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16th October 2015

Twins die as court rules for life support to be withdrawn

Two 14-month-old boys died after their life support was withdrawn following a court case where Mr Justice Holman ruled in favour of doctors’ judgement

Two 14-month-old boys have died after a court ordered their life support to be switched off against the wishes of the parents. The court case Central Manchester University Hospitals NHS Foundation Trust vs A and others took place on the 2nd of October 2015. The boys died around five days later in the presence of their parents and an Imam.

The boys, referred to as A and H in court proceedings, were both suffering from an unidentified degenerative disease of the brain. Treating doctors at the Royal Manchester Children’s Hospital gave evidence in court as to the “futile and unjustifiable” battle to support the twins.

The parents however said that such an act was against their Islamic faith and provided a document from the Islamic Fiqh Council of the Muslim World League in order to support their case.

The father, representing himself and his wife, said in court: “I have respect for the law of the United Kingdom, but, please, do not forget that withdrawal of life support goes against our beliefs.”

Judging, Mr Justice Holman, acknowledged this in his ruling and repeated claims he had made in a similar, earlier, case that: “I have the utmost respect for the father’s faith and belief, and for the faith of Islam which he practises and professes. But I regard it as irrelevant to the decision which I have to take and I do not take it into account at all.”

The parents also believed that their children smiled in their presence and flinched away when tickled.

Tragically, doctors stated that these movements were not indicative of pleasure and were in fact random movements.

The family, an Iraqi family who were living in Iraq, have a healthy four-year-old son. They had had a baby daughter who died at the age of eight months to an undiagnosed medical condition. Despite not being fully diagnosed, it manifested symptoms very similar to those that eventually led to the deaths of A and H.

The twin boys were born in Iraq in August 2014 before moving to the United Kingdom in December of that year. At the age of three to four months the boys’ situations began to deteriorate. They were admitted to hospital in mid-January 2015 at the age of five months and did not subsequently leave hospital care.

In April 2015, A required CPR for six minutes and was transferred to the paediatric intensive care unit at the hospital, where he remained on life support since. H was transferred shortly afterwards so that he could stay with his twin brother. In May, H also suffered a respiratory arrest and since then required mechanical ventilation too.

The judge also remarked on concerns raised by the father as to whether or not the nursing staff had been attentive and caring, urging the judge to dismiss the nursing report. The judge did disregard the report but made clear that he made no judgement or criticism towards the dedication or expertise of the nurses.

Doctors submitted evidence as to the suffering of the boys and potential future suffering if the boys were to continue on life support; they believed that the boys would be in near-constant pain and suffering without the ability to show signs of this. These signs are key in alerting medical staff as to the suffering of the boys and doctors believe that the decline in ability to express this would not have been necessarily linked with a deterioration to feel those sensations.

In order that the father did not suffer unduly, the judge announced the outcome of the case before his judgement, adding that: “I felt it would be unkind to the father, who attends alone and unsupported, save by the independent interpreter, to have to sit through a long judgement in a state of great anxiety and uncertainty as to outcome.”

The father also argued that his God may one day grant medical science sufficient progress as to cure the boys and pleaded that they be kept alive so that this may be possible. Doctors though gave evidence that left the judge “beyond any doubt that there is in truth no prospect of a cure for either of these boys ever.”

The outcome of the case was that it was lawful that the twins would have their mechanical ventilation withdrawn; that they would not be resuscitated in the event of cardiac arrest; that they would no longer undergo blood sampling or receive antibiotics unless it is the case that such treatment would ensure their comfort and diminish distress; and that it is lawful and in each child’s best interests to have been provided with palliative care only.”

Approving the transcript of the case, the judge added that he had been informed that life support was withdrawn from both boys at the Royal Manchester Children’s Hospital around five days after the ruling was made. This was done in the presence of the boys’ parents and an Imam and both boys died.

The judge concluded by adding: “May they rest in peace.”

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