Hippocratic Oath


“I will use treatment for the benefit of the ill in accordance with my ability and judgement, but from what is their harm and injustice i will keep from them” - Your Doctor ( Hippocratic Oath)
Putting aside the long hours of hard work and years of continual study; patients  putting their total lives and trust within a physician's hand imposes unbelievable responsibility and a pressure. In addition, the process individual coming to one another and sharing personal information they wouldn't disclose with a priest nor rabbi, and then more importantly disrobing and allowing touch begins a ritual of exceeding importance between patient and physician, providing  a career of physical emotional and moral challenges.

In this week's blog post we explore how  the most recent ethical issue within the NHS- The Charlie Gard controversy,  and the doctors response to the a morally troublesome situation acted upon the best interest of the patient.

The recent case of Charlie Gard, an infant who suffered from (MDDS) Mitochondrial DNA depletion syndrome and caught international recognition attracting the Pope and the U.S apresident Donald Trump, had caused controversy within medical ethics. MMDS had caused Brain Dysfunction and muscle weakness(Encephalopathy) in the infant from birth which meant the infant was unable to breathe or move without ventilation support or movement support. Medical specialities at the Great Ormond Street hospital at London where Charlie had been undergoing treatment came to the conclusion it would be in the best interest of the child to remove ventilation and focus on palliative soothing care for the child's last days.  Despite experts within the hospital and a team of secondary team of experts from Barcelona providing  a same second opinion, Charlie's parents - Chris Gard and Constance Yates, disagreed wanting to take Charlie to the America for experimental treatment known as nucleoside bypass therapy believing it could slow the progression of the infant's condition, raising over 1.3 million pounds to fund the treatment.

Despite disagreement and arguments from the patient's family stating their child is not in pain, the decision of the Great Ormond hospital to take the case to UK high court which supported the removal of life was opposed by the parents of the child, resulting in further appeal to the Court of Appeals and the UK supreme court which both ruled similarly in May and June supporting the original decision of the UK high court against the parents wishes.

The UK high court judge who ruled against the wishes of the parents stated in his decision there was no hope for Grads recovery or even improvement. Doctor Even Hinaro who was behind the ambiguous US treatment agreed by stating “it was unlikely he will improve with that therapy. Even if the therapy could flower further progression of the disease, it could not have reversed extant damage. The remainder of Gard’s life would be painful”.
Earlier this July Gards parents went back with the hospital went back to the court over claims the parents had would support putting the child into treatment, but after further examination of by Doctor Even Hirano who concluded “it was too late” to reverse extant damage causing his parents withdrew their appeal.
Charlie died on Friday 28th July 2017- just 11 months old, his fight coming to an early end as described by his parents. His life full controversy marked the country and the healthcare system with many questions; one of which being - questioning did the court and hospital have more authority over his life than his parents? Or is it only in the UK such things can happen?  The role of doctors in Charlie's case in deciding to end his ventilation support was not only a choice they concluded in making but an oath they swore to provide treatment by. The Oath consisting of the principle - “Do no harm” provides doctors a moral compass directing them in such choices between life and death. The decision to remove the ventilation provided as described by the family an “earlier” and much less painful death, providing charlie with the best care that could have been offered.

With Condolences to the parents of Charlie Gard
Universal Medicine Team (Mathew George)

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