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Originally posted by Justinian:

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Originally posted by orfeo:

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Originally posted by Justinian:
Why do you expect the hospital to be telepathic?

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I don't. I also don't expect them to ignore the fact that the parents had the presence of mind to take a feeding tube with them.

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Feeding the patient is not a cancer treatment.

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I don't suppose you have any references to legislation handy?

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Originally posted by Matt Black:
The healthcare service here has an ongoing responsibility to children and other legally vulnerable individuals, whether or not in hospital, hence the visits given as examples by North East Quine above. That relationship does not automatically terminate on discharge from hospital.

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Originally posted by North East Quine:
Originally posted by orfeo:

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Does the local hospital my nephew was born in have an obligation to be certain my nephew is being looked after? Is there some sort of roving duty of care in relation to all children in the area?

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Pretty much. The hospital check that, for example, if the parents are taking their newborn baby home by car, they are doing so in a properly fitted car seat. You can't just waltz out of hospital and put a baby in an unsecured carrycot on the back seat. Not here, anyway.

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Originally posted by North East Quine:
Originally posted by orfeo:

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I don't suppose you have any references to legislation handy?

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This is a Scottish government publication. See the box on page 10.

I assume the position in the rest of the UK is the same or broadly similar.

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Originally posted by orfeo:

Obligations arise from relationships. A hospital has an obligation to its patients. The patient relationship can be terminated.

It seems fairly clear to me that the parents, by their actions, were terminating the patient relationship. I would fully accept that the hospital had obligations towards the boy while they were treating him, but there seems to be this unstated assumption that they were still treating him. I don't think that assumption stands up very well to proper examination.

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Originally posted by orfeo:
Agreed. And?

Here's the disconnect I'm feeling right now with this 'child endangerment' argument that is currently running: where's the urgency? Where's the need to have court orders and arrest warrants within a single day?

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A belief that the parents would withhold cancer treatment may well justify action, but it does not justify we-have-to-find-him-right-now emergency-order action.

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Originally posted by JoannaP:

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Originally posted by orfeo:

Obligations arise from relationships. A hospital has an obligation to its patients. The patient relationship can be terminated.

It seems fairly clear to me that the parents, by their actions, were terminating the patient relationship. I would fully accept that the hospital had obligations towards the boy while they were treating him, but there seems to be this unstated assumption that they were still treating him. I don't think that assumption stands up very well to proper examination.

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Surely a doctor-patient relationship can only be terminated by one of the participants? The parents are not the patient and so do not have the right to terminate the relationship unilaterally.

Also, they did not terminate the relationship; they just removed Ashya from the hospital without providing any notice. Had they tried to discharge him or asked for him to be transferred to another hospital it would be different and the hospital would know that its duty of care had ended (assuming this was allowed to happen and Ashya was not made a ward of court).

According to your logic, when my grandmother, who was suffering from Alzheimer's, wandered out of the hospital after the hip replacement op and somehow managed to find her way home, she should have been allowed to stay home, having left her clothes, medication, etc. etc. in the hospital. At least she left the hospital under her own steam, which was more than Ashya did.

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Originally posted by JoannaP:
Surely a doctor-patient relationship can only be terminated by one of the participants? The parents are not the patient and so do not have the right to terminate the relationship unilaterally.

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Originally posted by Gee D:
And surely rights of guardianship of a child only leave the parents if there is a court order to that effect. The proper course for the hospital to take would have been to make an application to the relevant court for an order declaring the child a ward of the court or of the state. Courts here regularly consider applications for such an order when a child of JW parents is said to need a blood transfusion. A court will only make an order if it is satisfied that the treatment is necessary. Now Ashya is out of the UK, that may very well not be possible for such an application to be made. In the absence of an order it's hard to see that the parents her have committed any offence.

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Originally posted by Moo:

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Originally posted by JoannaP:
Surely a doctor-patient relationship can only be terminated by one of the participants? The parents are not the patient and so do not have the right to terminate the relationship unilaterally.

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Did they have the right to initiate the relationship unilaterally?

Moo

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How can anyone unilaterally initiate a relationship??

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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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Originally posted by orfeo:
Children of that age have no capacity to enter into a doctor/patient relationship, and so they also lack the capacity to end it. Their parents make those decisions.

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Originally posted by orfeo:
Your argument is lacking in logic. How did the doctor/patient relationship arise in the first place? Did Ashya create it?

No. Children of that age have no capacity to enter into a doctor/patient relationship, and so they also lack the capacity to end it. Their parents make those decisions.

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Originally posted by orfeo:
Your argument is lacking in logic. How did the doctor/patient relationship arise in the first place? Did Ashya create it?

No. Children of that age have no capacity to enter into a doctor/patient relationship, and so they also lack the capacity to end it. Their parents make those decisions.

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Originally posted by Moo:

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Originally posted by JoannaP:
Surely a doctor-patient relationship can only be terminated by one of the participants? The parents are not the patient and so do not have the right to terminate the relationship unilaterally.

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Did they have the right to initiate the relationship unilaterally?

Moo

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11. If a parent / legal representative requests to discharge a child from hospital contrary to medical advice, the Hospital Team should consider whether such an action is potentially harmful to a child’s welfare and of
immediacy as to require the initiation of statutory intervention to preclude such a course of action. Where immediate statutory intervention is considered to be necessary, Child Protection Procedures should be initiated and hospital staff should refer the child to Social Services with a view to the initiation of Emergency Protection Procedures.

12. Where medical and nursing staff conclude that there are no concerns identified, the request for discharge will be honoured and the parent / legal representative will be asked to sign the CTMA form. In these situations, hospital staff should consider whether a referral of the child to Social Services for assessment as a Child in Need is warranted.

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Originally posted by justlooking:
...In this case the parent removed a very sick child without any discharge arrangements and the hospital would have been failing in its duty of care if it took no action.

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According to Mr. King himself, the last thing he spoke with the hospital about with respect to treatment was taking Ashya off all cancer treatment. His subsequent actions that the hospital saw are entirely in line with the idea that he was doing this.

Do you believe that Mr. King should have been allowed to completely take Ashya off all cancer treatment? Just because he is the father?

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Originally posted by L'organist:
Bottom line is one must seriously question the gumption of 'the authorities' if the result of your concerns - however much you may feel them to be justified - is that a small child ends up in a foreign hospital without Mum or Dad, denied visits from siblings, unable to speak and being cared for by staff unable to communicate with him.

Do tell me which part of that makes any kind of sense.

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I think we can all see from this just how effective, caring, compassionate and intelligent a parent the state makes - but that is a better bet?

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Originally posted by itsarumdo:

This is one of the obfuscations around this case - what is legal as opposed to what is "right". The legalities of relationship and responsibility may affect how some one is allowed to act (or expected to act), but they do not define right action.

You're not alone in using legal terms in an essentially moral argument, because the legal principles have deeply infiltrated societal ways of thinking about this.

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Originally posted by North East Quine:
Originally posted by Justinian:

quote:

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According to Mr. King himself, the last thing he spoke with the hospital about with respect to treatment was taking Ashya off all cancer treatment. His subsequent actions that the hospital saw are entirely in line with the idea that he was doing this.

Do you believe that Mr. King should have been allowed to completely take Ashya off all cancer treatment? Just because he is the father?

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But this is where the massive breakdown in communication came about. Mr King stopped talking to the hospital because he feared being banned from his very sick son's bedside. He wasn't trying to take Ashya off all cancer treatment - the Prague hospital confirms that he was in contact with them, discussing radiotherapy in the form of Proton therapy. Indeed, he was trying to sell a property in order to pay for this treatment.

If Mr King hadn't been afraid of legal repercussions, he'd have been able to tell the hospital exactly what he hoped to do - and possibly Ashya could have been transferred straight from Southampton to Prague.

The big question to me is - how did a situation arise in which loving parents feared being banned from their child's hospital bedside because they were seeking alternative treatments? Had they misunderstood? Had someone at the hospital expressed themselves badly? How did this happen?

It seems to me that everything that happened thereafter flows from that.

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Originally posted by itsarumdo:

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Originally posted by justlooking:
...In this case the parent removed a very sick child without any discharge arrangements and the hospital would have been failing in its duty of care if it took no action.

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As I said previously, "Duty of Care" is a legal term.

This is one of the obfuscations around this case - what is legal as opposed to what is "right". The legalities of relationship and responsibility may affect how some one is allowed to act (or expected to act), but they do not define right action.

You're not alone in using legal terms in an essentially moral argument, because the legal principles have deeply infiltrated societal ways of thinking about this.

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In English tort law, an individual may owe a duty of care to another, to ensure that they do not suffer any unreasonable harm or loss. If such a duty is found to be breached, a legal liability is imposed upon the tortfeasor to compensate the victim for any losses they incur. The idea of individuals owing strangers a duty of care – where beforehand such duties were only found from contractual arrangements – developed at common law, throughout the 20th century.

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There are a number of distinct and recognisable situations in which the courts recognise the existence of a duty of care.

Examples include

one road-user to another
employer to employee
manufacturer to consumer
doctor to patient
solicitor to client
teacher to student

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At this point he himself says he became uncommunicative.

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Originally posted by Figbash:

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Originally posted by orfeo:
Your argument is lacking in logic. How did the doctor/patient relationship arise in the first place? Did Ashya create it?

No. Children of that age have no capacity to enter into a doctor/patient relationship, and so they also lack the capacity to end it. Their parents make those decisions.

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Your argument is lacking in reference to certain important facts. Southampton is a part of the United Kingdom, and not the United States of America.

It may be the case that US law recognises the parents of a child as the ultimate authority when it comes to making decisions on behalf of the child. UK law does not. In the UK it is acknowledged that parents do not always represent the best interests of their children and, when it is determined that such is that case, the state undertakes to represent the child's best interests.

In other words: in the US the child may be regarded as lying solely within the parents' dominion, and the rights of the parents to exercise said dominion are considered paramount, but in the UK the child is regarded as an individual, with rights which are considered more significant than those of the parents in those cases where the parents do not appear to have the child's best interests in mind. You may consider that illogical, but then, from a UK perspective the US position appears to be an abusers' charter.

Interestingly, this confusion is suffered also by Jehovah's Witnesses: their website explicitly states that parents do have absolute dominion over children, quoting the US Supreme Court as legal evidence to back this up. It does not seem to occur to them the the US Supreme Court does not hold sway outside of the US. As Jehovah's Witnesses emphasise the belief that parents do hold absolute sway, it is perhaps not surprising that they would, inevitably see the (child favouring) UK position as an affront to their sensibilities.

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Originally posted by Matt Black:
Orfeo, if you really find yourself unable to sleep, knock yourself out on these; you're welcome!

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Thankfully, I'm feeling tired.

But, you never know, if I feel the need for a bit of light reading in a break tomorrow from wrestling with my own horribly knotty legal problems (this week being knottier than usual)...

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Technology has brought us all closer together. Turns out a lot of the people you meet as a result are complete idiots.

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Originally posted by justlooking:
...

There are a number of distinct and recognisable situations in which the courts recognise the existence of a duty of care.
...

In this case the primary duty of the hospital is to the child who is its patient.

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Originally posted by Figbash:
... dah de hah de dah...

Once we have concluded that the child's rights are pre-eminent, then we must consider whether the parents will always act in their best interest. The answer, obviously, must be no. Therefore mechanisms are required to deal with cases where the parents' desires are clearly not in accordance with the child's inalienable rights. Now, you may believe that when parents make demands about medical treatment, and discuss same in such a way as to make it clear that they have no real understanding of the subject and are, essentially, risking their child's health for the sake of a fantasy, that is in accord with the child's needs; I do not. And that judgement is all that is needed. Right and wrong do not (and should not) enter into it.

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Originally posted by itsarumdo:
Although duty of care developed as common law, it is a direct genetic descendant of the health and safety at work act - see my post further up.

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Originally posted by orfeo:
My point was that the child lacks decision-making capacity, given the assertion that the child is the patient. I'm fairly sure that the UK doesn't allow children aged 5 to enter contracts or do anything else that requires legal capacity.

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Originally posted by L'organist:

I can't help feeling that fairly near to the surface of the UK medics minds was the fact that the Kings are JWs: when you couple that with them not mutely following the course outlined for their son unquestioningly you can see how this dreadful situation arose.

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Originally posted by BroJames:

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Originally posted by itsarumdo:
Although duty of care developed as common law, it is a direct genetic descendant of the health and safety at work act - see my post further up.

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This is an exact reversal of the actual historical reality.

The Health and safety at Work Act 1974 follows over 40 years after the basic establishment of the neighbour principle in Donoghue v Stevenson in 1932.

The general duty upon individuals to take reasonable care in their actions or omissions, so as not to cause harm to others proximate to them, was multiply established in case law before the Health and Safety at Work Act.

The Act is essentially a statutory formalisation of that pre-existing principle in the workplace setting, and makes its enforcement not merely a chance of which victims can afford to sue, but of the criminal law.

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Thankyou, Bro - I can't quite understand why this specific issue stirs me up quite so much, though the theme of being powerless against authority I guess does ring a lot of bells

I wan't so much referring to the Act itself, as the absorption into popular culture of the principles, and the gradual expansion of the Act or its general gesture into almost every crevice of activity. We've been legalised. Which I guess might not seem so bad if you're a lawyer

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"Iti sapis potanda tinone" Lycophron

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Originally posted by L'organist:
The fact remains that at no time during Ashya's time in Southampton General show any signs of mistreating the boy. Sure, they questioned the medical staff and asked about possible treatments - but wouldn't you?

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when all the information on the WWW is that PBT is ideal for the treatment of medulloblastoma.

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And they questioned also starting him on chemotherapy because it is frequently the case that chemotherapy is given AFTER radiotherapy for the simple reason that chemo leaves a patient so debillitated that they aren't up to the rigours of radiotherapy.

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As for the Kings being found 1000 miles away from the hospital in Prague, Mr King has stated from the beginning that they had gone to Spain to put property on the market, the sale of which will fund Ashya's treatment.

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Originally posted by Justinian:

In short Mr. King added "Dealing with estate agents" to an already tight timescale. As well as adding "Disrupted the chaemotherapy the hospital in Prague thinks is necessary" to the tight timescale.

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Originally posted by North East Quine:
Originally posted by orfeo:

quote:

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Does the local hospital my nephew was born in have an obligation to be certain my nephew is being looked after? Is there some sort of roving duty of care in relation to all children in the area?

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Pretty much. The hospital check that, for example, if the parents are taking their newborn baby home by car, they are doing so in a properly fitted car seat. You can't just waltz out of hospital and put a baby in an unsecured carrycot on the back seat. Not here, anyway.

Once you're home, there are follow-up visits by a midwife, and then by a health visitor. Plus you're expected to show up regularly to have your baby weighed at a clinic. I'm not sure at what point alarm bells would start ringing if you kept your baby away from all health professionals, but it would happen at some point.

Also (voice of bitter experience) if your child hasn't been fully vaccinated (because your child had an adverse reaction to the first vaccination and your GP refused to give the second, and this is fully documented on your child's medical records) there are reassessments every few years of your child's not-fully-vaccinated status.

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Originally posted by Gracie:
Also from further up the thread - I have listened a number of time to what Mr King has been saying and it was clear that the question was, what would happen if they refused any specific treatment (i.e. radiotherapy with devastating side effects) and most definitely not all treatment.

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Originally posted by Gracie:

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Originally posted by Justinian:

In short Mr. King added "Dealing with estate agents" to an already tight timescale. As well as adding "Disrupted the chaemotherapy the hospital in Prague thinks is necessary" to the tight timescale.

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Can you point to any evidence to prove that any assurance was given to Mr King before he left the hospital with his son that the chemotherapy was in preparation for the proton bean treatment or indeed that the hospital in Southampton had taken at all seriously his request for his son's medical inforamtin to be passed on to the centre in Prague?

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Also from further up the thread - I have listened a number of time to what Mr King has been saying and it was clear that the question was, what would happen if they refused any specific treatment (i.e. radiotherapy with devastating side effects) and most definitely not all treatment.

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Originally posted by JoannaP:

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Originally posted by orfeo:
My point was that the child lacks decision-making capacity, given the assertion that the child is the patient. I'm fairly sure that the UK doesn't allow children aged 5 to enter contracts or do anything else that requires legal capacity.

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Can you provide any evidence for the claim that to be a patient requires legal capacity rather than just to be in receipt of medical care?

What is the correct term used to designate a person in a coma in an Intensive Care Unit?

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Originally posted by JoannaP:

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Originally posted by orfeo:
My point was that the child lacks decision-making capacity, given the assertion that the child is the patient. I'm fairly sure that the UK doesn't allow children aged 5 to enter contracts or do anything else that requires legal capacity.

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Can you provide any evidence for the claim that to be a patient requires legal capacity rather than just to be in receipt of medical care?

What is the correct term used to designate a person in a coma in an Intensive Care Unit?

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Originally posted by JoannaP:

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Originally posted by Gracie:
Also from further up the thread - I have listened a number of time to what Mr King has been saying and it was clear that the question was, what would happen if they refused any specific treatment (i.e. radiotherapy with devastating side effects) and most definitely not all treatment.

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So why would the chief paediatrician lie? Do you believe that Mr King is also accurate when he says that the staff at Southampton hospital were going to kill Ashya or turn him into a vegetable?

A couple of people have suggested that the hospital staff were prejudiced against the Kings because they are Jehovah's Witnesses; I am wondering if the boot is on the other foot and the Kings were predisposed not to trust the hospital staff.

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Originally posted by Justinian:

The chance of recovering the communication is, to me, answered by Mr King's statement that "So from that moment on I had to keep everything quiet."

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Originally posted by orfeo:

You can claim all you like that only the actual patient has power over the doctor/patient relationship, but it's clearly not true because newborn infants do not choose their doctors.

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Do you believe that Mr King is also accurate when he says that the staff at Southampton hospital were going to kill Ashya or turn him into a vegetable?

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Originally posted by justlooking:

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Originally posted by orfeo:

You can claim all you like that only the actual patient has power over the doctor/patient relationship, but it's clearly not true because newborn infants do not choose their doctors.

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Has anybody claimed that?

As far as I can see the argument is that the doctor's duty of care is to the patient, however young that patient may be. Parents may choose a doctor for a child but they cannot control the doctor/patient relationship.

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