision
    to be made. They do not believe that there is any role for a Judge or a court. They
    believe that only they can and should speak for Charlie and they have said many times
    that they feel they have been stripped of their rights as parents.

    8. GOSH holds and is bound by different principles. A world where only parents speak
    and decide for children and where children have no separate identity or rights and no
    court to hear and protect them is far from the world in which GOSH treats its child
    patients.

    9. Throughout this court process, Charlie has been represented by his Cafcass Guardian
    who has visited him in hospital, spoken to Charlie’s parents, nurses and doctors and
    written reports that ensure that as much as is possible for a desperately unwell baby,
    Charlies own viewpoint is articulated and given weight. When asked what happens to
    the role of the Guardian if their belief that only they have the right to decide on Charlie’s
    treatment is correct, Charlie’s parents answer that he does not need a Guardian because
    they will speak for him.

    10. GOSH believes in its core that every patient is his or her own, unique and special person
    and that it owes a duty of care to each. The hospital’s mission statement is “The child
    first and always” and the hospital does not treat any child differently or as less of an
    individual because of the severity of illness or disability or because of infancy. If
    anything, special care is given to discover and work out with parents what is best for
    very vulnerable patients who cannot speak for themselves.

    11. This is not just Great Ormond Street’s core belief, it is its duty. The GMC’s Guidance
    “0-18 years: guidance for all doctors” emphasises two matters in particular. The first
    is treating children as individuals and acting in the child’s best interests. The second is,
    if it is necessary to do so, putting the child first. Paragraph 4 of the Guidance says:
    “When treating children and young people, doctors must also consider parents and
    others close to them but their patient must be the doctor’s first concern.”

  • 12. The decisions of the High Court, the Court of Appeal and the Supreme Court have all
    reaffirmed the fact that for the hospital and those who work there, Charlie’s welfare is
    paramount. And importantly, GOSH notes this part of the Supreme Court’s decision
    made on 8 June 2017:
    “Finally, the European Court of Human Rights has firmly stated that in any
    judicial decision where the rights under Article 8 of the parents and the child
    are at stake, the child’s rights must be the paramount consideration. If there is
    any conflict between them the child’s interests must prevail.”

    13. At the heart of Charlie’s parlous and terrible condition is the question, how can it be in
    his best interests for his life-sustaining treatment to be withdrawn? Charlie has been
    treated on GOSH’s neonatal intensive care unit for many months now and very sadly,
    the question that arises for him arises for other patients and families at the hospital too.
    GOSH has treated over a thousand patients with mitochondrial disease and offers
    pioneering treatment, including nucleoside treatment, where appropriate. Despite all
    the advances in medical science made by GOSH and the other hospitals around the
    world, there remain some conditions that we cannot cure and we cannot ameliorate.

    14. It has been and remains the unanimous view of all of those caring for Charlie at Great
    Ormond Street that withdrawal of ventilation and palliative care are all that the hospital
    can offer him consistent with his welfare. That is because in the view of his treating
    team and all those from whom GOSH obtained second opinions, he has no quality of
    life and no real prospect of any quality of life.

    15. The team did not come to that view alone. Where there are very difficult and serious
    decisions to be made, the hospital seeks out and welcomes opinions from others. This
    is a vital part of the duty of care where there may be room for doubt. Before asking the
    Court to make a decision, GOSH sought independent opinions from three different
    specialists each of whom came to the ward and assessed Charlie.

    16. The individuals cannot be named but reports were obtained from a paediatric
    neurologist at a London hospital and a report from a paediatric intensive care specialist
    at a different London hospital. In addition, a second opinion on nucleoside treatment was obtained from a mitochondrial specialist in the North of England. All three
    independent opinions confirmed the parlous nature of Charlie’s condition and his very
    poor prognosis. The view of the North of England consultant was that a three month
    trial of NBT treatment would not be in Charlie’s best interest.

    17. The Judge was provided with these independent reports. But in addition, Charlie’s
    parents also instructed their own expert. That doctor (who also cannot be named)
    assessed Charlie in April. He reached the same conclusions about Charlie’s condition
    as the specialists whom GOSH had consulted.

    18. At a three day hearing in April, the Court listened to evidence from two of Charlie’s
    treating doctors at GOSH and the nurse who had spent the most time by his bedside.
    They were able to describe the deterioration they had seen in Charlie since his
    admission. The Judge also heard from the American professor contacted by Charlie’s
    parents who agreed to treat Charlie with as yet unlicensed drugs under what in America
    is called the compassionate use exception. (Treatment would be conditional on the
    Federal Drug Administration authorising first use ever in a human being of 4 NBT
    compounds. GOSH understands that to date, the professor has not made any such
    application).

    19. The Court made clear findings about the efficacy of treatment. And clear findings about
    Charlie’s grievous condition and his lack of quality of life. The Judge made three best
    interests declarations about Charlie. These were:
    1) That it is not in his best interests for artificial ventilation to continue.
    2) That it is in his best interests to be provided with palliative care only.
    3) That it is in his best interests not to undergo nucleoside therapy.
    20. At the Court of Appeal, Charlie’s parents presented new evidence from the American
    professor offering to treat Charlie. The judges considered it carefully and listened to
    Charlie’s QC who did not seek to argue that the new evidence changed the Judge’s
    findings of fact of his balancing of the evidence. The Supreme Court said that the Judge
    had applied the correct legal test and the European Court of Human Rights found that
    Charlie’s rights and voice had been properly heard through his Guardian and that the
    findings of the UK courts were meticulous and could not be challenged.

    21. Since Charlie’s parents believe that only they have the right to decide what medical
    treatment is right for Charlie and when he should stop having treatment, it is not
    surprising that they appealed each decision and tried to change the legal test. Any proper
    system of justice must have a system of appeal and GOSH supports Charlie’s parents’
    right to challenge the judicial decisions. What has been very difficult, however, is the
    effect on Charlie of the delay.

    22. Charlie cannot make any choices for himself and throughout this time, he has had to
    endure months on a ventilator which means that air is forced into his lungs because he
    cannot use his muscles to breathe. He has had no quality of life because of the combined
    effect of seeing, hearing, moving or responding to any stimulus in any purposeful way.
    He has grown bigger but growth has not been accompanied by health. The reverse is
    true and there are signs of deterioration.

    23. GOSH is always willing to learn and well understands that genetics is a fast moving
    area of medicine where breakthroughs are being made all the time. When, in July,
    Charlie’s parents said they had new evidence that would change the Judge’s findings
    as to Charlie’s best interests, GOSH did not hesitate to return to Court so that the Judge
    could evaluate it.

    24. GOSH understands that the American professor who wishes to treat Charlie in America
    will be giving evidence to the Court by video link and looks forward to hearing what
    he has to say about the beneficial effect of NBT treatment on Charlie’s quality of life
    and awareness. As it has done throughout, GOSH will act in accordance with Charlie’s
    best interests and its duty of care to him. It will continue to provide him with the highest
    possible quality of care, to respect his dignity and the confidentiality of the details of
    his condition and treatment and to honour Charlie’s rights as his own, unique human
    being.
    KATIE GOLLOP QC
    Serjeants’ Inn Chambers
    13 July 2017
  • good statement
  • I hope the judge doesn't let this drag on any further - I really dislike the way this case has been manipulated via social media. It will become impossible going forward if this type of campaign becomes the norm and medical professionals are vilified by rent-a-mob groups.

    I've gradually lost sympathy with Charlie's parents and I hope for his sake his best interests are represented by the court.
  • 'I've gradually lost sympathy with Charlie's parents and I hope for his sake his best interests are represented by the court.'

    I've not lost sympathy but I can't quite fathom what they are trying to achieve. He has no quality of life and even if he has this treatment it isn't going to significantly increase his quality of life, if at all. In the mean time he is suffering. All you need to do is read the statement from GOSH to realise that. They are medical professional for a reason.
  • Mum & Dad......it's time to let me go.
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  • edited July 2017
    His parents have given up their legal battle and accepted the situation: http://www.bbc.co.uk/news/uk-england-40708343

    Was sad to read earlier that GOSH staff have been on the receiving end of abuse and even death threats from the public who supported his cause.
  • All so sad in every possible way.
  • Horrible case all round. While I sympathise with the parents I think they were wrong and its a real shame that they felt desperate enough to let pro-life obsessives get involved.
  • A real case of no possible winner. So sad.

    I hope the parents will be able to move on in their own way and own time.
  • edited July 2017


    The 'hope' was from a doctor with a financial stake in his treatment and with no knowledge of the patient at all.
  • Correct decision. Really is a sad state of affairs but the poor lad is suffering and you have to think of what sort of a life he'd lead, a tough say when I have no kids myself but I wouldn't want to see my kid suffer every day of his life. It's blind love from his parents but at the same time it's selfishness and the continuous digs at GOSH (who, correct me if I'm wrong, I believe are one of the top 5 hospitals around the world) really is uncalled for.
    Think they are just trying to find someone to blame. Unfortunate though.


  • The 'hope' was from a doctor with a financial stake in his treatment and with no knowledge of the patient at all.
    That really is sickening.
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  • It's been a very sad case and whilst I have every sympathy for Charlie's parents I don't think they have acted in his best interests. For them to say he would have been a fit little boy if he had been treated earlier is delusional. Furthermore to read that item 10 above and for them to have pinned their hopes on someone with a vested financial interest who had never even visited Charlie is bizarre. To those who abused GOSH staff and even visitors to GOSH, shame on you, scum.
  • The 'hope' was from a doctor with a financial stake in his treatment and with no knowledge of the patient at all.

    What a sick individual.
  • Horrible case. As a parent I would hope never to end up in a dreadfull cul de sac like that.
    But my reading of the GOSH statement bought tears to my eyes, but also a little anger. When you have a child with such a terrible condition, you have to accept the professionals know more than you do. Charlie's parents were in a terrible place, and their motives are beyond criticism. But sometimes you do these things because they are what you want to happen, in contradiction of the grim reality. I feel real heartache for this child, but he needs to be allowed to rest. And huge contempt for those who criticise the medical staff at GOSH. Sometimes it is the hardest thing to make these decisions, but criticising sithout knowlege from the stands is very easy ....and pathetic.
  • edited July 2017

    The 'hope' was from a doctor with a financial stake in his treatment and with no knowledge of the patient at all.

    What a sick individual.
    Totally agree. That fucker should be dressed in a lion outfit and hunted by a fat dentist from Iowa.



    Feel I should edit this. Just to say, as all right thinking people would, that this is a heart-breaking thing, and you know everyone is trying to do what they think is right. All strength to the little lad's mum and dad.
  • I hope anyone that abused the nurses at GOSH are arrested. Cowardly, spineless bullies plain and simple hiding behind social media or a phone think they are tough.
  • My heart goes out to his brave parents. I was in pieces watching the news tonight.
  • Rarely have I agreed with everything I've read on a thread and can only echo it. I know where the parents are.coming from, and it's devastating all round... But some people have left this with no credit. That includes nobody from GOSH
  • I guess as a parent you will naturally try to do anything to save their child but some outsiders certainly high jacked their grief and maybe gave them false hope?

    A sad state of affairs which has turned very bitter and sour when really it should have been about little Charlie coming first.
  • For some people, this is not a question of curing Charlie but more about their religeous views. We, as a society have to face up to the important question around quality of life - for all ages. There is a line here that has to be carefully moved along, at the moment I feel we are too far beneath it, but it would be dangerous to be too far above it also.

    You can't criticise the parents as they were given hope. And where there is hope you have to pursue it. I think in this case, that hope was given reclessly.
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