Charlotte Wyatt: Which matters more - quality of life or life itself?

The tragic story of Charlotte Wyatt has dominated the press in the last few weeks, and it is easy to see why. Charlotte was born in October 2003 at St Mary’s Hospital, Portsmouth at only 26 weeks, weighing just 1lb. In the past five months she has stopped breathing three times and has severe disabilities – she is deaf and blind, has brain damage and serious organ failure – and as a result is in constant pain. Portsmouth Hospitals NHS Trust took a decision that they did not want to resuscitate her if she stopped breathing again, as they believed she had no joy or quality of life, and has experienced nothing but pain since she was born. However, Charlotte’s parents Debbie and Darren Wyatt did not agree with this decision. They are Christians, and believe their faith means they should seek the preservation of life ‘at all costs’. Mrs Wyatt has said ‘If I agreed with the doctors I would hate myself for the rest of my life. We cling to the hope that she will still come home. Miracles happen.’

In most cases like this, parents and medical staff can come to an agreement over the best course of action for the child. However, no consensus could be reached here, and so the Wyatt’s went to the High Court to ask a judge to decide whether Charlotte had a legal right to be kept alive. Several similar cases have appeared before the courts, but mostly they have been decided in a private hearing. The Wyatts, however, decided they wanted their case to be heard in an open court with public and media access to ensure they could give the case a high public profile.

The two-day case was heard in the High Court by Mr Justice Hedley, a committed Christian who is the President of the Lawyer’s Christian Fellowship. He admitted that he was a ‘little uncomfortable’ about being the final arbiter of whether Charlotte should live or die, as he recognised that he was ‘being asked to override the wishes of these parents as to what is best for their daughter.’ He stated that the case involved the ‘fundamental principles of the sanctity of human life,’ and the concept of what constituted a bearable standard of living. He made his decision by examining past case law (which is binding on him) and the facts of the situation as presented to him. He said:

In reaching my view, I have of course been informed by the medical evidence as to the prospects to her of aggressive treatment. I hope I have looked much wider than that and seen not just a physical being but the body, mind and spirit expressed in a human personality of unique worth who is profoundly precious to her parents. It is for that personality of unique worth that I have striven to discern her best interests. It is my one regret that my search has led to a different answer than that sought by these parents.

He went on to say that all the evidence showed that Charlotte would have a terrible quality of life:

I do not believe any further aggressive treatment, even if necessary to prolong life, is in her best interests. I know that may mean she may die earlier than otherwise she might have done but in my judgement the moment of her death will only be slightly advanced.

The Wyatt family have decided not to appeal the decision, and Charlotte is not expected to survive the winter.

This is a controversial decision that has prompted both positive and negative responses in the national and international press. The advance of science that enables babies born at such a premature age to survive has created these new ethical dilemmas to which there is no easy answer. The law sets out clear legal principles for making such rulings, but the application of these principles causes difficulties. Charlotte is clearly not able to make her own decisions in this case, and so the normal course of action would be to let her parents decide. However, where there is a difference in opinion between the parents and clinicians about the child’s best interests, Section 15.2 of the British Medical Association guidance document – Withholding and Withdrawing Life-prolonging Medical Treatment – notes that it may be necessary to ask the court for guidance.

The law states that an omission to act that intentionally results in the patient’s death is permissible where it is not in the patient’s interests to continue treatment. This was concluded in the case of Airedale NHS Trust v Bland (1993), which is binding on all subsequent cases. The House of Lords (the highest level court in Britain) decided that Airedale NHS Trust could discontinue artificial hydration and nutrition of a young man in a permanent vegetative state, a decision which would lead to his death. The House of Lords also decided that there is no difference between discontinuing treatment and refusing to treat the patient, which is the situation in the Charlotte Wyatt case. The Airedale case concluded that in making the decision whether or not to provide medical treatment, the question to be asked is whether it is in the best interests of the patient that life should be prolonged. So a doctor is not under a duty to treat where it is not in the best interests of the patient. The earlier case of Re J (1990) had a very similar fact pattern to the Wyatt case. It was held that the principle of sanctity of life is a fundamental consideration – but it is not an absolute principle, and the duty of beneficence (doing the best for the patient) may lead to the conclusion that continued treatment is not in the best interests of the baby. It also held that ‘best interests’ is not purely an assessment of medical interests, and although it is important to consider the parents’ views of the child’s interests, these views cannot determine the course of treatment to be followed. An NHS trust is also entitled to consider whether further treatment would be the best use of available resources. The decision in Charlotte’s case therefore came down to what the judge deemed to be the best interest of the patient. Mr Justice Hedley heard all the medical evidence and concluded that Charlotte would be better off dying than continuing to live in her present state. He went on to direct that Charlotte should be given three things as she moves towards the end of her life: as much comfort as possible, as much time as possible to spend in the presence and in contact with her parents and she should be allowed to meet her end, in the words of Mr Wyatt, ‘with the TLC of those who love her the most.’

Should everyone have the right to be kept alive at all costs without an assessment of his or her likely quality of life? This is an ethical dilemma which has prompted widely differing views. Christians believe that the sanctity of life is indisputable. In Genesis 1:27, the Bible tells us that ‘God created man in his own image, in the image of God he created him’ (NIV). It is clear that every human has huge intrinsic worth because God has created each one of us, and God loves sick babies as much as he does healthy adults. Many have argued that to stop Charlotte living by failing to resuscitate her is playing God, and not valuing her as a human being important to God. But doctors and the courts have begun assessing a person’s ‘quality of life’ and whether they should have the right to live based on this evaluation. This is a worrying trend. Charlotte Wyatt has known only suffering in her eleven-month life. Even if she was resuscitated, she would most probably not live beyond her infancy. Although she has significant worth as an individual, her death would be a kind end to the pain she has suffered, and resuscitation would only serve to prolong her agony. However, the basis of the decision moved into the realm of an assessment of quality of life and that is concerning. Nuala Scarisbrick of the British pro-life group LIFE highlights another particular concern, that ‘doctors have no training in measuring “quality of life”. No one has. It is a subjective and dangerous catchphrase of the eugenics and euthanasia lobbies.’ (press release on LIFE UK). The current trend in our society is to devalue those who have mental and physical disabilities. Many parents who find out their baby is not going to be ‘perfect’ seem ready to have an abortion or give up on a child who has the prospect of surviving to adulthood. In a culture where image is crucial and where family responsibilities have been seriously eroded, it seems that parents and doctors alike are making value judgements on the worth of those who are born with some impairment. We need to be reminded as a society that everyone is made in the image of God, and therefore worth more than we could ever imagine.

This ethical dilemma is one that did not and indeed could not have existed ten years ago. Scientific advances have allowed premature babies like Charlotte to survive from a much earlier age than ever before. This, and other similar ethical questions, are likely to become a more frequent occurrence. Indeed, there is another similar case coming to court in the next few weeks. Nine-month-old Luke Winston Jones has the genetic disorder Edwards Syndrome, and the doctors at Alder Hey Hospital have decided that it is in Luke’s best interests not to resuscitate him should he stop breathing. His mother wants to challenge this decision in the High Court, as she believes her son is nowhere near as ill as Charlotte and should be kept alive as long as possible. There seems to be no definite moral or ethical answer to these cases, but what is clear is that the families involved in these cases need our love and prayers to support them through such difficult times.

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