Alfie Evans case

Alfie James Evans (9 May 2016 – 28 April 2018), was an infant boy from Liverpool with an undiagnosed neurodegenerative disorder, later revealed to be GABA-transaminase deficiency.

The medical team and the child's parents disagreed about whether to maintain his life support or to withdraw it, resulting in a legal battle.

Alder Hey Children's NHS Foundation Trust sought a declaration that continued mechanical ventilation was "unkind and inhumane", and not in the child's best interests.

Alfie's parents, Kate James and Thomas Evans, contested the application.

In November 2016, at six months of age, Alfie Evans was reviewed at the general pediatric outpatient clinic at Alder Hey Children's Hospital.

He was found to be functioning in a range appropriate for a 6-week to 2-month-old infant.

On 14 December 2016, Alfie was admitted to Alder Hey Accident and Emergency Department with a history of coughing, high temperature, and a reported episode of rhythmic jerking of his jaw and all four limbs.

On 15 December, he showed sudden unprovoked movements compatible with infantile/epileptic spasms.

An EEG performed on 16 December 2016 confirmed hypsarrhythmia.

A further EEG was taken in January 2017 and "was markedly different, showing attenuation with little in the way of reactive response for protracted periods of time. Changes only really occurred when Alfie had an epileptic seizure."

Alfie's parents wished to remove him from Alder Hey and seek further care at the Bambino Gesù Hospital in Rome.

In September 2017, Italian doctors from Bambino Gesù Hospital produced an assessment report on the possibility of transferring Alfie to Italy.

According to their report on the case, they could offer prolonged ventilator support, with a surgical tracheostomy and would remove a nasogastric tube, replacing it with a gastrostomy.

During assessment, Alfie suffered "epileptic seizures induced by proprioceptive stimuli", and the report warned that "with similar stimulations related to the transportation and flight, those seizures might induce further damage to the brain, [putting] the whole procedure of transportation at risk."

Alfie remained in Alder Hey Hospital for the duration of 2017, with no improvement in his condition.

At the end of the year, the hospital applied to have life support switched off.

Alfie Evans' case drew significant public attention in the United Kingdom and overseas, with his parents establishing "Alfie's Army", an online campaign group dedicated to seeking further treatment and opposing the withdrawal of life support.

Supporters established a petition on change.org, calling on Alder Hey Hospital to allow Alfie Evans to be transferred to a hospital of his parents' choice.

His parents also approached Dr. Michio Hirano, a US-based neurologist who had offered treatment in the case of Charlie Gard.

Alfie's parents claimed a parental right to make decisions about their son's care, arguing that the hospital itself should not be able to make care-decisions for their son without their consent.

Large protests emerged outside Alder Hey Hospital on 12 April after his family insisted on their right to take him home.

On 16 April, Merseyside Police launched an investigation into "instances of verbal abuse and acts of intimidation" with judges raising concerns about threatening conduct by protesters towards hospital staff.

Alfie's parents apologised, saying they did not intend to "harm or cause conflict or upset".

Merseyside Police Chief Inspector Chris Gibson released a statement regarding social media posts regarding the Alder Hey Hospital and Alfie Evans's situation: "malicious communications and threatening behaviour will be investigated and, where necessary, will be acted upon."

On 19 December 2017, Alder Hey applied to the High Court to withdraw parental rights from Alfie's parents and to withdraw treatment by ventilation.

The ventilatory support was removed on 23 April 2018 following a series of unsuccessful appeals from Alfie's family.

Alfie continued to breathe naturally for five days after the removal of his breathing tube.

He died at 2:30 a.m. on 28 April 2018.

On 18 April 2018 Alfie's father flew to Rome for a 20-minute meeting with Pope Francis.

The case was commented on by the Pope via Twitter, who stated his "sincere hope that everything necessary may be done in order to continue compassionately accompanying little Alfie Evans, and that the deep suffering of his parents may be heard."

He restated his support after the removal of life support, saying "Moved by the prayers and immense solidarity shown little Alfie Evans, I renew my appeal that the suffering of his parents may be heard and that their desire to seek new forms of treatment may be granted."

Cardinal Pietro Parolin, Cardinal Secretary of State of the Holy See, criticized the decision to refuse the transfer of Evans to Italy, calling it "uncomprehensible".

Conversely, Cardinal Vincent Nichols, Archbishop of Westminster, defended the Hospital's decision, stating that the Church "says very clearly we do not have a moral obligation to continue a severe therapy when it’s having no effect, while the church’s catechism also teaches that palliative care, which isn’t a denial of help, can be an act of mercy".

Nichols also criticized those who “used the situation for political aims”.

The Cardinal's position received strong criticism, and Conservative MP Nadine Dorries stated that "bishops should hang their heads in shame”.

In October 2018, following an ad limina visit to the Vatican City, Archbishop Malcolm McMahon of Liverpool told The Tablet that Catholic Bishops of England and Wales had clarified their position to the Holy See.

The Church of England declined to comment on the issue.

The President of Poland Andrzej Duda also expressed his support.

On 23 April, Alfie was granted Italian citizenship under the request of Brothers of Italy's leader Giorgia Meloni.

The Italian Ministry of Foreign Affairs said it hoped Alfie would be allowed "immediate transfer to Italy".