Background to our submission The Court of Appeal ruled that St. Mary's Hospital staff could assist 'Jodie' Attard in self-defence, by separating her from her sister and performing an operation, which they admitted they knew would lead to the death of 'Mary' Attard. The ruling was strictly related to whether the operation to separate the conjoined twins should go ahead, if that meant baby 'Jodie' had a greater chance of survival. We believe the Court of Appeal judgement does not relieve St. Mary's Hospital of a duty of care to Mary before, during and after the operation, and a duty to ensure that all reasonable efforts were made to keep her alive by providing any necessary medical procedure or treatment. Regardless of 'Mary's' perceived chances of survival as an individual after the operation, the Coroner is still required to satisfy him/herself that St. Mary's Hospital staff demonstrated a duty of care by avoiding intentionally killing Mary. Our campaign has been organised by independent disabled people and is a human rights campaign. We believe any decisions to legalise/decriminalise deaths of disabled children/adults caused by active means, or withdrawal of treatment, must be challenged for the protection of all. We believe all lives are of equal value, as promised in the Human Rights Act. The campaign has no link with any religious or pro-life group. 'Mary' Attard 'Mary & Jodie' Attard were born on 8th August 2000 at St. Mary's Hospital. Their parents said "It is God's will that those two twins have been born alive and are continuing to make progress and indeed have made progress in the first seven days." Michaelangelo and Rina Attard 's positive observations about the babies were very much echoed by St. Mary's Hospital staff. At several weeks old it was reported that 'Mary' was growing as she was benefiting from the nutrition during her feeds. We believe up to the day of the operation 'Mary' was thriving and growing each day with greater strength. News reports just before the operation suggested St. Mary's Hospital staff had reported 'Mary and 'Jodie's' condition to be still stable. "The Hospital said the health of the twins had changed little since the time of the court ruling, although details were being kept secret." (Yahoo UK and Ireland News - 24/10/200). This indicates that neither baby was at risk of dying at the time of the operation. 'Mary' consistently out-performed the low expectations St. Mary's Hospital staff had of her. Therefore, was it possible for St. Mary's Hospital staff to accurately predict 'Mary and Jodie's' chances of survival, or the babies' response to treatment, which could have potentially saved both their lives? We ask the coroner to consider how often Mary out performed those expectations in terms of her whole development and her will to be alive. Michaelangelo and Rina Attard said both of their daughters were responding well and that Mary knew she was in the hands of those who love her. ('Tonight with Trevor McDonald' - 7th December 2000) - We were also pleased to hear 'Jodie' is doing really well, wish her every success in her life and welcome her into the world. 'Mary' Attard has had a powerful effect upon our lives; her fighting spirit and public profile has given society the opportunity to examine what it means to be human. Through 'Mary's' determination and her will to survive she managed to achieve national / local media coverage / debate, and assisted judges evaluate our legal definition of life during some very high profile court cases. If 'Mary's' solicitor had taken her fight for life to the House Of Lords and European Courts of Human Rights then she would have been instrumental in re-defining legal definitions relating to disabled people's right to life, which will affect future legal decisions. Intention to kill 'Mary' "Bona Fide medical or surgical treatment is not "unlawful" and therefore death resulting there from does not amount to murder, even though death or serious injury is foreseen as a probable consequence. Nor does it amount to manslaughter, unless the person giving the treatment has been guilty of gross negligence. (Criminal Pleading Evidence, para 19-38 - Court of Appeal). We believe an operation to be 'Bona Fide' when performed with the intent of either improving, prolonging or saving a person's life and health (or to remove organs with appropriate consent). If 'Jodie' died as a consequence of the separation operation, then the surgeon may be cleared of murder or of severe neglect as the operation was carried out in order to solely save her life. "The Universality of the right demands that the right to life be treated equally. The intrinsic value of their lives (Jodie and Mary) is equal. I have already indicate that the value of each life in the eyes of God and in the law is equal." (from the Court of Appeal judgement) St. Mary's Hospital had prior knowledge that Mary was going to die because of the separation operation. Therefore surely the hospital can not avoid Mary's death being murder, manslaughter or a result of serious neglect, unless they sought appropriate advice from leading surgeons and seriously considered infant transplantation, or other potentially life saving treatment for both babies. After the Court of Appeal requested another opinion, a Great Ormond Street Hospital Paediatric Surgeon said "Although my impression is that they (Mary and Jodie) can live together for many months, or perhaps a few years." during the Court of Appeal case. "Miss Parker QC on Jodie's behalf asked the surgeon a "VERY THEORETICAL QUESTION." WHETHER Mary could be kept alive if she were attached to a heart lung machine immediately after the common aorta was severed. He agreed that it was possible but he went to on say " it is not something we would plan as part of the procedure...Here for the weaker of the twins, unless there was a heart and lungs available for transplant instantly, there would not really be that much point." (Court of appeal Judgement) No one really knows if Mary would survive the heart and lung transplant as the Great Ormond St. Hospital team said "Heart and Lung transplantation has not been performed in early infancy to my knowledge, even if it was considered to be technically feasible, donor organs of appropriate size are not available." Can the coroner satisfy him/herself whether St. Mary's Hospital had done everything possible to ensure Mary (without doubt) was seriously considered for medical treatment which may/would have saved her life? Questions to be asked 1. At the time of her birth and leading up to her death, was Mary considered for any kinds of treatment? If so what, and if not why not? 2. What practical steps did St. Mary's Hospital staff take with consulting leading surgeons with appropriate expertise (e.g. infant transplantation) when deciding whether to consider Mary for treatment? 3. How accurate / reliable / appropriate are the child developmental tests used by St. Mary's Hospital when determining how 'Jodie and Mary' could live together or separately with appropriate life-saving intervention? 4. How did St. Mary's Hospital arrive to the decision of a risky operation to separate 'Jodie and Mary' which has never been performed before, whilst using the same reason for not considering or performing a heart and lung transplant or other life saving treatment on Mary? 5. When deciding on the date of the operation, how did St. Mary's Hospital take into consideration Great Ormond Street's Hospital team advice, which may have prevented the premature death of Mary? 6. Were press reports correct, that 'Mary and Jodie' were stable on the day the separation operation was performed? 7. Is Life saving surgery something, which is usually, done when a person's life is under immediate threat? If so, how appropriate was it to separate 'Mary and Jodie' on November 3rd rather than at a later date when St. Mary's Hospital staff could have had more time to consider and plan any life saving treatment for both? 8. What steps did St. Mary's Hospital take during the operation, especially immediately before 'Mary's' death to save her Life? A press release from St. Mary's Hospital, issued after Mary's death, said "Despite the best efforts of medical staff, Mary died during the operation," Could St. Mary's Hospital describe what these best efforts were? (Various TV interviews) 9. At what point in the operation did 'Mary' Attard die? After asking these questions we ask the Coroner to consider the verdict of "Murder" or "Manslaughter" for the cause of 'Mary' Attard's death. We ask the coroner to consider whether to make appropriate recommendations both to the Department Of Heath and St. Mary's Hospital. |