Doctors need not ventilate baby to prolong his life
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《英国医生杂志》
Doctors caring for a terminally ill baby with a chromosomal disorder need not provide mechanical ventilation to prolong his life, the senior family judge for England and Wales ruled last week.
The case of 9 month old Luke Winston-Jones is the second battle between parents and doctors over the treatment of a baby with a limited life expectancy to reach the High Court in the last month.
Both Luke's mother and the parents of 12 month old Charlotte Wyatt described their infants as "fighters" because both had lived longer than doctors had predicted, and both sets of parents argued that mechanical ventilation should not be ruled out.
Ruth Winston-Jones described her son, Luke, as "a fighter" because he has survived longer than doctors had p redicted
Credit: PA
Luke's mother, Ruth, also wanted the possibility of cardiac massage left open for her son, who has Edwards' syndrome or trisomy 18 syndrome, a condition severely affecting most of his organs. Few babies with the disorder survive beyond a year.
The Liverpool Royal Children's NHS Trust, which is treating Luke at Alder Hey Hospital, and his home trust, North West Wales NHS Trust, sought a court declaration that neither mechanical ventilation nor cardiac massage would be in Luke's best interests.
Dame Elizabeth ruled that Luke should not be mechanically ventilated, but after the trusts withdrew their application for a declaration ruling out cardiac massage that option was left open.
Dame Elizabeth said mechanical ventilation would be against Luke's interests because it was highly likely he would become dependent on the ventilator, depriving him of his mother's cuddles for the rest of his short life. Expert evidence was that his chances of dependency were 75% to 100%.
She said it would be up to doctors' clinical judgment whether to provide cardiac massage if the occasion arose.
She called for an end to the conflict between mother and doctors. "It is the duty of the mother for the sake of Luke to reduce areas of conflict to a minimum and listen to what is proposed by those who have a great deal of medical and nursing experience."
The judge said: "It is important that everyone in this case, both hospitals and particularly the mother and her family, who have been so supportive of her, should turn over a new leaf and move forward." The mother must "accept the clinical judgment of the doctors who are caring for her child," she added.
Earlier this month Mr Justice Hedley ruled that mechanical ventilation would not be in the best interests of Charlotte Wyatt, a profoundly handicapped baby born three months prematurely ( BMJ 2004;329: 875, 16 October).(Clare Dyer, legal corresp)
The case of 9 month old Luke Winston-Jones is the second battle between parents and doctors over the treatment of a baby with a limited life expectancy to reach the High Court in the last month.
Both Luke's mother and the parents of 12 month old Charlotte Wyatt described their infants as "fighters" because both had lived longer than doctors had predicted, and both sets of parents argued that mechanical ventilation should not be ruled out.
Ruth Winston-Jones described her son, Luke, as "a fighter" because he has survived longer than doctors had p redicted
Credit: PA
Luke's mother, Ruth, also wanted the possibility of cardiac massage left open for her son, who has Edwards' syndrome or trisomy 18 syndrome, a condition severely affecting most of his organs. Few babies with the disorder survive beyond a year.
The Liverpool Royal Children's NHS Trust, which is treating Luke at Alder Hey Hospital, and his home trust, North West Wales NHS Trust, sought a court declaration that neither mechanical ventilation nor cardiac massage would be in Luke's best interests.
Dame Elizabeth ruled that Luke should not be mechanically ventilated, but after the trusts withdrew their application for a declaration ruling out cardiac massage that option was left open.
Dame Elizabeth said mechanical ventilation would be against Luke's interests because it was highly likely he would become dependent on the ventilator, depriving him of his mother's cuddles for the rest of his short life. Expert evidence was that his chances of dependency were 75% to 100%.
She said it would be up to doctors' clinical judgment whether to provide cardiac massage if the occasion arose.
She called for an end to the conflict between mother and doctors. "It is the duty of the mother for the sake of Luke to reduce areas of conflict to a minimum and listen to what is proposed by those who have a great deal of medical and nursing experience."
The judge said: "It is important that everyone in this case, both hospitals and particularly the mother and her family, who have been so supportive of her, should turn over a new leaf and move forward." The mother must "accept the clinical judgment of the doctors who are caring for her child," she added.
Earlier this month Mr Justice Hedley ruled that mechanical ventilation would not be in the best interests of Charlotte Wyatt, a profoundly handicapped baby born three months prematurely ( BMJ 2004;329: 875, 16 October).(Clare Dyer, legal corresp)