Read on Twitter
Some thoughts on Poole J's decision that it is not in the best interests of Pippa Knight - who is 5 and who has been ventilated on ITU since Jan 2019 - to have further life sustaining medical treatment, whether in hospital or at home.
https://www.judiciary.uk/wp-content/uploads/2021/01/Guys-and-St-Thomas-v-Knight-judgment.pdf
https://www.judiciary.uk/wp-content/uploads/2021/01/Guys-and-St-Thomas-v-Knight-judgment.pdf
Pippa suffered brain damage caused by illness in 2017.
Her father could not cope and took his life (see para 11).
She has a sibling and her mother has cared for 2 bereaved children, one severely disabled, in an exemplary way ever since.
One's heart goes out to the whole family.
Her father could not cope and took his life (see para 11).
She has a sibling and her mother has cared for 2 bereaved children, one severely disabled, in an exemplary way ever since.
One's heart goes out to the whole family.
The situation is tragic. And the judge highlighted how Pippa has inspired everyone around her.
The application was made by the treating hospital's Trust and was supported by Pippa's Guardian. It was opposed by Pippa's mother.
NB:The COA will probably be asked to hear an appeal.
The application was made by the treating hospital's Trust and was supported by Pippa's Guardian. It was opposed by Pippa's mother.
NB:The COA will probably be asked to hear an appeal.
The decision deals with:
i) the weight to be given to parental wishes, when a child's life is at stake, and how those should be balanced with the child's best interests;
ii) the concept of dignity;
iii) the no pain+no awareness = no harm in treating argument.
i) the weight to be given to parental wishes, when a child's life is at stake, and how those should be balanced with the child's best interests;
ii) the concept of dignity;
iii) the no pain+no awareness = no harm in treating argument.
The Judge is very clear - para 93:
“...it is not a parent’s right to determine when, how and where death occurs, or whether life sustaining treatment should be prolonged. Nor do I accept that the court should consider Pippa’s interests through the prism...
“...it is not a parent’s right to determine when, how and where death occurs, or whether life sustaining treatment should be prolonged. Nor do I accept that the court should consider Pippa’s interests through the prism...
of her mother’s interests: the court is concerned with Pippa’s best interests which must be assessed from her perspective, not from anyone else’s viewpoint.”
In para 100 the Judge addresses the argument that if the child feels no pain, the law should provide the solution that gives most comfort to the child's family, and that it is cruel to deprive the family of that comfort. The Judge says:
"But the law seems to me to be clear that the benefits that Pippa has brought, and may continue to bring, to others, and the satisfaction of the wishes of a child’s family, are not the focus of the court’s attention. It is her welfare that is paramount not the welfare of others".
He deals with the "problematic" concept of dignity in para 86 saying that it does not assist him in identifying Pippa's best interests.
He notes how the concept has been used to support decisions to continue and withdraw life sustaining treatment.
And the wide range of views.
He notes how the concept has been used to support decisions to continue and withdraw life sustaining treatment.
And the wide range of views.
Wisely, he says:
"given the very different ideas expressed to the court about what would constitute dignity for Pippa in life and in her dying, I shall not presume to adopt some supposedly objective concept of dignity to determine her best interests."
"given the very different ideas expressed to the court about what would constitute dignity for Pippa in life and in her dying, I shall not presume to adopt some supposedly objective concept of dignity to determine her best interests."
In para 76, he gives the most - perhaps only - reasoned decision of why the argument that "no physical harm can be caused by medical treatment to a person with no capacity to feel pain and no conscious awareness" should be rejected that I have seen.
In doing so, this v recently appointed judge, draws on his background as a clinical negligence silk.
He says: "The fact that a person has no conscious
awareness does not give their clinicians, or anyone else, licence to perform procedures on them irrespective of their benefit."
He says: "The fact that a person has no conscious
awareness does not give their clinicians, or anyone else, licence to perform procedures on them irrespective of their benefit."
And goes on to cite cases where compensation for pain and suffering have been made to people in a coma:
"because the law recognises that even the
fully unconscious individual may experience a loss of function and a diminished quality of life even if they do not suffer pain."
"because the law recognises that even the
fully unconscious individual may experience a loss of function and a diminished quality of life even if they do not suffer pain."
The judge considers Bland and the 2 strands of thought about whether there is any balancing exercise of benefits/burdens to be conducted where the patient is in a persistent vegetative state (as Pippa is). See paras 25-29.
Since he was invited by all of the parties to consider the benefits and burdens to Pippa that go beyond those of which she is conscious (she has no awareness at all) and her interests in the broadest possible sense, he reaches no conclusion on the right approach in law.(para 108)
The hearing was conducted with conspicuous professionalism and in an atmosphere of calm. The representation was of the highest possible standard and there was considerable mutual respect amongst the doctors giving evidence (para 66). The judge's reasons are clearly explained.
Pippa's mother is clearly an extraordinary person and the most loving and devoted mother. She could not have done more for her daughter. There is nothing one can say in this situation but everyone learning of her plight will wish her well in the days to come.