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• Dilemma indeed
  Sharryn E Gardner
  Published on: 22 March 2016

• Published on: 22 March 2016

  Dilemma indeed

  • Sharryn E Gardner, Paediatric A&E Consultant

  Dear Editor,

  I read with interest Robin Powell’s analysis of the ramifications for Paediatricians of the recent judgement in MB [2006] EWHC 507 (Fam) (1). Although Mr Justice Holman made it very clear in his final words of judgement that ‘every case and every child is unique, and this case concerns M alone’(2) , the case will undoubtedly be used as precedent. M is indeed unusual in that he was diagnosed with SMA1 s...

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  Dear Editor,

  I read with interest Robin Powell’s analysis of the ramifications for Paediatricians of the recent judgement in MB [2006] EWHC 507 (Fam) (1). Although Mr Justice Holman made it very clear in his final words of judgement that ‘every case and every child is unique, and this case concerns M alone’(2) , the case will undoubtedly be used as precedent. M is indeed unusual in that he was diagnosed with SMA1 so young and apparently ventilated very early in his clinical course - most neuromuscular patients being ventilated much later and for acute episodes or establishing home ventilation (3).

  All of the doctors (including expert witnesses) giving evidence (all eminent tertiary neurologists/intensivists) signed up to a consensus statement (4) which essentially described the futility of the case, but also the ongoing burdens on the child where the benefits to the child were uncertain and rapidly diminishing. The judge rejected this overwhelming view as he could not accurately quantify the benefits to M of continued existence though he could more easily quantify his burdens.

  It has long been accepted that doctors cannot be compelled to provide treatment against their better judgement by the courts (5) but doctors here are effectively forced to do so every time the endotracheal tube needs changed. By opting not to withdraw care, the medical staff are obliged to continue to perform what they may themselves view as a battery. Only the most junior nursing staff were in any way supportive of this treatment.

  This case is one where medical opinion was unanimous and rejected by the courts. It seems likely given the declaration that not providing intravenous antibiotics was lawful that despite the ongoing quality care, pneumonia was likely to lead to M’s eventual death within a relatively short time frame. Unfortunately the situation is not yet satisfactorily resolved.

  References:

  (1) An NHS Trust v MB & Anor [2006] EWHC 507 (Fam).

  (2) An NHS Trust v MB & Anor [2006] EWHC 507 (Fam)109.

  (3) Arch Dis Child 2004;89;170-175.

  (4) An NHS Trust v MB & Anor [2006] EWHC 507 (Fam)26.

  (5) Re J {A minor}(Wardship: Medical Treatment} [1991] 1 FLR.

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  Conflict of Interest:
  None declared.

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