It is lawful to withhold medical treatment from two gravely ill identical twins, the High Court has declared.
Central Manchester University Hospitals NHS Foundation Trust v A & Others concerned a pair of brothers born to an Iraqi family. They were born in the Middle Eastern nation in August last year and initially appeared to be normal. In December, the family travelled to the UK where the mother planned to become a student. But the twins – who have an older brother– soon began to jerk and move in an abnormal way and “ceased to feed well”. They were admitted to hospital in January and have remained there ever since.
In April, one of the two babies suffered a “cardio-respiratory arrest” and was placed on a ventilator. Later the other boy also suffered respiratory arrest and, like his brother, has remained on a ventilator ever since. The condition of both twins has continued to deteriorate since these incidents.
They have been diagnosed with an untreatable and progressive neuro-degenerative disorder and both babies are dependent on their ventilators because they cannot breathe on their own.
In the High Court, Mr Justice Holman explained that:
“If the mechanical ventilation is withdrawn from either of them, he will inevitably die, probably within an hour or two, being unable to breathe naturally. This situation has persisted now for several months. The treating medical team consider that it is unethical to maintain the ventilation and [believe] that they are now needlessly prolonging pain and suffering for each boy.”
The NHS Trust therefore applied to the court for a declaration that it would be lawful to switch off the machines.
The Judge noted that their parents “very understandably” felt they could not consent to this. He expressed considerable sympathy for their plight, declaring:
“No one, which includes myself, who has not been in the position of the parents in this case can possibly truly appreciate and understand the agony with which they are faced.”
He was also complimentary about the father, who attended court to represent the couple’s views in the case.
“Although his command of English is limited and he has communicated mainly through an interpreter, he is, if I may very respectfully say so, a man of obvious intelligence and insight. He has participated in this hearing with intelligence, a complete grasp of the issues, moderation in his approach, and, I would add, considerable personal charm.”
It was clear, continued Mr Justice Colman, that the parents had cared for the twins “with very great tenderness.”
Nevertheless, it was clear from the medical evidence that the two babies had suffered significant brain damage and had only survived due to the artificial assistance provided by the ventilation machines. Their situation was irreversible and would only grow worse.
The Judge therefore concluded:
“… it seems to me that artificially to prolong their lives in this particular case lacks any purpose, confers no benefit at all apart from the fact of physical survival, and involves perpetuating the infliction of pain and discomfort for no gain or purpose. It is not in the best interests of either boy that the process be artificially prolonged, and it is in their best interests that nature should now be permitted to take its inevitable course. That is the tragic genetic destiny of each of these boys.”
The judgement can be read here.