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» Ship of Fools   » Ship's Locker   » Limbo   » Purgatory: Who knows best - the state or the parents? (Page 1)

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Source: (consider it) Thread: Purgatory: Who knows best - the state or the parents?
seekingsister
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# 17707

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I'm sure many in the UK have seen the story of Ashya, a 5 year old boy whose parents removed him from the hospital against medical advice. A European arrest warrant was issued for them and when apprehended they were jailed and separated from their son.


quote:
A European arrest warrant has been issued for the parents of a five-year-old boy with a brain tumour, missing from hospital since Thursday.

Ashya King was taken out of Southampton General Hospital by his mother and father against medical advice.

Hampshire Police believe he may have been taken to Spain and police are at a Marbella property owned by the family.

It turned out that

1. they were taking him to Europe to receive a treatment currently not approved by the NHS for the child's condition but available abroad

2. They did not break any laws in taking him out of the hospital.

And now charges have been dropped.

BBC News

It seems to me that an undue amount of resources were spent in chasing down this boy and his family, who did nothing other than make a decision about his care which surely is their right.

So - should it be a crime to remove a loved one from hospital to pursue alternative medical treatment?

[ 08. January 2015, 14:40: Message edited by: Barnabas62 ]

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Horseman Bree
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We have had several cases of parents refusing blood transfusions (e.g. JWs) or otherwise impacting treatment in ways that were not in the child's best interests. In some cases, those children died or were left with impaired health.

Admittedly not all cases, but enough to make it valid to question the parents' judgment.

And "undue resources" used: surely it is appropriate to attempt to ensure that the child's welfare was being looked after? Do you prefer to let the child disappear with no further requests for information?

At what point does the state (actually, you) have no interest in the welfare of the child? Would you prefer some sort of Victorian-Oliver-Twist sort of child care?

Yes, sometimes the system gets it wrong. Yes, sometimes the parents get it wrong. And sometimes people who don't know about the actual situation get it wrong.

Possibly a tangent, but ISTM related: at what point does the parents' wrongheadedness about vaccination have to be curbed IN THE INTEREST of the other children who may be exposed to diseases unnecessarily? In our crowded and insanitary world, you can't run everything on some vague innuendo that "I saw on the Internet".

Letting Ashya simply disappear makes it much more dangerous for many other kids, if their parent(s) decide to take unilateral action.

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It's Not That Simple

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Eutychus
From the edge
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It was interesting watching the media coverage of this unfold in the UK compared to the coverage in France, which was non-existent for at least the first 12 hours or so (I had a special interest, because I'm probably the closest shipmate to where their ferry arrived in France. I was wondering what I would do if I spotted them).

The French police would not issue the "AMBER" style alert, simply because the grounds for doing so were not fulfilled - first and foremost, no offence was committed.

In early UK media coverage, amidst the usual hysteria I noted the child was said to be removed from the hospital "without the hospital's consent".

Excuse me? I thought it was patients that gave or withdrew their consent, not hospitals or doctors (no court order was in place). The French media more correctly recorded "against medical advice".

I also think the hospital misled the police about the seriousness of the situation. They have more to answer for than the police. They wailed about the battery life of the feeding device when apparently it was as easy to recharge as an iPhone.

The parents have done a very good PR job - possibly with outside advice? - which seems to have resulted in a rare victory of common sense via social media.

And I can't help thinking it might well, ironically, do a lot to improve the image of Jehovah's Witnesses.

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Let's remember that we are to build the Kingdom of God, not drive people away - pastor Frank Pomeroy

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no prophet's flag is set so...

Proceed to see sea
# 15560

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Discharge was parental controlled disappearance? That's not acceptable. Discharge with a credible health plan even if the doctors disagreed, this may be acceptable unless it was for faith healing or something without data to back it.

As for vaccinations, the new policy here for health workers is either get a 'flu vaccine or when ordered to do so at work, wear proper protection to avoid getting infected or infecting others. I suspect that not being paid for sick days when it is the 'flu and you've not been vaccinated is also the consequence. My employees are told to get vaccinated (free for all here through medicare), and haven't had the issue of considering not paying them if ill with the 'flu.

I don't think it is a problem to order conduct from people for the sake of others. We already do this with various activities, like regulating public drinking and smoking, use of mobile phones, etc. The difference I think is regulating things for the good of the individual and considering that the government or officials know better than the individual. Except that we already require people to go to school and get educated even if they don't want to be there. Thus, there is obviously some middle ground where we must require certain things, and will let other things go.

Not being vaccinated is just plain stupid.

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Out of this nettle, danger, we pluck this flower, safety.
\_(ツ)_/

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Byron
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Glad the charges have been dropped, and that the family can reunite.

On the issue, parents' rights over their children aren't absolute. They're obliged to act in their child's best interests. If the hospital had reason to believe that their actions had endangered Ashya, they may have acted properly on the info they had.

Right now it looks like a tragic misunderstanding between parents, hospital and prosecutors.

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Doublethink.
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In certain circumstances, refusing appropriate medical treatment for your child would constitute neglect.

Thresholds for what is held to constitute abuse, and what constitues a crime, are not the same.

I note from Cancer Research UK, proton beam therapy is thought to be appropriate for only about 1% of patients - and the evidence for advantage over conventional treatment is not that great.

Nonetheless, the NHS will send folk abroad for this treatment if a special panel agrees the patient is suitable.

In the King case, it looks as if the medical team and the parents disagreed about whether this was a suitable treatment for their son.

I seriously doubt the only ongoing medical care aside from radiotherapy the child needs is a battery operated feeding mechanism - even if this was the main thing highlighted in press coverage. A tube into the stomach carries infection risk that requires careful management It is said in news reports that he has very little physical movement. This leads to all sorts of other problems that need ongoing management - many of which can become dangerous quickly.

We don't know how exactly the brain tumour effects this child either.

I have no doubt both the medical team and the parents thought they were acting for the best, but That doesn't mean they are right.

Given the police were told the child might die, it seems to me they did the best they could based on the information they had at the time.

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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell

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Zoey

Broken idealist
# 11152

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The account currently being given in the press is that the family travelled to Spain in order to sell a property they own there, with a view to the proceeds of that sale funding the proton beam therapy. I don't understand why one parent didn't go to sell the Spanish property leaving Ashya and the rest of the family (including the other parent) in the UK, with ongoing medical care, support from friends and family, etc, until the funds had been raised. I also don't understand why the parents carried out their actions in a secretive way. As has been said - they did not kidnap their son and it's not illegal for a parent to remove their child from hospital. But surely the more sensible plan would have been to talk to the hospital about one's proposals i.e. we want to take our child to X medical facility in country Y in order to get Z treatment available there. If hospital and parents had been unable to agree what was in the child's best interests, the case would have gone to court for a determination on that front, but just disappearing from a hospital with a seriously ill child isn't a great plan either. At present, to me, it looks like the family's plans were ill thought-through. I can understand the family feeling desparate and acting irrationally, but also don't think it's fair at this point to criticize the hospital's and police's actions as harshly as some sections of the media appear to be doing. I agree that the state intervention has not been ideal in that it's resulted in Ashya being separated from his parents whilst he has been seriously ill. However, the UK operates on the basis that when a child is at high risk of harm through his or her parents' actions, then the state does intervene. When Ashya's parents didn't return with him to the hospital as expected on Thursday last week, the hospital tried to contact them and was unable to do so. What does the media expect the hospital and the state to have done at that point - shrugged and decided that it didn't matter that a seriously ill child in need of ongoing medical care had disappeared without anybody knowing what arrangements his family might or might not have put in place for his ongoing care?

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Pay no mind, I'm doing fine, I'm breathing on my own.

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Zoey

Broken idealist
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quote:
Originally posted by Byron:
Right now it looks like a tragic misunderstanding between parents, hospital and prosecutors.

I would agree with this, but argue that most of the responsibility for the 'misunderstanding' / lack of communication lies with the parents - they didn't talk to the hospital about their plans and weren't contactable when hospital staff became worried about Ashya's welfare because he hadn't returned to the hospital as expected. I'm sure the parents were motivated by desperately wanting to do what they felt best for their son, rather than by any malice, but I still think they went about it entirely the wrong way and I'm not sure how the hospital and police would have been expected to react (given that they couldn't contact the family or obtain reassurance about Ashya's welfare) if not in roughly the way they did.

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Pay no mind, I'm doing fine, I'm breathing on my own.

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Firenze

Ordinary decent pagan
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And if the publicity generated results in him receiving a therapy which the doctors in his case did not think would be efficacious? That's a lot of expenditure which is not now available for other patients in less dramatic circumstances. A little learning is a dangerous thing, as witness the rise of antibiotic resistant bacteria because of the number of vociferous patients who knew they were what their sniffly kid needed (and line-of-least-resistance doctors).

I realise a medical degree/x years of clinical practice does not make someone infallible, but it still trumps any amount of bopping round the Internet.

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Ariel
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quote:
Originally posted by seekingsister:
So - should it be a crime to remove a loved one from hospital to pursue alternative medical treatment?

What would the answer be if someone's loved one had Ebola, or some other horribly contagious disease, and was removed from hospital by their family to pursue alternative medical treatment, possibly at home or possibly by a local healer?
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Eutychus
From the edge
# 3081

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quote:
Originally posted by Zoey:
But surely the more sensible plan would have been to talk to the hospital about one's proposals i.e. we want to take our child to X medical facility in country Y in order to get Z treatment available there.

The father's answer to that, in the first video posted on his behalf, was that when they made these sorts of noises to the hospital they were told a Child Protection Order would be sought if they persisted with that line of argument.

Do you have any idea what it is like to be threatened with losing the custody of your child to the state, or how hard it can be to get it back? I can see how this case might set a terrible precedent for other families, but I can totally sympathise with this family devising a plan to act before the hospital could put such an order in place.

The family's view appears to be that the hospital was basically looking to experiment with radiotherapy despite proven risks. The child, they felt, was to be a guinea pig. Proton beam therapy results appear to be unconfirmed (no better or worse than radiotherapy) but at least do less collateral damage.

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Let's remember that we are to build the Kingdom of God, not drive people away - pastor Frank Pomeroy

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Caissa
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Parents have a duty of care. When they do not meet it, the state is obliged to intervene.
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Zoey

Broken idealist
# 11152

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Child Protection Orders do not exist in the UK. Children can be subject to a Child Protection Plan, but that does not give the Local Authority or any other arm of the state any legal powers in respect of the child. Court orders for which Local Authorities can apply in respect of children in England and Wales include: Emergency Protection Orders, Interim Care Orders and Care Orders.

My brain is not up to responding to the rest. (I'm a UK children's social worker. I wouldn't propose that Ashya's parents should lose custody of him and would be surprised if any social worker or member of medical staff is arguing that. I think children should be with their birth parents unless they are at risk of serious harm and that risk cannot be managed. Despite this and the amount of time and effort I and my colleagues put in to trying to support children within their birth families, it's good to know that we are still viewed by many as evil kiddy-snatchers who get our jollies stealing children for no good reason.) Probably shouldn't be posting in Purg, so am going to duck out.

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Pay no mind, I'm doing fine, I'm breathing on my own.

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Zoey

Broken idealist
# 11152

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quote:
Originally posted by Zoey:
I wouldn't propose that Ashya's parents should lose custody of him and would be surprised if any social worker or member of medical staff is arguing that.

Moreover, if that were seriously being proposed by a state body, his parents would be entitled to free legal representation and I would be astounded if a court in England or Wales agreed to a care plan whereby they lost care of him on the basis of the facts as currently presented.

I know, I know - I said I'm ducking out and that is what I should do.

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Pay no mind, I'm doing fine, I'm breathing on my own.

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Sioni Sais
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Primarily, care for the child should be the parents responsibility. It looks like, at the very least, there was a breakdown in communications between the hospital and the parents, with everyone refusing to back down at which point the hospital seems to have called in the cavalry (in the form of the police).

I hope we don't decide future policy on the basis of this case, which looks a hard one, because hard cases make bad law [Snore] . Leave the marginal ones to the judges.

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"He isn't Doctor Who, he's The Doctor"

(Paul Sinha, BBC)

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Eutychus
From the edge
# 3081

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I apologise for the wrong terminology and erroneous legal conclusions (or at least implications I drew).

Among my longstanding local church friends I have a social worker who for a large part of her career has been involved in removing children from the care of their parents, and parents of children who have been removed from their care, so I can see this issue from both sides.

The fact remains that in this case, the parents say they got the distinct impression they would not be able to have access to their child if social services got involved and that this would happen if they persisted asking about alternative treatment options. I can understand that mindset even if they were mistaken, and I think this explains why they acted pre-emptively, even if opinion is divided as to whether they were justified in doing so.

I note the health trust is still talking in terms of a lack of consent on the part of the hospital, which sounds scary to me.

While this still looks like having indirect benefits for JWs, I wonder whether the family's reaction is coloured by a certain view of "The World"™.

(x-post)

[ 02. September 2014, 21:17: Message edited by: Eutychus ]

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Let's remember that we are to build the Kingdom of God, not drive people away - pastor Frank Pomeroy

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Doublethink.
Ship's Foolwise Unperson
# 1984

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quote:
Originally posted by Eutychus:
The family's view appears to be that the hospital was basically looking to experiment with radiotherapy despite proven risks. The child, they felt, was to be a guinea pig. Proton beam therapy results appear to be unconfirmed (no better or worse than radiotherapy) but at least do less collateral damage.

Using radiotherapy to treat cancer is hardly experimental. Unconfirmed is not the same as equivalent.

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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell

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Eutychus
From the edge
# 3081

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quote:
Originally posted by Doublethink:
Using radiotherapy to treat cancer is hardly experimental. Unconfirmed is not the same as equivalent.

I am not a doctor and I appreciate the problems with protocol by internet.

As I understand it, the family's arugment is that there is less collateral damage - especially in children - with proton therapy, the therapeutic outcomes of which are disputed.

Apart from the treatment options themselves, we also don't know enough about the child's prognosis to take an informed view. But if the family felt the side-effects of the proposed treatment greatly outweighed any uncertain benefits, and had assurances from another hospital of treatment with fewer side-effects, I can understand them wanting to exercise that option, and having trouble seeing why they shouldn't be allowed to.

In their case, meeting resistance from the hospital staff when this idea was raised probably strengthened, rather than lessened, their resolution.

[ 02. September 2014, 21:27: Message edited by: Eutychus ]

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Let's remember that we are to build the Kingdom of God, not drive people away - pastor Frank Pomeroy

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Zoey

Broken idealist
# 11152

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quote:
Originally posted by Eutychus:

The fact remains that in this case, the parents say they got the distinct impression they would not be able to have access to their child if social services got involved and that this would happen if they persisted asking about alternative treatment options.

I wish they had got decent legal advice before doing a flit. It really doesn't sound as if they did. If social services become involved, in England and Wales, social services have a **duty** to promote contact between children who are Looked After by the state and members of their birth family. The contact must be in the best interests of the child - hence, if children are in permanent foster care and parents don't present appropriately at contact sessions then contact may stop being offered and, additionally, children in permanent foster care need to settle in that foster care, so contact with their birth parents may only be once every few months. However, whilst Care Proceedings are going on, social services in England and Wales have a legal duty to promote the relationship between a child who is subject to such proceedings and their birth family (usually offering supervised contact multiple times a week). Moreover, I continue to think that a court in England would almost certainly not approve a care plan for Ashya to be placed in foster care or away from the custody of his parents - I would expect the court to make a determination regarding what medical treatment is appropriate for him, but would expect everybody (social workers, court, etc) to see that, aside from the issue of what medical care is in his best interests, there is no question that his parents can care for him appropriately and meet his needs and are therefore the best people to do so.

(Thank you for your post, Eutychus. As you may have guessed, I'm a bit tetchy currently for reasons entirely unrelated to this thread and your first response to me wound me up somewhat. I'm grateful for your follow up.)

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Pay no mind, I'm doing fine, I'm breathing on my own.

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Eutychus
From the edge
# 3081

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And thanks for that. I agree that with different and better advice, they might have acted differently. But how hard it is in situations like this to know who will give you truly wise advice and who you can really trust. [Votive]

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Let's remember that we are to build the Kingdom of God, not drive people away - pastor Frank Pomeroy

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justlooking
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quote:
Originally posted by Caissa:
Parents have a duty of care. When they do not meet it, the state is obliged to intervene.

Exactly. And in this case there was a temporary Wardship Order which made the child a ward of court. The parents were legally obliged to comply with the court's direction. All that was known for certain was that the parents had disappeared with a very sick child who needed specialised medical care. Parents don't have the right to put their child in danger and the priority was to find Aysha and ensure his safety.

IMO the authorities acted properly. The arrest warrant was for suspected neglect or cruelty and since there was initially no information about how Aysha would be fed and cared for there was justifiable suspicion that he might be in danger.

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Doublethink.
Ship's Foolwise Unperson
# 1984

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It looks as if both Neon Roberts & Aysha King had/have medullablastoma.

Info.

[ 02. September 2014, 21:53: Message edited by: Doublethink ]

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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell

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JoannaP
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# 4493

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quote:
Originally posted by Eutychus:
quote:
Originally posted by Doublethink:
Using radiotherapy to treat cancer is hardly experimental. Unconfirmed is not the same as equivalent.

I am not a doctor and I appreciate the problems with protocol by internet.

As I understand it, the family's arugment is that there is less collateral damage - especially in children - with proton therapy, the therapeutic outcomes of which are disputed.

Apart from the treatment options themselves, we also don't know enough about the child's prognosis to take an informed view. But if the family felt the side-effects of the proposed treatment greatly outweighed any uncertain benefits, and had assurances from another hospital of treatment with fewer side-effects, I can understand them wanting to exercise that option, and having trouble seeing why they shouldn't be allowed to.

In their case, meeting resistance from the hospital staff when this idea was raised probably strengthened, rather than lessened, their resolution.

AIUI, the oncologist responsible for treating Ashya believes that, for his particular tumour, there would be no difference in outcome between proton beam radiation and whatever the normal type of radiotherapy is. I do not know how much variation there can be in brain tumours nor how much detail the websites discussing proton beam therapy go into about the differences. The Czech hospital which had agreed to treat Ashya had apparently not seen any brain scans or medical records, so were hardly speaking from a position of knowledge of this particular tumour.

I also note that, according to Southampton Hospital, they had offered the family a second opinion and were prepared to discuss travelling abroad for proton beam therapy, possibly including applying for NHS funding to do so, as nearly 100 other children have done.

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"Freedom for the pike is death for the minnow." R. H. Tawney (quoted by Isaiah Berlin)

"Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety." Benjamin Franklin

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LucyP
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# 10476

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quote:
Originally posted by no prophet:
.

As for vaccinations, the new policy here for health workers is either get a 'flu vaccine or when ordered to do so at work, wear proper protection to avoid getting infected or infecting others. I suspect that not being paid for sick days when it is the 'flu and you've not been vaccinated is also the consequence. My employees are told to get vaccinated (free for all here through medicare), and haven't had the issue of considering not paying them if ill with the 'flu.


This is a tangent, but - really, people don't get paid if they have "the flu"? I am pro-vaccination and have had the flu shot, but am under no illusions about its efficacy: approximately 60%.

Are payments only cancelled if the sick person has had swabs done which have proved that their illness was one of the 3 strains prevented by that year's vaccine? Because there are plenty of viruses that can give you flu-like symptoms (parainfluenzae, nonseasonal strains of influenza, CMV, rhinoviruses, RSV, coronaviruses, to name a few) which are not covered by the vaccine. Other viruses are far more common. What if the person calls in sick with "a bad cold" - do they still get paid then, or are they forced to leave the house to visit the doctor to get swabs done to ensure it's not influenza?

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anoesis
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# 14189

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quote:
Originally posted by LucyP:
quote:
Originally posted by no prophet:
.

As for vaccinations, the new policy here for health workers is either get a 'flu vaccine or when ordered to do so at work, wear proper protection to avoid getting infected or infecting others. I suspect that not being paid for sick days when it is the 'flu and you've not been vaccinated is also the consequence. My employees are told to get vaccinated (free for all here through medicare), and haven't had the issue of considering not paying them if ill with the 'flu.


This is a tangent, but - really, people don't get paid if they have "the flu"? I am pro-vaccination and have had the flu shot, but am under no illusions about its efficacy: approximately 60%.

He did say "not being paid for sick days when it is the 'flu and you've not been vaccinated", which I take to mean that those who have been vaccinated are safe to claim sick leave if they do contract influenza or one of the illnesses which can masquerade as influenza, because they've done what they can to reduce the risk to themselves and others.

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The history of humanity give one little hope that strength left to its own devices won't be abused. Indeed, it gives one little ground to think that strength would continue to exist if it were not abused. -- Dafyd --

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L'organist
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posted by Joanna P
quote:
AIUI, the oncologist responsible for treating Ashya believes that, for his particular tumour, there would be no difference in outcome between proton beam radiation and whatever the normal type of radiotherapy is. I do not know how much variation there can be in brain tumours nor how much detail the websites discussing proton beam therapy go into about the differences. The Czech hospital which had agreed to treat Ashya had apparently not seen any brain scans or medical records, so were hardly speaking from a position of knowledge of this particular tumour.

I also note that, according to Southampton Hospital, they had offered the family a second opinion and were prepared to discuss travelling abroad for proton beam therapy, possibly including applying for NHS funding to do so, as nearly 100 other children have done.

The trouble is that because there is no facility for proton beam therapy (PBT) in the UK there will always be the suspicion that a decision that a treatment won't be recommended because it simply isn't available. At the moment UK patients who require PBT are sent to the US.

Cost is another factor: the government made £250m available for the development of 2 PBT facilities in September 2013 but these won't come on-stream for years. Meanwhile the radiation therapy innovation fund was only charged with £23m which is a drop in the ocean.

Outside London especially the NHS is way behind on many treatments for cancer that have been available for 10-15 years or more in the USA and some European countries. PBT has been available in the US for more than a decade but the UK centres won't be on-stream for at least another 3 years. Brachytherapy is the same, etc, etc.

As for thr possibility of Ashya being taken abroad for treatment: the procedure for organising this to be paid for by the NHS is extremely long-winded. Doctors cannot simply recommend it but have to go through a long and time consuming rigmarole to get a decision from NICE (these decisions are made on a patient by patient basis). The time from applying to send a patient to decision is usually 8-10 weeks and, because the patient remains in the UK until a funding decision has been reached there is then a further wait of about 9 weeks before the first PBT session is made.

Tragically there have been quite a few cases in patients whose PBT has eventually been approved that the lengthy process to get funding has meant tumours have grown so the prognosis is significantly less good than at the time the application was made - delays cost lives, to be blunt.

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orfeo

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quote:
Originally posted by Caissa:
Parents have a duty of care. When they do not meet it, the state is obliged to intervene.

Meeting parental duty of care is not equal to mindlessly agreeing with everything a doctor tells you.

I have to say this whole excuse of "oh, but we didn't know what the parent's intentions were" seems extraordinarily lame to me at the moment. It makes it sound like they'd threatened to harm him or kill him.

As things stand, the proposal to make this child a ward of the State sounds like a gross usurpation of the proper role of medical professionals.

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justlooking
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quote:
Originally posted by orfeo:

As things stand, the proposal to make this child a ward of the State sounds like a gross usurpation of the proper role of medical professionals.

There is no proposal to make the child a ward of court, he was made a ward of court under a temporary order. Being a ward of court does not make the child a 'ward of the state', it means decisions will be authorised by a judge and, most importantly, it means the child will be represented independently of parents, doctors or social workers. The court has a duty to act in the child's best interests and to consider the situation from the child's viewpoint. In this case there was good reason to fear for Aysha's safety and therefore a duty to take whatever action was needed in order to locate him and ensure he was getting the care he needed.

[code]

[ 03. September 2014, 05:31: Message edited by: Eutychus ]

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Justinian
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quote:
Originally posted by seekingsister:
So - should it be a crime to remove a loved one from hospital to pursue alternative medical treatment?

Without the loved one's consent? Yes.

In the case of children it depends. Children are not deemed able to give consent.

If you are removing them and having their treatment replaced with snake oil of one sort or another again, yes. That's as abusive to the child as beating them up would be.

If you are having them discharged for something that has a plausibly good chance of success under current medical guidance then the parents are in the right. This is rare and was not communicated clearly. It is (fortunately) what was happening here.

Do parents own their children? No. Children are individual beings that need protection. The parents are normally the people in the best place to make such decisions. But not always.

(Trigger warning: The cases of Victoria Climbie and Baby P are harrowing reading even if I only linked Wikipedia).

[ 03. September 2014, 02:08: Message edited by: Justinian ]

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Leorning Cniht
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quote:
Originally posted by no prophet:
Except that we already require people to go to school and get educated even if they don't want to be there.

We require them to be educated. We do not require this to happen in a school. And, at least here, it is not up to the local school to determine whether or not the parents' plan for their child's education is appropriate.

On the other hand, the parents are obliged to give their children an education that, in at least broad terms, is equivalent to or better than that provided by the public schools.

My general opinion for children and hospital treatment is similar. I don't think it's reasonable to require the hospital to be able to prevent a child from leaving (one assumes that the parents would be removing their child because, for whatever reason, they aren't happy with the treatment at the hospital, and there would seem to be potential conflict of interest and prestige issues involved if the hospital are allowed to keep the child against his parents' will.

On the other hand, parents should be required to provide proper treatment, and there's a difference between the school case and the hospital case - if you mess up your child's education for six months, and then the state calls you on it, the damage can be mended. If you remove your sick child in order to place energized crystals around him and chant a lot, he might die.

So perhaps what is needed is a letter from the parents informing the hospital that they are removing their child, and placing him under the care of <specific named doctor, with actual qualifications> at <recognized medical facility>. It's reasonable to give the hospital 15 minutes to verify the existence of the doctor and the facility.

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Leorning Cniht
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quote:
Originally posted by L'organist:
The trouble is that because there is no facility for proton beam therapy (PBT) in the UK there will always be the suspicion that a decision that a treatment won't be recommended because it simply isn't available. At the moment UK patients who require PBT are sent to the US.

Given the straight choice, and assuming that money was no object, if I had some kind of brain cancer, I would choose proton therapy over conventional radiotherapy any day of the week, and if I could find someone with a carbon machine willing to take me on as an R&D case, I'd choose carbon over protons. I don't see why I wouldn't make the same choice for one of my children.
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orfeo

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quote:
Originally posted by justlooking:
quote:
Originally posted by orfeo:

As things stand, the proposal to make this child a ward of the State sounds like a gross usurpation of the proper role of medical professionals.

There is no proposal to make the child a ward of court, he was made a ward of court under a temporary order. Being a ward of court does not make the child a 'ward of the state', it means decisions will be authorised by a judge and, most importantly, it means the child will be represented independently of parents, doctors or social workers. The court has a duty to act in the child's best interests and to consider the situation from the child's viewpoint. In this case there was good reason to fear for Aysha's safety and therefore a duty to take whatever action was needed in order to locate him and ensure he was getting the care he needed.
I stand corrected on my misuse of terminology. However...

What good reason to fear for his safety?

This is what I mean when I say that the "we didn't know where he as or what his parent's intentions were" claim seems like a self-justifying smokescreen.

They clearly didn't think he had been abducted by a stranger. That's inconsistent with referring to his parent's intentions and obtaining an arrest warrant for his parents.

And I haven't seen the slightest bit of evidence that his parents were considered a danger to him. There's no suggestion that I've seen that they were abusive, violent, failed to provide him with food or shelter, or anything else that would suggest a child is 'at risk'. There's not even any evidence that they refused him medical treatment - if they were the kind of parents who ascribed everything to God's will and thought the way to deal with illness was to pray, he wouldn't have been in hospital in the first place.

No, the sole basis for "fearing for his safety" is that his parents wanted a different medical treatment in a different location.

The implications are pretty staggering. What's next? What happens to adults who say they want a second opinion?

I will agree that it wasn't the best move for his parents to remove him from the hospital without notice, but I can well understand why they did. No-one should have EVER suggested to them that their power to make medicial decisions for their child might be taken away, because I don't think there was any justification for that suggestion.

I wouldn't be surprised if what the hospital said to the police was "THEY'VE TAKEN HIM OUT OF TREATMENT!". Because if they'd added "to take him to different treatment", the cause for alarm would have evaporated. There is absolutely no fear for the safety of a child involved in switching doctors.

The very notion of the hospital 'agreeing' to any of this is based on the false notion that the hospital had any business having a say in the first place. I'm not required to consult my GP or optometrist before trying a different GP or optometrist, any more than I'm obliged to notify my hairdress or gardener.

[ 03. September 2014, 03:15: Message edited by: orfeo ]

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Eutychus
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quote:
Originally posted by justlooking:
quote:
Originally posted by Caissa:
Parents have a duty of care. When they do not meet it, the state is obliged to intervene.

Exactly. And in this case there was a temporary Wardship Order which made the child a ward of court.
Not, I think, until after the parents had been arrested (without charge), and passed on the grounds that the parents were in custody.

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orfeo

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quote:
Originally posted by Eutychus:
quote:
Originally posted by justlooking:
quote:
Originally posted by Caissa:
Parents have a duty of care. When they do not meet it, the state is obliged to intervene.

Exactly. And in this case there was a temporary Wardship Order which made the child a ward of court.
Not, I think, until after the parents had been arrested (without charge), and passed on the grounds that the parents were in custody.
The timeline I've found indicates:

28 August - parents remove him from hospital

29 August - made a ward of the court

30 August - parents arrested.

So it seems he wasn't a ward of the court at the time that his parents took him from the hospital.

It also seems that various authorities were told he was in grave medical danger in a misleading fashion, referring to the battery life of the machine without mentioning a charger.

There certainly doesn't seem to be any evidence that he was in worse shape when he arrived in Spain than he had been in Southampton. The biggest distress he seems to have suffered is being separated from his parents.

[ 03. September 2014, 05:54: Message edited by: orfeo ]

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Doublethink.
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BBC news reports the tumour was removed last month. I would reiterate that I think that it is highly unlikely that the only ongoing care a child a few weeks post brain surgery needs, (aside from radiotherapy) , is a battery operated feed.

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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell

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justlooking
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Eutychus - From what I've read the temporary wardship order was made as an emergency measure after Aysha had been removed from hospital. The police acted on the information they had at the time - that a very sick child had been taken away and his whereabouts unknown. The doctors, the court and the police all acted properly IMO and they acted in accordance with UK child protection laws.

orfeo - the reason to fear for the child's safety was his need for specialised medical care which included being fed via a tube. In the absence of any information about how his parents intended to ensure his continued care and safety it seems reasonable to me that action was taken immediately to find him and make sure he was safe.

In the UK parents have considerable flexibility if they provide for a child's education outside the school system. They still, however, have a legal duty to arrange education in accordance with 'age, aptitude and ability' and to make provision for any special needs. Case law gives some framework for what a non-school education might be and education authorities have regulations and guidelines for managing the relationship with home educating families. The Education Act also specifies that a child's wishes and feelings must be taken into account in arranging their education. This applies to schools too.

ISTM that some of the outcry in this case comes from a view of children as property either of their parents or of the state and cases making the news are often discussed as if they are a battle between parents and state authorities. But UK law treats children as having rights and interests independent of their parents or of state authorities. When it comes to a dispute or when a child is seen to be in danger the court and legal system ensure the child's rights and interests take priority. e.g This case

[ 03. September 2014, 06:41: Message edited by: justlooking ]

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bib
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We had a patient, a little 3 year old with leukaemia, whose parents were determined to take him home and feed him only sterile water as the mother had a dream that this would bring about a cure. The hospital prevented this from happening and the child eventually responded to proper medical treatment. Surely it would not have been ok for the parents to be allowed to carry out their plans as the child would have died. Would that be considered manslaughter?

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Doublethink.
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It would certainly count as abuse under the category of neglect. I assume that the child ended up on the at risk register.

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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell

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Eutychus
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quote:
Originally posted by justlooking:
When it comes to a dispute or when a child is seen to be in danger the court and legal system ensure the child's rights and interests take priority.

This is all well and good, but this is about balance of powers. The troubling thing from my perspective is the scale of the UK police response, apparently well ahead of any decision by a magistrate with regard to the child.

(In France, serious investigations quickly fall within the remit of a magistrate. I often find myself railing against this, but this case makes it look like not such a bad idea).

A quick browse does not reveal in what circumstances Child Rescue Alerts can be issued in the UK, but in France the equivalent requires a decision, independently of the police, by the prosecutor. And in possession of the same information as the UK police, the French prosecutor decided not to deploy such a sledgehammer - most probably because there was no relevant charge to be brought.

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itsarumdo
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It's a question as to who thinks they know best and what the proper order of guardianship should be

Parents should be allowed to be adequate, to be sufficiently competent, to be humanly imperfect in theor decisions provided that they are doing their best for the child. This is about expression of parental love.

OTOH, the state's primary responsibility is to protect its citizens from its own excesses, and its secondary responsibility iost to protect them from other people and from themselves.

In child protection we now have an ATTITUDE that says - every adult is suspicious, is a potential child abiuser or is inadequate to make the correct decisions, because state child protection knows best, and only we are really safe. That attitude is corrosive - how can a world be safe for children if they get the message that all adults are dangerous? It is a lso a displacement of the state's position re its citizens - somehow the state's position as a dangerous guardian and parent that has to be watched and kept in check has been projected back at its citizens. The active abuse of children when they are in state protection - e.g. care homes - is a case in point - it's not that they represent a high proportion of the children abused, but rather like an airplane or a train crash, it all happens in one place and there should have been measures in place to prevent this in the first place. It's all very well making legislation to prevent abuse when under state protection, but that should apply to abuse FROM the state and its employees, NOT from potentially responsible adults. The state's administrative structures are ideal for infiltration by anyone who has criminal motives, and so the state should be prepared for that, one way or another. However, the legislation for private individuals should be different, and be based on the principle that most adults do not wish to harm children. Furthermore, it should be fairly extreme cases, where a clear boundary has been crossed which prompts the state to "save a child" by removing guardianship from its parents or normal family guardians. The threat of making the child a ward of court should the parents disagree with the doctors diagnosis or proposed treatment is the only reason this family took off in a car.

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justlooking
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Eutychus - The police applied for an international arrest warrant because the child had been taken out of jurisdiction of the UK court. I don't see any other way of ensuring the French or Spanish police could act swiftly. Until the family were found there was no information about if or how they were caring for Aysha and meeting his medical needs.

[ 03. September 2014, 07:47: Message edited by: justlooking ]

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seekingsister
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quote:
Originally posted by itsarumdo:
In child protection we now have an ATTITUDE that says - every adult is suspicious, is a potential child abiuser or is inadequate to make the correct decisions, because state child protection knows best, and only we are really safe. That attitude is corrosive - how can a world be safe for children if they get the message that all adults are dangerous? It is a lso a displacement of the state's position re its citizens - somehow the state's position as a dangerous guardian and parent that has to be watched and kept in check has been projected back at its citizens. The active abuse of children when they are in state protection - e.g. care homes - is a case in point - it's not that they represent a high proportion of the children abused, but rather like an airplane or a train crash, it all happens in one place and there should have been measures in place to prevent this in the first place. It's all very well making legislation to prevent abuse when under state protection, but that should apply to abuse FROM the state and its employees, NOT from potentially responsible adults. The state's administrative structures are ideal for infiltration by anyone who has criminal motives, and so the state should be prepared for that, one way or another. However, the legislation for private individuals should be different, and be based on the principle that most adults do not wish to harm children. Furthermore, it should be fairly extreme cases, where a clear boundary has been crossed which prompts the state to "save a child" by removing guardianship from its parents or normal family guardians. The threat of making the child a ward of court should the parents disagree with the doctors diagnosis or proposed treatment is the only reason this family took off in a car.

You've captured my thoughts very well here.

The press coverage of this over the weekend before the family was found, essentially painted the parents as anti-medicine kooks who snatched their child and were taking him "to Europe" - that terrifying place where there are no hospitals or doctors, of course.

The hospital completely overreached and I hope an investigation and even charges are made against the individuals who threatened to take Ashya from his parents over a disagreement over medical treatment. That is why they fled - because they had been told the state would take their child from them.

quote:
King said when he questioned the doctors' plans, they threatened to take Ashya away from him via a protection order.

"We couldn't take it anymore, not knowing and not being able to question anything," King said. "We couldn't be under that system anymore."

ABC News
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seekingsister
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quote:
Originally posted by bib:
We had a patient, a little 3 year old with leukaemia, whose parents were determined to take him home and feed him only sterile water as the mother had a dream that this would bring about a cure. The hospital prevented this from happening and the child eventually responded to proper medical treatment. Surely it would not have been ok for the parents to be allowed to carry out their plans as the child would have died. Would that be considered manslaughter?

But what if the parents wanted to take the child to the US or Europe for an alternative medical treatment? Surely that's different from home remedies?

If the NHS will not fund overseas treatment then they need to allow families to choose to withdraw from NHS care and pursue alternatives at medical centers that will provide them.

Otherwise it seems that if you disagree with the NHS they will use the force of the police to ensure you comply with their treatment.

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justlooking
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quote:
Originally posted by itsarumdo:
The threat of making the child a ward of court should the parents disagree with the doctors diagnosis or proposed treatment is the only reason this family took off in a car.

Making a child of ward of court doesn't necessarily mean the court will decide in favour of the doctors' proposals. The court will have to listen to all interested parties, including the child, and to then make a decision in accordance with the child's best interests.

Children under 16 can, in many circumstances, give or refuse consent to medical treatment if doctors consider them capable of understanding their situation and making an informed decision. Where there is a dispute, including a dispute about a child's ability to make a decision, then the case is referred to court. The newsworthy cases are often those involving under 16 year old pregnant girls but most such cases never get to court because the girl decides, ideally with the support of her parents but sometimes without them ever knowing if she chooses to have an abortion.

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North East Quine

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There seems to be a lack of hard facts in this case, particularly around the parents ability to have their son treated by proton therapy in Prague.

According to this BBC report, Mr King contacted the Prague centre on 20 Aug.

What doesn't seem clear is why Southampton Hospital wouldn't co-operate with the Prague centre by sending medical details which would let the Prague centre assess Ashya's suitability for proton therapy.

What is also not clear is whether Southampton hospital did, as Mr King alleges, threaten to involve social services because he was contacting Prague.

Somewhere along the line there appears to have been a massive breakdown in communication.

I can understand the initial impetus to find Ashya, but I cannot understand why, when he was found and hospitalised in Spain, he was kept apart from his parents. What was the risk in letting his parents remain at his bedside? Why did they need to be handcuffed and imprisoned?

How much distress was caused for that little boy by keeping him apart from his family? It seems callous to me.

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Jane R
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seekingsister:
quote:
If the NHS will not fund overseas treatment then they need to allow families to choose to withdraw from NHS care and pursue alternatives at medical centers that will provide them.
Except they will fund overseas treatment, if they think the outcome is likely to be significantly better for the patient in question than having the treatment available in the UK. As several other people have said, this is not always the case. Cost is a factor (because if you spend umpty thousand pounds on one expensive treatment that may not work you may run out of money for mundane but very effective treatments like hip replacements, hernia operations and gallstone removals) but a five year old child with a brain tumour will get priority for any money that's going. If the NHS really can't fund your overseas treatment then you can try to raise the money yourself - some parents have set up charities to raise the money for their children to have treatment abroad, and as far as I am aware the NHS was very supportive of them. But they didn't rush out of the country with their sick child in tow without telling the hospital what they were doing.

BTW proton beam therapy is a type of radiotherapy. The radiation is more tightly focused on the tumour, but it's still radiotherapy. Some of the media coverage seems to be implying that it's a magic bullet that doesn't involve nasty radiation at all.

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Eutychus
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quote:
Originally posted by justlooking:
Eutychus - The police applied for an international arrest warrant because the child had been taken out of jurisdiction of the UK court. I don't see any other way of ensuring the French or Spanish police could act swiftly. Until the family were found there was no information about if or how they were caring for Aysha and meeting his medical needs.

I think you miss my point though, which is that in France, while the police did not do nothing at all, they did not at any time launch the high-profile "hunt" the UK police wanted them to.

They did not have the powers to do so without a magistrate, and presumably the magistrate that did - the procureur - did not judge there were grounds to do so. That to me looks (here) like a good check in the system.

The UK police claimed they had implemented the European Arrest Warrant merely to give them the right to talk to the parents.

When the police caught up with the parents, they were not just "talked to". They were arrested, charged, and put in prison. Do you think that should happen every time the police want to "talk to" somebody?

I agree with Sioni Sais that extreme cases make bad laws, but I also think that in this instance, a sledgehammer was used to crack a walnut, as the result of a chain of errors and an imbalance in powers.

[ 03. September 2014, 08:36: Message edited by: Eutychus ]

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Let's remember that we are to build the Kingdom of God, not drive people away - pastor Frank Pomeroy

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justlooking
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# 12079

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quote:
Originally posted by Eutychus:
The UK police claimed they had implemented the European Arrest Warrant merely to give them the right to talk to the parents.

When the police caught up with the parents, they were not just "talked to". They were arrested, charged, and put in prison. Do you think that should happen every time the police want to "talk to" somebody?

The Spanish police arrested the parents and arranged for the child to be taken to hospital but did not charge the parents with any offence. They were held pending a decision about extradition but the UK then withdrew the arrest warrant.

It was a fast moving case and the legal action was sparked by the parents' action in removing Aysha from medical care without giving any information about where they were going and what arrangements they had for meeting his continued medical needs.

Posts: 2319 | From: thither and yon | Registered: Nov 2006  |  IP: Logged
Eutychus
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# 3081

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quote:
Originally posted by justlooking:
The Spanish police arrested the parents and arranged for the child to be taken to hospital but did not charge the parents with any offence. They were held pending a decision about extradition but the UK then withdrew the arrest warrant.

As I understand it, the arrest warrent included a specific charge to do with harm to a vulnerable child (can't remember the exact charge). This was presented at the time as a device to enable the police to talk to the parents. It quickly became much more than a device.

It would have been much faster to send UK police to Spain to question them than complete extradition proceedings.
quote:
the legal action was sparked by the parents' action in removing Aysha from medical care without giving any information about where they were going and what arrangements they had for meeting his continued medical needs.
My point is that, at least initially, as I understand it, it was not legal action but far-reaching police action, well ahead of any "ward of court" or other decision. I think having a magistrate somewhere in the proceedings would have been a worthwhile check in this case.

[ 03. September 2014, 09:02: Message edited by: Eutychus ]

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Let's remember that we are to build the Kingdom of God, not drive people away - pastor Frank Pomeroy

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seekingsister
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# 17707

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quote:
Originally posted by Jane R:
If the NHS really can't fund your overseas treatment then you can try to raise the money yourself - some parents have set up charities to raise the money for their children to have treatment abroad, and as far as I am aware the NHS was very supportive of them. But they didn't rush out of the country with their sick child in tow without telling the hospital what they were doing.

But given that Hampshire police have established that what the parents did is not illegal, why do they have to tell the hospital anything? Especially if Mr King's claim that they threatened him with a protection order if he continued to ask for a transfer to a proton therapy clinic is true.
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