The fight of Alfie Evans

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The Alfie Evans case was a legal case in 2018 involving Alfie Evans (9 May 2016 – 28 April 2018), an infant boy from Liverpool with an undiagnosed neurodegenerative disorder.

The medical team and the child's parents disagreed about whether to maintain Evans' life support or to withdraw it, resulting in a legal battle. Alder Hey Children's NHS Foundation Trust sought a declaration that continued ventilatory support was "unkind and inhumane", and not in Evans' best interests. Alfie's parents, Kate James and Thomas Evans, contested the application.

The ventilatory support was removed on 23 April 2018 following a series of unsuccessful appeals from Alfie's family. Alfie continued to breathe naturally after the removal of his breathing tube. He died at 2:30 a.m. on 28 April 2018.

In November 2016, at six months of age, Alfie Evans was reviewed at the general pediatric outpatient clinic at Alder Hey Children's Hospital. He was found to be functioning in a range appropriate for a 6-week to 2-month-old infant. On 14 December 2016, Alfie was admitted to Alder Hey Accident and Emergency Department with a history of coughing, high temperature, and a reported episode of rhythmic jerking of his jaw and all four limbs. On 15 December, he showed sudden unprovoked movements compatible with infantile/epileptic spasms. An EEG performed on 16 December 2016 confirmed hypsarrhythmia. A further EEG was taken in January 2017 and "was markedly different, showing attenuation with little in the way of reactive response for protracted periods of time. Changes only really occurred when Alfie had an epileptic seizure."

Alfie's parents wished to remove him from Alder Hey and seek further care at the Bambino Gesù Hospital in Rome In September 2017, Italian doctors from Bambino Gesù Hospital produced an assessment report on the possibility of transferring Alfie to Italy. According to their report on the case, they could offer prolonged ventilator support, with a surgical tracheostomy and would remove a nasogastric tube, replacing it with a gastrostomy. During assessment, Alfie suffered "epileptic seizures induced by proprioceptive stimuli", the report warned "due to stimulation related to the transportation and flight, those seizures might induce further damage to the brain, [putting] the whole procedure of transportation at risk.Alfie remained in Alder Hey Hospital for the duration of 2017, with no improvement in his condition. At the end of the year, the hospital applied to have life support switched off.

Alfie Evans' case drew significant public attention in the United Kingdom and overseas, with his parents establishing "Alfie's Army", an online campaign group dedicated to seeking further treatment and opposing the withdrawal of life support. Supporters established a petition on change.org, calling on Alder Hey Hospital to allow Alfie Evans to be transferred to a hospital of his parents' choice. His parents also approached Dr Michio Hirano, a US-based neurologist who had offered treatment in the case of Charlie Gard.Alfie's parents claimed a parental right to make decisions about their son's care, arguing that the hospital itself should not be able to make care-decisions for their son without their consent.[8]

Large protests emerged outside Alder Hey Hospital on 12 April after his family insisted on their right to take him home.On 16 April, Mersey-side Police launched an investigation into "instances of verbal abuse and acts of intimidation" with judges raising concerns about threatening conduct by protests towards hospital staff. Alfie's parents apologized, saying they did not intend to "harm or cause conflict or upset". Mersey-side Police Chief Inspector Chris Gibson released a statement regarding social media posts regarding the Alder Hey Hospital and Alfie Evans situation: "malicious communications and threatening behavior will be investigated and, where necessary, will be acted upon.

On 19 December 2017, Alder Hey applied to the High Court to withdraw parental rights from Alfie's parents and to withdraw ventilation. The case was heard at a public hearing in the Family Division of the High Court in London. Alder Hey claimed that continuing life-support treatment would not be in the best interests of Alfie and sought declaration that "is not lawful that such treatment continue". Lawyers acting on the hospital's behalf further claimed that further treatment for Alfie would be "unkind and inhumane". A doctor treating Alfie further stated that there was "no hope" for the child, and that he was in a semi-vegetative state from a degenerative neurological condition that medics have not been able to definitively identify. The parents denied this, with Alfie's father claiming that his son "looks him in the eye" and "wants help".

The High Court ruled in favor of the hospital on 20 February 2018. In their judgement, the High Court stated that an MRI scan taken in February 2018 revealed that "[Alfie's] brain [was] entirely beyond recovery" and that "the brain was now only able to generate seizure" with "progressive destruction of the white matter of the brain which Dr R interpreted as now appearing almost identical to water and cerebrospinal fluid (CSF)." The Court noted that the medical consensus, including of doctors asked to testify by the parents, was that Alfie had a fatal and untreatable condition, but they differed over the best course of action concerning his end-of-life care. High Court judge Mr Justice Anthony Hayden concluded that "I am satisfied that continued ventilatory support is no longer in Alfie's best interest"

Alfie's parents appealed against the decision in late February. On 6 March, the Court of Appeal upheld the earlier ruling of the High Court. They stated that the High Court judge was "meticulous and thorough", and that medical evidence showed Alfie was "deeply comatose" and "to all intents and purposes unaware of his surroundings". The parents applied to the Supreme Court of the United Kingdom on 20 March, which refused the right for another appeal. On 28 March the European Court of Human Rights ruled the case inadmissible, finding no violation of human rights.

In a High Court judgement of 11 April 2018, the judge remarked that "by the end of February the connective pathways within the white matter of the brain which facilitate rudimentary sensation — hearing, touch, taste and sight, had been obliterated. They were no longer even identifiable on the MRI scan". The High Court backed an end-of-life care plan drawn up by medical specialists attached to Alfie Evans' case.

Alfie's father said that Alfie was wrongly "detained" at Alder Hey. High Court judge Hayden dismissed that complaint, and appeal judges upheld his decision.On 17 April Mr Evans and Ms James asked the Supreme Court to consider their case again. Their application to appeal was refused on 20 April. The justices wrote, "Alfie looks like a normal baby, but the unanimous opinion of the doctors who have examined him and the scans of his brain is that almost all of his brain has been destroyed. No-one knows why. But that it has happened and is continuing to happen cannot be denied. there is no hope of his ever getting better." The European Court of Human Rights again determined their appeal on these grounds to be inadmissable.

The case concerned the family's argument that the prevention of Alfie's transfer from Alder Hey Hospital constituted deprivation of liberty and a violation of Article 5 (right to liberty and security) of the European Convention on Human Rights. The decision resulted in a protest of at least 200 people taking place outside of Alder Hey hospital

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