Doctors "Best Interests" decision to stop treatment overturned by the courts.

[holyshedballs]

Although the circumstances are different, the general principle remains that doctors do not make the decisions regarding our health and our bodies.

Following GMC guidance doctors give advice on medical best interests, but the guidance recognises that the patient or their carer(s) must consider wider factors in arriving at a decision.

It's a pity that the case had to go to the High Court for a ruling.

TAFIDA RAQEEB v BARTS NHS FOUNDATION TRUST

From Medscape medscape.com/viewarticle/91...

The parents of Tafida Raqeeb won a High Court battle in their bid to move their daughter from a UK hospital to Italy for treatment.

Specialists at the Royal London Hospital, Whitechapel, who were caring for the disabled 5-year-old, said further treatment would be futile because she would not recover from arteriovenous malformation.

However, her parents, Shelina Begum and Mohammed Raqeeb, from Newham in East London, disagreed with doctors caring for their daughter who argued that she should be allowed to die. They argued that their daughter was from a Muslim family and that their faith said that only God could take the decision to end her life.

'We Have Always Been Hopeful'

The parents launched a fundraising campaign as part of their fight to take their daughter to Gaslini Children's Hospital in Genoa, where they said doctors had offered to care for her.

Following the ruling, Shelina Begum, Tafida's mother, insisted that their daughter was not dying. "We have always been hopeful that she might make something of a recovery if she is given the time and the right treatment," she said.

Barrister David Lock QC, who represented them, commented: "My clients have asked me to express their profound thanks" for a ruling that had come as an "enormous relief" to them.

Mr Lock added that the child's parents just "wanted to get on with the transfer".

The High Court heard that Tafida collapsed after telling her parents one morning in February this year that she had a headache.

Last month, Barts Health NHS Trust said it was "a very sad medical case and difficult for everyone involved". However, they said that following discussion with medical specialist clinicians caring for Tafida they had been advised "that further medical treatment would not improve her condition and would not be in her best interests".

'A Finely Balanced Case'

In his judgement, Mr Justice Macdonald said it was a "very finely balanced case and one that I have wrestled with in reaching my decision".

The case, which was heard in the week of the 9th September, was made up of two parts: a judicial review to determine whether it was lawful for Tafida to travel to Italy to continue to receive life sustaining care, and a hearing to determine the best interests of Tafida in relation to her ongoing care.

Mr Macdonald said: "I am satisfied, on a fine balance, that it is in Tafida's best interests for life sustaining treatment to continue" and that she could be taken to Italy for treatment."

Alistair Chesser, chief medical officer for Barts Health NHS Trust said in a statement: “We followed the guidance of the General Medical Council and referred this tragic case to the Family Division of the High Court to reach an independent view about Tafida’s best interests.

"The High Court weighed up clinical and ethical considerations and decided on the balance of evidence that life-sustaining treatment should continue. After careful consideration regarding the wider implications of the judgment, we have decided not to appeal.

"Our doctors and nurses will continue to provide Tafida with the best possible care as long as she continues to be our patient. We will also support the family as they make alternative arrangements for Tafida’s care.

The full judgement is here

judiciary.uk/wp-content/upl...

[Hidden]

Once upon a time I believed every word a doctor said to me.

Those days are long gone after years of arguing and being treated as if I were a nitwit.

[Angel_of_the_North]

Well, that's a step up from the case of that poor kid whose parents wanted to take him to eastern europe for proton beam therapy. That family was pursued by interpol and arrested for daring to do something that the NHS said was quackery - of course, since he got better, proton beam therapy units are being set up in this country. Doctors just hate to be wrong

[humanbean in reply to Angel_of_the_North]

And what about the case of Mary Kidson? Her daughter was prescribed various hormones by one of the Hertoghe doctors in Belgium, and she thrived on them. Then the girl's vindictive father got involved (the parents were divorced or were getting divorced and he appears to have wanted to punish his wife) and brought the police into it, and ended up with the mother being charged with poisoning her daughter, despite the fact that all the meds the girl was taking were prescribed by doctors.

In the end Mary Kidson went to jail for a few months and her daughter ended up in a psychiatric hospital for quite a long time (a couple of years? I'm not sure). What a wonderful husband and father there was in the case! (sarcasm)

The other galling thing about the case is that the prosecution started (as is usual, I think), and it seemed that treatment of hormone problems was going to be discussed in court. That would have been amazing and wonderful - endocrinology and the medical profession in the UK on trial. In the end though, Mary Kidson was freed before the defence ever gave their case.

meassociation.org.uk/2014/1...

[holyshedballs in reply to humanbean]

Yes that's right.

A terrible case. Even Social Workers were involved under the allegation made by some doctors that the child was being abused by the administration of hormones.

A case that should never have happened but the courts came down again on the side of the patient.

I post these cases to show patients that the doctor does not own their condition and that the patient (or their carer) makes the decision about their care.

[humanbean in reply to holyshedballs]

I wondered at the time if the fact that there was, apparently, no case to answer was because endocrinologists and the medical profession generally would have had to justify their decisions on thyroid treatment in a court of law and they probably couldn't have done it. The scrutiny would have been excruciating for them. So they rigged it so that the prosecution gave their side of the story (as they always do first), but the defence never managed to put them in the dock to make them justify their actions, because the case collapsed, in effect, because the judge said there was no case to answer. And I think that withdrawing the accusations after the prosecution gave their case, but before the defence had a chance was a plan worked out before the case started.

Am I making any sense? My reply feels muddled.

[holyshedballs in reply to humanbean]

I'm trying to find the judgement for this case but no luck so far. However, the barrister has posted a summary of the case on his wikipedia page en.wikipedia.org/wiki/Ken_H...

We have moved on since then with the Mental Capacity Act and further understanding of the limits of MEDICAL best interests, the Montgomery v Lanarkshire case, the GMC Code of Practice etc. are all showing us that doctors do not have the influence or power some of them think they have.

I would like a a transcript but to me it is unusual for a judge to give such a clear direction to jury that there is no evidence of GBH.

An orthodox endo give evidence. Dr Neil Fraser, the paediatrician in charge of child safeguarding in Herefordshire and also a specialist in hormonal disorders, said in a report for the trial that he strongly disagreed with the Belgian physician’s methods.

Courts have repeatedly said that the court is not the adjudicator between two methods of treatment. It is for the patient to decide on their treatment. However, the doctor doesn't have to provide that treatment if s/he disagrees with it.

where the doctors crossed the line in this case is that they took extreme actions beyond their Code of Practice to prevent a treatment they disagreed with, even though the evidence in front of their eyes showed them that Hertoghe's method is working.

As I posted before, the GMC have Counsel's Opinion that "our" method of treatment is supported by a respectable body of medical opinion and therefore cannot be used to bring a case of medical negligence. And that's another reason why this case should never have happened. Some people may think that's WHY the case DID happen.

[humanbean in reply to holyshedballs]

As I posted before, the GMC have Counsel's Opinion that "our" method of treatment is supported by a respectable body of medical opinion and therefore cannot be used to bring a case of medical negligence.

Sorry, I got confused in that sentence who "our" was referring to. Thyroid patients or doctors?

[holyshedballs in reply to humanbean]

I mean the methods and treatments that are being campaigned for on this site and others, not the orthodox method that was/is being pushed by the BTA et al.

[Hillwoman in reply to holyshedballs]

Thanks for posting about this important case and its implications.

I didn't know the GMC had obtained Counsel's Opinion on treatments other than levo, but then I've been out of touch with recent developments. This makes me wonder how and why they could strike off a Functional Medicine practitioner a couple of weeks ago for going slightly off-piste with the interpretation of TFTs in a handful of patients? I can't get access to the full report in the BMJ.

[holyshedballs in reply to Hillwoman]

that's really interesting!! If you have the name of the doctor, it should be downloadable from the GMC or Medical Practitioners Tribunal Service. Could you let me know if you do know?

[Hillwoman in reply to holyshedballs]

I'll have another look around. Back soon!

[Hillwoman in reply to holyshedballs]

Dr Georges Mouton. I misread the report: he's been suspended, not struck off. A very good endo, according to people on another forum who have consulted him.

bmj.com/content/367/bmj.l5916

[holyshedballs in reply to Hillwoman]

Thanks for that. The transcript of the hearing should make good reading!!

[holyshedballs in reply to Hillwoman]

I think the doctor you are referring to is George Mouton. He was in front of the MTPS 25 - 27 September 2019

He hasn't been struck off he has been suspended for 9 months

I wrote to the GMC as a FoI request a couple of years ago for details of any doctor who has been struck off for prescribing thyroxine or T3. None had.

[Redlester in reply to Angel_of_the_North]

if they hadn't done it their child would be dead because doctors hate to be wrong. I never cease to be amazed by how little they know