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Conflict of Interest: Cards Stacked Against Charlie Gard?

Conflict of Interest: Cards Stacked Against Charlie Gard? Read Transcript


Well, joining me now is Melissa Moschella.

She is a medical ethics professor

at Columbia University.

Thank you for joining us, Melissa.

It's a pleasure to be here.

I wanted to address, when you look at the parties involved

in the case of 11-month-old Charlie Gard,

and in particular you look at his guardian who is represented

in court by a woman by the name of Victoria Butler-Cole,

a lawyer who is associated with the dignity in dying movement,

in your view, does this represent a conflict

of interest?

I think there's certainly an ideological and perhaps also

political conflict of interest in the fact that the lawyer

representing Charley's court-appointed guardian is

a vocal advocate for physician-assisted suicide

and euthanasia.

Her specific position is as the head

of an organization that doesn't itself

advocate for those things.

But that organization is inextricably

tied to another organization that's

a very vocal political advocate for relaxing

the laws in this area.

So the lawyer that's representing

Charlie's court-appointed guardian, Mrs. Victoria

Butler-Cole, she is clearly an advocate

for what you might call a quality of life ethic,

namely a kind of ethical perspective

in which human life is not necessarily seen

as intrinsically valuable.

Rather some human lives are seen as perhaps not

worth living if they're going to involve

a significant amount of suffering or severe disability

with no hope of an eventual cure.

That's a view that's become increasingly popular

with the movement for legalization

of assisted suicide and euthanasia.

But it's a view that remains extremely controversial,

certainly a view that goes against the values

of many people, many religious people, certain Christians.

And so it's clearly unfair.

They're stacking the deck in favor

of one very controversial point of view, which

happens to be also the same controversial point of view

that the doctors have in this case, the Ormond Street

Hospital doctors.

It's unfair that everybody in this case except for Charlie's

parents are on one side of a very controversial issue.

In your view, what is the best way to rectify that?

How do you resolve this potential conflict of interest

then?

I really think the only way to rectify this situation would be

for her to step down and for a different attorney to be

appointed to represent Charlie's court-appointed guardian.

I think, honestly, Charlie doesn't

need a court-appointed guardian or an attorney

to represent that guardian because Charlie has parents who

are his natural guardians who are clearly

loving and dedicated and want his best interests.

So I see actually no reason why we

need any of these further representatives for him.

You had mentioned that this represents

an ideological conflict of interest.

Do you believe that most ethicists would reach

the same conclusion you reach?

I'm not sure what others would think.

I think most people would agree that this

looks at least unseemly, that at the very least,

there is a suspicion, an appearance of a conflict

of interest, which already undermines the kind of trust

in the fairness of the proceedings.

And so whether or not everybody would

agree that there is an actual conflict of interest,

I think people would agree that really the suspicion here

is enough to call into question the fairness

of the proceedings.

And that's a good enough reason to do something

to remedy the situation.

You sit on the clinical ethics committee at Columbia

University Hospital.

If you were presented with a case like this,

how would you recommend reconciling

that particular dilemma?

Well, first I should clarify that I haven't yet

had the experience of being on a clinical ethics

consultation in Columbia.

It's a new position for me.

OK.

But having clarified that, I think

that if I were presented with a situation like this,

I think the best way to deal with that conflict

is to recognize the conscience rights of the doctors.

If the doctors believe that any further treatment is futile,

would only cause further suffering,

and so have a kind of moral objection to continuing

with further treatment, I don't think the doctors

should be required to do that.

On the other hand, the parents are

the kind of automatic legal proxy for Charlie.

And therefore, as with any other medical decision making,

that wish should be followed unless it's clearly

against any obvious ethical principle, which in this case,

it's not.

So they should be free to take Charlie elsewhere,

to another doctor who is willing to provide that treatment.

In this case, that would be Dr. Michio Hirano,

my colleague at Columbia, who is willing to offer

that treatment.

When you look at a case like this and try to see

if there's anything good that can come out of it,

we're talking about issues of course that have to do with

end-stage care.

We're also talking about parental rights

versus parental responsibility or parental discretion.

Is there anything good that can come out of this

that perhaps parents and doctors and families can start

addressing now in light of what's

happening with Charlie Gard, his parents, and the hospital?

Well, I think one very good thing

has been precisely the public conversation,

the public debate, that this case has sparked.

It's definitely raised awareness about the problems

of a system in which the state sees itself

really as the primary authority, the primary decision

maker on the part of a child, even

over and against the wishes or decisions of very loving, very

competent parents.

And a lot of people are worried about that.

And I think that's a very good thing.

So calling attention to that is good and is a cautionary tale

not only for those in the UK, but also for us

here in the US where our system has

more protections for parental rights

but is nonetheless far from perfect in that regard.

And then I think secondly that more discussion

about end of life care, about ensuring

that, for those who are adults, that their wishes are expressed

in advance, that they have appointed a health care

proxy to make decisions.

And in the situation that they may find themselves

incompetent, I think that's all very good to be more

in the public eye so that people do take the initiative

to make those decisions, make their wishes known in advance

so that they can then be respected by the medical team.

Melissa Moschella at Columbia University.

Thank you so much for your time.

You're welcome.

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