There is an urgent matter on the desk of British Prime Minister Boris Johnson today. A two-year-old girl named Alta Fixsler, an Israeli citizen residing in the U.K., was born with a severe brain condition, and her parents have sought every recourse they could for her care. Tragically, against her parents’ wishes, Alta’s doctors at the Royal Manchester Children’s Hospital (RMCH) have decided to remove the little girl from life support against her family’s will. Her parents have made arrangements to have her moved to Israel, and the government of Israel and two different Israeli hospitals support Alta’s parents in the matter and have agreed to care for her. However, RMCH has petitioned a judge of the British High Court to disconnect her life support, and their motion has been granted against her parents’ and the Israeli government’s wishes. The Israeli Minister of Health has now petitioned the U.K. Secretary of State for Health and Social Care to permit Alta to be transferred to Israel.
A similar and notorious English case came before the European Court of Human Rights some four years ago, concerning a young boy named Charlie Gard. In June of 2017, the ECHR ruled that as a matter of law it was in Charlie’s best interests to die, and his parents were wrong to seek to preserve his life while pursuing a potentially life-saving experimental procedure. In that case, as in this one, a foreign hospital had offered to provide further care at no cost whatsoever to the British healthcare system or any British hospital.
Little Alta is now in danger of being left to die just as Charlie Gard was, against her parents’ wishes.
This constitutes a violation of Alta Fixsler’s right to life, of her parents’ right to choose how to care for their child, of her parents’ religious freedom, and of the laws of the Republic of Israel of which she is a citizen. Once again, we have here a shocking example of the European trend to disregard an individual’s right to life, relying either on physicians, judges, or politicians to determine the value of an innocent person’s life.
First, Alta’s right to life is of paramount importance. Without protecting the right to life, a society cannot protect any other of that individual’s critical freedoms, such as the freedom of speech, of association, or of the press; a dead person has no freedom of any sort at all. Neither can the RMCH argue that Alta’s right to life comes into conflict with other public interests, such as might be the case if her ongoing medical care were to cost the NHS large sums of money. Her parents merely seek to return to their home country, where they will avail themselves of medical care at no cost to the United Kingdom. Second, it is Alta’s parents, not the RMCH or the courts of the United Kingdom, that have the right to make final decisions regarding the termination of her life support. Third, Alta’s parents are Hassidic Orthodox Jews, and their faith requires that life support never be terminated for a human with a life expectancy of more than six months. The State of Israel forbids the same by law. One physician has estimated her life expectancy at six to eight years, with the likelihood she will live into her teens if she once reaches age four. To terminate her life support would violate her family’s religious freedom and show a disregard for the laws of her home country. Moreover, since Alta is an Israeli citizen, and since the State of Israel has offered to care for her at its own expense, for the RMCH to refuse to release her may even constitute false imprisonment of an Israeli citizen whose family desires to transport her elsewhere for treatment.
One would hope that Alta’s life could be preserved upon appeal to the ECHR. Sadly, as we have seen in the case of Charlie Gard, the ECHR would be unlikely to overturn this decision. Nonetheless, there are some differences between Alta’s case and Charlie’s that are worthy of consideration.
There are three questions at the core of the legal issue in Alta’s case.
The first is who has the right to make decisions for Alta. In this respect, the ECHR is sadly unlikely to disagree with the judgment of the British High Court. According to the Family Division of the British High Court, Alta’s medical doctors are responsible to testify as to what is best for the child even if this violates her parents’ wishes or religious beliefs. In this case, all the doctors involved agree that she would experience severe pain if she were transported. However, her parents and the government of Israel believe that she could perhaps be saved, and Israeli law once again requires that her life be preserved due to her long life expectancy. Nonetheless, since the RMCH believes her chances of survival to be minimal, British courts have judged that the pain she would suffer outweighs any benefit. This is tragic and highlights the need for the British government to grant leave for her to be transported to Israel; the British legal system will not save her.
The second legal issue is one of religious liberty. Since Alta’s parents’ faith forbids terminating her life support, the decision of the High Court’s Family Division is a direct violation of Alta’s freedom of thought, conscience, and religion under Article 9 of the European Convention on Human Rights. However, the court in Alta’s case did not draw this conclusion so simply. It did not agree that little Alta could be assumed to be a member of the same religious faith as her parents, but implied that she should instead be treated neutrally (i.e., as someone without faith), and her objective well-being should be assessed by her doctors, giving relatively little weight to her parents’ preferences.
The court also presented a shallow analysis of the meaning of religious observance which deprived it of its power. The court treated religion merely as a means to personal comfort or joy; and sadly, because of little Alta’s condition, she is unable to experience many, if any, pleasant sensations. The court therefore implied that, even if Alta were considered an Orthodox Jew, such religious faith should not be weighed heavily because she would be unable to benefit from it. This of course is a misunderstanding of the depth, breadth, and nuance of the freedom of religion. Religious faith and observance are often grounded in views of reality that are understood to give one’s life objective meaning independently of how the adherent feels or experiences that faith.
There may also be some chance that the ECHR would view Alta’s case differently than Charlie Gard’s. In the Gard case, Charlie’s parents were of similar personal conviction to Alta’s, and of course the ECHR sadly did not protect their religious freedoms. However, the Fixslers have a formal affiliation with a religious denomination that officially forbids such termination of life support, which may carry greater weight than the mere personal convictions of her parents. It is at least a distinction the Court might be persuaded to consider. In either case, it would be best for the British government to grant the request of the Israeli Minister of Health and intervene on her behalf, to avoid the risk that she be allowed to die prematurely.
The third legal issue is one of international jurisdiction. Alta is a citizen of Israel and, as noted above, the laws of the State of Israel forbid the termination of life support for a medical patient with a life expectancy of more than six months. It is difficult to establish Alta’s precise life expectancy, but at least one physician estimates it to be between six and eight years at the least, twelve to sixteen times longer than the time period permitted by Israeli law. There is even a reasonable possibility she could survive into her teens. The decision of the Family Division of the British High Court, if upheld, would therefore almost certainly violate Israeli law. Though the RMCH is not within the State of Israel, it nonetheless seeks to force an Israeli citizen who is currently in the United Kingdom against her will to be left to die when her home country has requested she be released, and such release would have no adverse consequences to the RMCH. It could only hypothetically harm Alta, if one falsely assumes that her life is of less importance than the physical pain she would suffer if moved.
The pandemic has been a lesson in power: nothing can compete, it turns out, with the combined force of the modern state and the medical establishment. Western governments have long had extraordinary capacities for surveillance, control and punishment — but it’s only when they started “following the science” that this actually translated into people being fined for sitting on park benches, banned from seeing relatives, and now, some predict, subjected to a social-credit-style regime of vaccine passports and semi-compulsory health monitoring. Suddenly the decades of Lefty theorising about “biopolitics” and “techno-medical despotism” seem a bit less abstract.ReplyDelete
Of course, you can regard the last eighteen months as a necessary, temporary episode rather than a sinister new dawn. But either way, it casts a fresh light on familiar disputes about the state versus the individual. Take the current controversy over Alta Fixsler, a severely disabled two-year-old girl from Manchester. Her parents want to take her abroad for healthcare. The courts have prevented them, ruling that she should instead be taken off life support. Cue international outrage — especially from the US, where prominent politicians from Marco Rubio to Chuck Schumer have sided with Alta’s parents. Now Alta has been granted a US visa, even though the High Court had refused her permission to travel.
As with the cases of Charlie Gard and Alfie Evans, Alta’s story has exposed a strange detail of the British system: when parents and doctors disagree about a gravely-ill child, a judge has to decide on that child’s “best interests” without giving special weight to the parents’ wishes. If the doctors say they think extra treatment or care is too burdensome, the court is very likely to back the doctors over the parents — in other words, to “follow the science.”
True, parents’ rights shouldn’t be unlimited; true, doctors are the experts. But the experts have sometimes got these cases wrong; and the heartbreaking result of the UK system is that parents are prevented from even trying to save their children’s lives. At the Court of Appeal, Lord Justice Baker conceded that the current law can seem cruel. “I understand why [Alta’s parents]have pursued this appeal and deeply regret that I cannot do more to help them,” he said in his ruling. “As a judge, however, my duty is to apply the law.”
There is a movement to reform that law: instead of judges and doctors deciding on a child’s “best interests”, a court could only overrule parents’ wishes if doctors show that the child is at risk of “significant harm.” There are several good reasons to hope for such a change. It would acknowledge the rights of parents; it would prevent national embarrassment the next time this happens; and by checking the power of doctors over life-and-death decisions, it would be a small sign that we aren’t doomed to live under a medical tyranny.
The Fixsler family is fighting to keep their 2-year-old daughter, Alta, on life support in the U.K. But the Hasidic Jewish family is facing one court defeat after another in what a family friend calls a “devastating” situation.ReplyDelete
“At any time, the hospital can start a 72-hour clock to discontinue the care for Alta,” Yossi Gestetner, a family friend and spokesperson for the Fixslers, told EWTN News In Depth on Aug. 6.
Since birth, little Alta has received life-sustaining care as a patient at the Royal Manchester Children’s Hospital. Born eight weeks premature in Manchester, England, she suffered a severe hypoxic-ischemic brain injury at birth.
The legal battle over her life began in May when Manchester University National Health Service Foundation Trust petitioned the British High Court for permission to remove her life support. The trust argued that Alta didn’t have quality of life and was experiencing pain.
Others disagreed. Multiple pediatric neurologists said that Alta did not feel pain. But the courts still sided against the Fixsler family, even when they turned to the U.K. Supreme Court, Court of Appeal, and the European Court of Human Rights.
“It's obviously very, very difficult for the parents to process what has been happening over the last few weeks,” Gestetner said.
He criticized the courts for “essentially saying that parents do not have the right” to decide what is in the best interest of their own child. As court after court rules that the National Health Service (NHS) can decide little Alta’s fate, “it is devastating,” he said.
“It's like (the U.K. government has) control, literal control on people's medical decisions, especially once the person is within a medical institution and especially if it's the case of a child,” he cautioned.
While Alta’s parents moved to the U.K. in 2014, they are Israeli citizens. Her father is also a U.S. citizen. As Orthodox Hasidic Jews, Abraham and Chaya Fixsler want to keep Alta on life support, in accordance with their faith and Israeli law.
“Parents, whether on their own device or whether influenced by their religious teachings, have the right and responsibility to try to find the best care,” Gestetner stressed.
The Fixslers want to transfer their daughter to a hospital abroad and hospitals in both Israel and the United States have offered their services. But the U.K. court system has ruled that there is no medical benefit to moving Alta and that it would only cause her more pain. Gestetner disagreed.
Medical professionals, he said, “know how to do that in a careful and delicate way.” Pain is an “interesting reasoning, to prohibit trying to care for Alta,” especially when medical professionals in the U.S. and in Israel say that her condition could potentially improve, he said.
“I don't think anyone credible would argue that a facility in Manchester – no offense to the professionalism of the staff – but nobody would think that a local institution in Manchester has the same capabilities as some of the experts and institutions here in the U.S. or over in Israel,” he urged.
Human-rights figures and politicians are speaking out for Alta, including Democratic Senate majority leader Chuck Schumer of New York, who worked to obtain a U.S. visa for the toddler. Gestetner recognized that both Democrats and Republicans are attempting to help Alta.
“I think a lot of senators who are not necessarily ‘pro-life’ understand the basic concept of” parental rights, he stressed.
Congressman Lee Zeldin (R, NY-1) just issued the following statement regarding a European Court of Human Rights’ decision to allow a United Kingdom hospital to go forward with an order to end two year-old Alta Fixsler’s life against the wishes of her parents by taking her off life support. Alta is a two year-old Jewish girl who has suffered from a severe brain injury since she was born eight weeks premature in 2018:ReplyDelete
“It is not up to doctors and European judges to determine that this young girl has no right to continue fighting for her life. Alta Fixsler’s parents are Hasidic and the sanctity of life is at the heart of their deeply held religious convictions. Decisions about Alta’s future should be determined by the people who know and love her the most. If British doctors and hospitals refuse to provide Alta the care she needs, her family should not be stopped from traveling to the United States or Israel, where further medical options can be explored and the sanctity of her life and religious liberty will be valued. While transferring Alta will be complicated and dangerous, the stubbornness and inhumanity of the hospital and the courts have left no other options in the efforts to save this young girl’s life.”
Alta Fixsler has been at the Manchester University NHS Foundation Trust since birth. Alta’s father is also a United States citizen.
Alta Fixsler is living on borrowed time – and this week it’s set to run out in a heartbreaking case that sees her parents pitted against her doctors in a fight over the sanctity of life.ReplyDelete
The two-year-old was born severely brain-damaged and has never spent a night out of hospital.
Manchester University NHS Foundation Trust has won the right to withdraw life-sustaining treatment and may turn off her ventilator as early as tomorrow.
This is against the wishes of her parents, devout Hasidic Jews, who do not believe their daughter should be allowed to die.
Speaking exclusively to The Mail on Sunday, Mr Fixsler said: ‘There is no reason to kill Alta, she does not need to die because she is not like me and not like you, she should be allowed to live her life like any other child.
‘We know she is different but we love her no less than we love our son, who is a happy, healthy little boy.
'They are both our children, gifts from God, and equal in our eyes. No hospital and no doctor should be able to take the decision of what is in the best interests of a child. This is something for the father and the mother to judge, yet this is being denied to us.’
The tragic case goes to the heart of the moral, spiritual and legal debate in Britain about ethics of life and death. is further complicated by the fact the couple and their daughter are Israeli citizens and have a private air ambulance waiting to fly Alta to Jerusalem where she has been promised ongoing life support.
The Israeli government has made a formal request for her to be allowed to go, and the country’s Chief Rabbi and its Attorney General have declared the ending of Alta’s life illegal under Jewish law.
Reuven Rivlin, President of Israel until last month, has personally appealed to Prince Charles to intervene.(continued)
(continued)A similar offer of care has been made by a hospital in the US – Mr Fixsler grew up in New York, and has joint Israeli-US citizenship.ReplyDelete
In the US he has the support of political heavyweights including Senate Majority Leader Chuck Schumer and Senator Ted Cruz.
‘We feel as if the National Health Service is holding our daughter hostage,’ said Mr Fixsler. ‘It seems to us the NHS wants to kill her.
‘I think people in the UK need to know more about this issue, that loving parents don’t have rights over their own child.
'I will not agree to anything to help the NHS make Alta’s life shorter. We asked God for a healthy baby, Alta is who He chose to give us. We will never desert her.’
The family is realistic about Alta’s condition – they are not hoping for a miracle recovery or placing their faith in an outlandish treatment.
They know their daughter will never gain minimal consciousness and cannot move, see, swallow or hear.
They also accept her life expectancy is possibly as little as six months. But it was against their wishes that, last December, the trust applied to the High Court for the right to withdraw life support.
The Trust says the little girl is capable of feeling consistent pain and allowing her to die is in her best interests.
It sought external expert opinion from paediatricians at Great Ormond Street Hospital and Sheffield Teaching Hospital, both of whom supported Alta’s doctors.
The court hearing took place in May this year and the withdrawal was authorised on May 28. Mr and Mrs Fixsler were refused permission to Appeal and the European Court of Human Rights supported the original ruling.
Mr Justice MacDonald, who heard the case, concluded: ‘We have no means of knowing the exact nature of her experience of pain given the catastrophic nature of her brain damage.(continued)
(continued) 'There is no reason to consider that such pain would be experienced by Alta in any way other than as a negative experience. Indeed, the experience of pain without the ability to understand it, is arguably an even worse predicament than pain accompanied by understanding.’ReplyDelete
In considering her family’s faith, the judge pointed out that Alta’s case was governed by secular law.
‘The presumption in favour of taking all steps to preserve life, whilst strong, is also rebuttable,’ he wrote.
‘That this is so, recognises that life cannot be, and should not be, preserved at all costs.’
The Trust argued that granting permission for Alta to fly to Israel or America would cause her greater pain than her current care, something with which her parents vehemently disagree.
Alta’s mother and father have been together since 2010 when Mr Fixler was 19 and Mrs Fixsler, a teacher, was 22. After marrying in Jerusalem, they moved to Manchester with their son, now eight.
The couple tried for a second child in the UK but after a complicated pregnancy, Mrs Fixsler went into premature labour at 34 weeks.
Alta was deprived of oxygen during birth and only just survived with massive loss of brain structure and a damaged brain stem.
Her parents both visit her in hospital regularly. From the outset, they have wanted to bring their daughter home, and have opened their apartment in Salford for inspection by social services and the trust.
They were prepared to buy their own ventilator in the hope they could offer their daughter a better quality of life.
Now that modest dream seems more distant than ever. When ventilation is withdrawn, their daughter will die although it could take hours, days or weeks.
Despite knowing their daughter’s condition, when she was born they picked the name Alta, which means ‘old’ in Yiddish, hoping that she would live a longer life than doctors predicted. ‘She is a challenge,’ says Mr Fixsler.
‘But we have always believed as her parents we can rise to it.’
A spokesman for Manchester University NHS Foundation Trust has said: ‘We recognise that this is an incredibly difficult and distressing time for Alta’s family, and we will continue to support them.
‘Due to patient confidentiality, it would be inappropriate to comment further.’
The parents of terminally-ill Alta Fixsler face a fresh battle with a Manchester hospital trust over their wish for her to die at home.ReplyDelete
The Manchester Evening News reported last week how her parents Chaya and Abraham, an Orthodox Jewish couple, have rented a flat in Salford which they believe is suitable for their two-year-old daughter to spend her final hours.
The couple have exhausted all legal options in trying to prevent Manchester University NHS Foundation Trust (MFT) from withdrawing life-sustaining care.
Alta suffered severe brain damage after being born prematurely at 34 weeks in December 2019 and has never left hospital.
The Fixslers, who have joint US-Israeli citizenship, wanted to fly her out of the UK to try offers of alternative treatment.
However, doctors at MFT say Alta is able to feel pain and it would not be in her 'best interests' to allow her to travel abroad.
High Court judge Mr Justice MacDonald ruled in favour of the Trust in May.
a person holding a teddy bear sitting on top of a bed: Alta was left severely brain damaged after being born prematurely at 34 weeks© PA Alta was left severely brain damaged after being born prematurely at 34 weeks.
The Fixslers cannot accept that Alta should be allowed to die - but their final wish is that she should be able to do so at home with her family where they will feel 'comfortable'.
They say it is also important so that they are able to observe certain Jewish customs.(continued)
(continued) The High Court ruling stated it could be possible for Alta to go home if there was agreement with the Trust.ReplyDelete
But now Alta's medical team have written to the High Court to make clear they believe that the withdrawal of mechanical ventilation should take place either in the hospital's Intensive Care Unit or Derian House, a hospice in Chorley, Lancashire.
A report from a specialist paediatric doctor concluded that the Fixslers' flat is 'inaccessible' to the particular type of trolley that Alta requires to be transported.
The High Court application also states that the Trust believes the couple would be unable to meet Alta's palliative care needs.
The skills required include 'management of Alta’s tracheostomy, safe oxygen administration, feed administration and medication management,' the application says.
"This adds a considerable burden to parents and these factors explain why withdrawal of mechanical ventilation at home is so rarely undertaken; only once or twice each year," the application states.
The parents have argued that they have had tracheotomy training and that they only require a 'fresher course' to be able to look after Alta.
The Fixslers' cause has had support in the US and Israel.
They also supplied video evidence from Hatzola, the community ambulance service, showing that a bariatric stretcher was able to enter the property without issue.
However, the Trust's application states: "Hatzola does not have experience in transporting critically ill, mechanically ventilated children and are not familiar with a PCC transport trolley and the equipment associated with it, which includes a mechanical ventilator, monitors, infusion pumps and other equipment.
"Hatzola do not have the experience or knowledge necessary to make a valid accessibility assessment of the family home in Alta’s case."(continued)
(continued) The Trust also refutes any suggestion that doctors are under 'pressure' to withdraw Alta's care and highlights the difficulties staff have faced dealing with a case that has attracted international attention.ReplyDelete
The Fixslers' cause has attracted support from high-profile figures including US Senator Chuck Schumer and the former President of Israel, Reuven Rivlin.
"All clinical and nursing staff have been nothing but respectful to the parents and their wishes since the order of MacDonald J," the application states.
"Since then, as it has throughout, it has been extremely difficult for staff who have continued to provide care to Alta knowing the court’s findings.
"They have done so with great professionalism and dedication, despite the frequently inaccurate and sometimes offensive and hateful comments made about the team in the international and national online media."
The Trust says the couple's flat is 'inaccessible' to the specialist trolley Alta requires The Trust's application also makes mention of the current strain on NHS resources.
Alta's doctor said that during conversations with Salford's community nursing team at the start of August, it had been made clear that 'staff availability would be a problem over several periods in the next few weeks because of annual leave'.
And in arguing in favour of Alta being allowed to die in the hospice Derian House, they say this would represent 'a more appropriate use of healthcare resources overall and would allow us to admit another critically ill child to PICU at a time of considerable national pressure on PCC [Paediatric Critical Care] beds.'
Reacting to the Trust's application, the Fixslers told the MEN: "We are heartbroken that the NHS Trust is rushing to euthanise our beautiful daughter, without consent, against our wishes and our beliefs, and without listening to us.
"We have spent over two years getting to know our daughter and now the NHS Trust insists on rushing to end her life. Why are they in such a rush?"
Royal Manchester Children's Hospital has made a fresh application to the High Court© MEN Media Royal Manchester Children's Hospital has made a fresh application to the High Court.
"We have not been allowed to seek a second opinion on her condition – this should be a basic right for any patient, but especially in this case which is now a matter of life or death.
"We have not been listened to."
The MEN approached the Trust for further comment on the High Court application.
A spokesperson said: “We recognise that this is an incredibly difficult and distressing time for Alta’s family and we will continue to support them.
"Due to patient confidentiality, and ongoing legal proceedings, we are unable to comment further.”