<Law>
<Tutor>
<Department>
The Flitland Crown Court convicted Dr. Arthur Jones for the crime of murder for withdrawal of life-support treatment to premature-born Baby X. Prior to his conviction, Dr. Jones did not dispute the antecedent facts that led to the death of Baby X. He reasoned out that the offense was committed to give way for the more viable Baby Y. There was only one available life-support system, and the question was, to whom he should administer the life-support treatment, to less viable Baby X or to more viable Baby Y?
Dr. Jones’ treatment to Baby Y was not questionable. He provided care to the baby upon the belief that he would survive. But how about Baby X who also needed extra care? The physician decided on his own clinical judgment and took the life of the unfortunate baby at the expense of the other one, who also died days after Baby X’s death.
Dr. Jones could never justify his withdrawal of life-saving treatment to Baby X. The element of mens rea was present because he had prior knowledge that removing the life-support system would lead to Baby X’s death. Although he knew that he was culpable with his actions, he proceeded with his decision and even rationalized it to be cleared from responsibility of killing the baby.
Dr. Jones clearly violated the rights of Baby X to life and to protection as stipulated in international human rights conventions including the United Nations Conventions on the Rights of the Child (UNCRC) which entitled all children regardless of their age, race, religion and economic status of their inherent rights as human beings. The European Convention on Human Rights and the Human Rights Act of 1998 also affirm this inherent rights and compelled the state to exercise its duties to investigate suspicious death, and prevent foreseeable loss of life. Laws such as the Children Act of 1989 and 2004 affirmed the rights of children to be given adequate protection and services in realization of their contribution to the society. If children were deprived of healthcare, then all these are futile. The Court of Appeals should look into the best interest of Baby X and that is to provide him the justice that he deserved from Dr. Jones’ gross recklessness.
Dr. Arthur Jones’ justification on the offense at the expense of Baby X’s life could be attributed as murder by a healthcare professional. The UK Ministry of Bioethics defined murder as intentionally mercy-killing the patient. In the case of Baby X, the circumstances pinpointed Dr. Jones’ intention to euthanize the baby based on his very questionable clinical judgment.
According to Lord Hope in In re Regina v. Mitchell ([1983] Q.B. 741), the intention that should be discovered was synonymous to the intention to do the act regardless of who the victim was. Since the child was born alive and died as a result of an offense proved that there was manslaughter and the actus reus for the act was completed by the infant’s death.
Dr. Jones’ defense that the infant was less viable could not suffice to free him from the responsibility of killing Baby X. The House of Lords’ Lord Keith standpoint on the Airedale NHS Trust v. Bland (1993) that in the matter of J. (A Minor) (Wardship: Medical Treatment) [1991] Fam. 33, the Court of Appeals ruled that withholding of life-saving treatment from the very young child was lawful as if saved, his life would be in misery as he would have to endure pain and agony. The judgment would be of value as to the consequences to the person whose treatment was being withheld, and to the one administering the treatment who is under scrutiny. It should be noted that administering a treatment to a person who does not have the cognitive capacity and does not have any chances to recover would not matter as there would be no difference at all whether he lives or dies.
Dr. Jones had to prove first that his clinical judgments were accurate for both infants before he reason out that he acted on the best interests of the patients. His liability on the crime should withstand and should not be dismissed by the Honorable Court as no one could attest that he made the right decision in pulling plug from Baby X for Baby Y’s survival. The intention was clear. He killed the baby out of his wrong judgment. Note that there was no intervention from other medical practitioners that should also provide opinion before the act. Dr. Jones used the element of necessity to clear him from the crime of murder.
In the matter of A (children) (Conjoined Twins: Surgical Separation) (2000) 4 AER 961, Lord Justice Brooke based his definition of necessity from Sir James Stephen in his Digest of the Criminal Law (1887), that the act could not be a crime in several cases if the person accused can prove that the act was committed to avoid the consequences that was unavoidable and if not committed, he and the others he wanted to protect would suffer the consequences as a result of the evil act; that nothing was committed except for the reasonable purpose and that the evil act committed was commensurate the evil act that he wanted to avoid.
The reasonable purpose of Dr. Jones was unacceptable because the jury stood that the mens rea requisite was complete. In the appeal of Woollin in re Regina V. Woollin (1998), Lord Styne mentioned in his argument the ruling in Director of Public Prosecutions v. Smith [1961] A.C. 290 that murder was committed due to the death or serious body harm that was “foreseen” by the defendant as a result of his actions and that he had foreseen the risk that could happen for his action as any person of reason can do.
Dr. Jones was criminally liable as he had the responsibility to care for the patient instead of killing him. There could have been other options had he considered the opinion of fellow healthcare professionals or the consent of parents of Baby X to ensure that both babies would survive despite the unavailability of another life-support system equipment. In Airedale NHS Trust v. Bland, Lord Keith of Kinley emphasized that medical practitioners who were responsible in administering treatment for the unconscious patient should not cease the treatment in cases where there are chances for the patient to survive; otherwise, it would be negligence part which is unlawful and could held them accountable.
Dr. Jones could not even prove that his clinical judgment was sound. His own views would not suffice to corroborate his assessment on the best interests of the two babies. The General Medical Council UK’s guidelines in determining the best interests of children ages 0-17 indicated the following views that Dr. Jones could have considered before he pulled the plug from Baby X:
- The opinion and preference of the child or the young person, unless they cannot express it;
- Their parents’ opinion
- Their cultural, ethnical, and religious views and values;
- The opinion of other healthcare professionals that were part of the provision of services to the child.
The GMC also warned healthcare professionals not to make any assumptions on the best interests of the child based on the factors that are considered inappropriate and discriminating in nature such as their appearances, behavioral manifestations and even disabilities.
Dr. Arthur Jones, being the in-charge of the premature baby unit of the hospital did not act on the best interests of Baby X with the aforementioned criteria. He neither consulted the parents nor his fellow practitioners on the decisions he made. How did he know in the first place that Baby Y was more viable when the infant suffered the same fate as Baby X did? Setting aside Baby Y’s life threatening state, what if Baby X survived with the life-support system despite his “less viable” situation? Lord Keith of Kinley opined in Airedale NHS Trust v. Bland (1993) p. 868 D that medical treatment would be inappropriate or a requirement to extend the patient’s life unless it would be therapeutic for the unconscious patient and it would improve his situation. This further placed Dr. Jones’ competence and his adherence to Code of Ethics of Medical Doctors under scrutiny.
Also, Dr. Jones violated the basic right of Baby X’s family to informed consent. The imminent danger in the life of the baby should be the basis for immediate consultation with his family in order for them to decide if they would continue or not the treatment. In re Chester v. Afar, the House of Lords affirmed the importance of informing the patients on the risks of the medical treatment as it recognizes the patient’s autonomy and dignity to make decisions before deciding whether or not to proceed with the treatment. Dr. Jones’ actions was synonymous to the requests of the doctors in a hospital in Canada that the Canadian Supreme Court dismissed.
Chief Justice Beverley McLachlin ruled that under Ontario’s Health Care Consent Act, treatment could also take place to something that would prolong the life of the patient. According to her, life-support provides a preventive purpose that may extend a life and avoid death as long as it is effective.
In the United States, the general rule for medical practitioners was bound by the patients’ consent. In re Gravis v. Physicians & Surgeons Hosp., 427 S.W. 2d 310, 311 (Tex 1968), physicians should ask for the consent of the patient before undergoing any treatment, otherwise it could be considered as abuse.
Albeit Dr. Jones’ incompetence is the hospital’s negligence. In the first place, why did the hospital allow such inadequacy to happen? It was the hospital’s responsibility to procure life-support systems because they knew that such circumstances happen. The case of Baby X was not an isolated one. Premature babies in the unit also needed the life-support system with the complications that premature birth bring. It was the hospital administration’s duty to look after its logistical needs to be able deliver the best services to the patients; after all, hospitals were built to cure the sick, save the lives of the dying from the imminent threat, and ensure the quality of life. The basic right to health care was deprived not only to Baby X but also to other babies in the unit with the hospital’s negligence. The hospital should also be held accountable for tolerating this inadequacy and for negligence of its duties.
The appeal of Dr. Jones should not be considered by the Honorable Court despite the on-going public debate on the issue of euthanasia. The Royal College of Obstetricians and Gynecologists in 2011 already raised this concern to test whether the sickest newborn babies should be euthanized to prevent the prolonging agony of the babies and their parents. The withdrawal and withholding of treatment already started in the case of Airedale NHS Trust v. Bland where it was questioned where his life-prolonging treatment should be continued or not. Lord Goff in Re Airedale NHS Trust v. Bland clarified that an active role in causing the death of an individual just to finish all his pain and agony is characterized as euthanasia. Euthanasia is not acceptable at the common law and is still under debate on its moral and social standing in English Laws. From this ruling, it could be concluded that euthanasia would not justify the offense against Baby X.
Dr. Jones was persistent that there was no murder for his part but the jury was convinced that the mens rea and actus reus requisites were completed upon the death of the baby. Sir Thomas Birmingham in re Airedale NHS Trust v. Bland explained why murder was considered a grave crime. He said that the laws and moral standards have a profound respect for the sanctity of life and that is the reason why murder is considered as the worst and heinous of all crimes.
The decision should not be reversed because there was prima facie in the commission of murder. In re Regina v. Mitchell ([1983] Q.B. 741), Lord Hope stated that the defendant should accept the decisions made by the jury as long as they were convinced that he intentionally did the unlawful offense; and though the death, as he claimed was only to save him from the agony and pain, the nature and quality of his actions were considered criminal and therefore punishable under the law.
The English Law had been looking after the best interests of children as early as 1930s with laws and issuances that recognizes the rights of children. The English government even initiated programs such as the Every Child Matter (ECM) to deliberate on policies and development programs that would ensure that the rights and welfare of children are protected. This serious actions manifested the care of the state for its citizens who would serve as its future leaders.
Dr. Arthur Jones’ crime against Baby X now poses a challenge to the Justice System to weigh on the ground why medical practitioners should be accountable and responsible in adhering to their profession’s code of ethics, and more importantly, to stand on their role to nurture the sanctity of life and not to serve as butchers and executioners.
References:
Dubber, M. (2002) Criminal Law: Model Penal Code: Foundation Press.
Greer, S. (2006). The European Convention on Human Rights: Achievements, Problems and Prospects. Cambridge University Press.
General Medical Council (nd). 0-18 years guidance: Assessing best interests. Available at: http://www.gmc-uk.org/guidance/ethical_guidance/children_guidance_12_13_assessing_best_interest.asp
Huxtable, R. (nd) D (en) ying Life: The Sanctity of Life Doctrine in English Law, Available at: www.retfaerd.org/gamle_pdf/2002/3/Retfaerd_98_2002_3_s60_81.pdf
John J, Schreiber, M., and Reardon F. (2004) 'The "Emergent Circumstances" Exception to the Need for Consent: The Texas Supreme Court Ruling in Miller v. HCA', Journal of Perinatology, (2004), pp. [Online]. Available at: http://www.nature.com/jp/journal/v24/n6/full/7211105a.html
Ministry of Ethics (nd) Suicide, Assisted Suicide and Euthanasia, Available at: http://ministryofethics.co.uk/?p=11&q=3
Ministry of Ethics (nd) Main Principles of Consent, Available at: http://ministryofethics.co.uk/?p=6
Ovey, C; White, R. (2006). Jacobs & White: The European Convention on Human Rights (4th ed.). Oxford University Press.
United Kingdom House of Lords Decisions (1993) Airedale Hospital Trustees v Bland [1992] UKHL 5, Available at: http://www.bailii.org/uk/cases/UKHL/1992/5.html (Accessed: 4th February 1993).
United Kingdom House of Lords Decisions (1998) Woollin, R v. [1998] UKHL 28, Available at: http://www.bailii.org/uk/cases/UKHL/1998/28.html (Accessed: 21st July 1998).
United Kingdom House of Lords Decisions (nd) A (Children), Re [2000] EWCA Civ 254 , Available at: http://www.bailii.org/ew/cases/EWCA/Civ/2000/254.html#sectionII-15 (Accessed: 22 September 2000).
___________. (2009) Baby Does and the Right to Lifesaving Treatment, Available at: mn.gov/mnddc//Moral_and_Ethical_Issues4-Baby-Doe-Kappel.pdf
