Parents of boy were embroiled in a protracted legal battle over his treatment before his death
9 May 2016: Alfie is born in Liverpool to Tom Evans and Kate James, now aged 21 and 20.
December: Alfie is taken to Alder Hey Children’s hospital after suffering seizures.
The Guardian view on Alfie Evans: a true tragedy | Editorial Read more
11 December 2017: Hospital bosses say they are liaising directly with the family after disagreements over his treatment. Alfie’s parents say the hospital has applied to the high court to remove parental rights and withdraw ventilation.
19 December A high court judge, Mr Justice Hayden, begins overseeing the case at a public hearing in the family division of the high court in London. The hospital says continuing life-support treatment would not be in Alfie’s best interests, but his parents disagree and say they want permission to fly him to Italy for treatment.
1 February 2018: A hearing begins at the high court in Liverpool in which lawyers acting for the hospital claim further treatment for Alfie is unkind and inhumane.
2 February: One of Alfie’s doctors tells the judge there is no hope for the youngster, who is in a semi-vegetative state from a degenerative neurological condition doctors have not been able to definitively identify.
5 February: Tom Evans tells the court Alfie “looks me in the eye” and wants his help.
20 February: Hayden rules in favour of the hospital bosses, saying he accepts medical evidence which shows further treatment is futile.
1 March: Three court of appeal judges begin analysing the case after Alfie’s parents mount a challenge to the high court ruling. The family ask for the appeal hearing to be adjourned for a few weeks so they can discuss the ruling with lawyers, but the judges refuse.
6 March: Court of appeal judges uphold Hayden’s decision.
8 March: Alfie’s parents ask for the case to be considered by supreme court justices.
20 March: Supreme court justices decide the case is not worth arguing and refuse to give the couple permission to mount another appeal.
28 March: Judges at the European court of human rights reject a bid from Evans and James for them to examine issues relating to Alfie’s future, saying they find no appearance of any human rights violation.
11 April: Hayden endorses an end-of-life care plan for Alfie drawn up by specialists.
12 April: Protesters gather outside Alder Hey hospital as Alfie’s father insists he has the right to take him home.
16 April: Alfie’s parents argue he is being wrongly detained at Alder Hey and make a habeas corpus application. Judges at the court of appeal in London rule against them and again uphold Hayden’s decisions.
17 April: Alfie’s parents ask supreme court justices to consider their case for a second time.
18 April: Tom Evans flies to Rome and meets Pope Francis.
20 April: The supreme court rules against Alfie’s parents for a second time, refusing them permission to appeal against the decision. The parents make an application to the European court of human rights in Strasbourg to take Alfie to Rome for treatment.
23 April: The European court of human rights refuses the application. Alfie is granted Italian citizenship. The Italian ministry of foreign affairs says: “The Italian government hopes that in this way, being an Italian citizen will enable the immediate transfer of the child to Italy.” A high court judge dismisses new submissions made in private by the lawyers for Alfie’s parents via telephone. At around 9pm, life support is withdrawn by doctors at Alder Hey hospital, according to Tom Evans. He says in a Facebook post that his son has been breathing unaided since 9.17pm.
25 April: Alfie’s parents fail in an 11th-hour attempt to persuade judges to let them move the terminally-ill youngster to a hospital abroad.
26 April: Alfie’s parents pledge to work alongside doctors to give the boy “the dignity and comfort he needs”.
28 April: The 23-month-old dies at 2.30am, his parents say on Facebook. “Our baby boy grew his wings tonight at 2:30 am. We are heartbroken. Thank you everyone for all your support,” the post says.
A leading expert in medical ethics has called for new mediation panels to prevent the “entrenched disagreements” that surrounded the treatment of Alfie Evans, the 23-month-old boy who died yesterday, almost a week after his life support was withdrawn.
Dominic Wilkinson, professor of medical ethics at the University of Oxford and a neonatal consultant, said that independent mediators could help people such as Alfie’s parents, Thomas Evans and Kate James, who repeatedly clashed with doctors over their child’s treatment for a degenerative brain disease, culminating in a protracted high court battle.
The call for a fresh approach came amid an outpouring of grief from well-wishers, including Pope Francis, with more than 1,000 people gathering near Alder Hey children’s hospital in Liverpool to mourn Alfie’s death early yesterday morning.
Wilkinson, a consultant neonatologist at Oxford’s John Radcliffe Hospital and specialist in newborn intensive care and medical ethics, said that there needed to be “greater ethics support” within specialist children’s hospitals to help all parties reach a consensus in future cases.
“Looking forward, there is a real need to try to resolve disagreements between parents and doctors. Entrenched disagreement can reach a point where it’s very difficult to step back from,” he said.
“I think there are an interesting number of possibilities – in particular, formal mediation involving somebody independent of the hospital and the family who can sit down with both parties and try to help rebuild communication and help find common ground,” he added.
Hours after the news that Alfie had died at 2.30am – five days after his life support was withdrawn on Monday when a last-ditch appeal to the high court was turned down – mourners carrying flowers began arriving at Alder Hey.
By early afternoon, hundreds had congregated in Springfield Park, near the hospital, to release blue and purple balloons exactly 12 hours after the boy had died.
One card left on flowers laid outside the hospital read: “We fell in love with a little boy we never knew. Alfie will be forever engraved in our heart. Fly high little man.”
Among the messages of support was one from the Pope, who took a personal interest in the case and tweeted his condolences, writing: “I am deeply moved by the death of little Alfie. Today I pray especially for his parents, as God the Father receives him in his tender embrace.”
A statement followed from Archbishop of Liverpool Malcolm McMahon,, on behalf of the Catholic Bishops’ Conference of England and Wales, which said: “All who have been touched by the story of this little boy’s heroic struggle for life will feel this loss deeply. We must thank Tom and Kate for their unstinting love of their son, and the staff at Alder Hey Hospital for their professional care of Alfie.”
Facebook Twitter Pinterest Alfie Evans’s parents Kate and Tom. Photograph: Philip Toscano/PA
Earlier, Alfie’s father Thomas had written a message on Facebook stating: “My gladiator lay down his shield and gained his wings … absolutely heartbroken.”
His sister, Sarah, told the crowd at Springfield Park: “Our gorgeous little warrior took his last breath at 2.30 this morning. Our hearts are broken. We are absolutely shattered as a family. Thomas just wants to thank you all for the support you’ve all shown. There’s only one Alfie Evans.”
A spokesman for Alder Hey offered Alfie’s family their “heartfelt sympathy and condolences” and said it had been a “devastating journey” for the parents.
“All of us feel deeply for Alfie, Kate, Tom and his whole family and our thoughts are with them.
“This has been a devastating journey for them and we would ask that their privacy and the privacy of staff at Alder Hey is respected.”
It signalled a tragic end to a fractious relationship between Evans and Alder Hey with the father regularly speaking out against hospital bosses as he argued for his son to be transferred to a hospital in Italy with links to the Vatican.
Alfie had been in a semi-vegetative state for more than a year and scans of his brain had shown that almost all of it had been destroyed. Judges had agreed with doctors that further treatment would be futile and that there was no hope of him getting better.
His parents, both in their early 20s and from Liverpool, had insisted their son was not in pain or suffering but lost a string of cases in the high court, court of appeal, supreme court and European court of human rights.
Wilkinson also called for the government to increase support and funding for clinical ethics committees.
“These committees are very poorly resourced within the NHS but they are important both for families and for health professionals in the context of these disagreements. They help clarify what the key issues are and try to find ways forward without having to go to court.
“They are a resource and a way of trying – with the child’s interests right at the front of their minds – to sidestep the particular disagreement where that has occurred between families and professionals,” he added.
He said that such committees existed in about half of NHS trusts but tended to be ad hoc and inadequately supported.
“They need to be better resourced, better funded and more of them,” said Wilkinson.
The news was as tragic as it was inevitable.
Alfie Evans, the 23-month-old boy whose rare degenerative brain condition sparked a long legal battle over whether his life support should be withdrawn, lost his fight for life yesterday.
Alfie’s parents, who fought so hard for their son, should be allowed to grieve in peace.
Alfie Evans, the 23-month-old boy whose rare degenerative brain condition sparked a long legal battle over whether his life support should be withdrawn
Nobody can blame them for refusing to accept the inevitability of his death.
But their grief and despair have been hijacked by mob sentiment, provoked by extremists acting as provocateurs to stir up hatred against the very people who had done so much to help him.
As a senior neurosurgeon, I am not only familiar with matters of life, death and the terrible burden of deciding where the boundary between the two might lie.
I know, too, about the vast kindness, endless dedication and humanity of my colleagues in the Health Service who must be protected from the sort of vilification – and even death threats – we have seen in recent days.
Who can forget the grotesque sight of the baying mob, who last week attempted to storm Alder Hey Children’s Hospital, where Alfie was cared for until the end by a skilled and committed team of doctors and nurses?
Police were called to guard staff and other patients from the protesters.
Alfie’s father, Tom Evans, threatened to take out private prosecutions for murder against three doctors who had so diligently cared for his son.
Those who have distastefully sought to make political capital from this tragic episode include pro-life campaigners, libertarians who think the State has no place in deciding when treatment should be withdrawn, advocates of quack medicines and even the rabble-rousing former American congressman Joe Walsh, who tweeted last week: ‘Why does an American need an AR-15 [a type of gun]? To make sure what’s happening to Alfie Evans never happens here.’
Does he seriously suggest that Alfie’s doctors and nurses should be murdered with assault rifles?
Alfie's parents outside court during their emotional legal battle to keep their son on life support
The mob shouted ‘Save Alfie Evans’ while attacking those who spent nearly two years trying to do precisely that.
FOR all their efforts, Alfie could not be saved. All that could be done was to arrange the best palliative care so his young life could end with dignity and without undue discomfort.
I watched the Alfie Evans case with great personal interest. My own son came close to dying from a brain tumour when he was only a few months old but was saved by surgery.
I later became a paediatric brain surgeon myself and cared for many children, some with terrible brain damage or fatal, malignant tumours.
I loved my patients and I learned of the overwhelming force of the love we have as parents.
But I also learned that children sometimes die, however hard we struggle to keep them alive, and that some children’s brains can be so damaged that they are not capable of a meaningful existence.
The question of what constitutes a meaningful existence is dreadfully difficult, especially if a child with severe brain damage can only survive by being kept on life support, as was the case with Alfie.
It is probably the hardest question in medicine, and best dealt with by agreement between doctors and parents.
And if the relationship between the parents and doctors breaks down – a rare but deeply tragic occurrence – the decision must be made in a court of law.
How else is the problem to be resolved? With assault rifles? By a howling mob?
Some of the tributes which have been laid to remember the youngster, who passed away on April 28
Those who rail against the supposed injustice of Alfie’s treatment would do well to read the lengthy judgment of Mr Justice Hayden, who presided over the High Court application for the hospital to be allowed to take Alfie off a life-support machine, a decision that ultimately brought his short life to a close.
The 23-page document describes in painstaking detail how the hospital and its doctors bent over backwards to accommodate the wishes of Alfie’s parents. Some of the details are distressing.
Alfie was first diagnosed with encephalopathy – a condition in which the brain is steadily destroyed – when he was just six months old.
His condition grew inexorably worse until he became unresponsive and his only physical reactions were spasms.
A brain scan carried out on February 2 confirmed the progressive destruction of the white matter of Alfie’s brain which, doctors said, appeared ‘almost identical to water and cerebrospinal fluid’.
The diagnosis of specialists from Alder Hey – which the judge acknowledged as ‘world-class’ – was reviewed by specialists from Great Ormond Street, Munich and Rome.
They agreed Alfie’s condition was incurable and that he was in a semi-vegetative state. Every care, in other words, was taken at every stage.
With all the specialists agreeing that treatment was futile, the only dispute was over how long he should be artificially kept alive – a decision in which the court weighed Alfie’s needs and his quality of life.
Last week, the judge refused the family’s request to take their son for treatment in Rome and criticised an adviser of theirs – law student Pavel Stroilov, who is linked to the pro-life Christian Legal Centre – as a ‘fanatical and deluded young man’ whose legal advice had come close to contempt of court.
Such is the nature of the people deriding our medical profession in such destructive terms.
Those in the screaming mob accusing doctors and nurses of murder had no idea as to how Alfie’s condition could be treated.
They had no understanding of the nature of catastrophic brain damage and what it can mean.
This is not an argument about the medical profession playing God. Instead we are talking about long hours of dedicated labour and expertise which must take precedence over mob sentiment.
By all means campaign for your beliefs, but you have no right to terrorise the doctors and nurses who are doing their best to help their patients – work which is difficult enough as it is.
And why frighten the other sick children in the hospital? How can you possibly justify that?
Yes, the case of Alfie Evans was horribly difficult, but the rule of the mob has no part to play.
The people who took part in the demonstrations outside Alder Hey should be ashamed of themselves.
Alfie Evans’ family say they have been left “shattered” by the toddler’s death at the end of a long and bitter legal battle that has reverberated around the world.
The terminally ill toddler died at 2.30am on Saturday at Alder Hey Children’s Hospital in Liverpool, five days after life support was switched off.
Twelve hours later, more than 1,000 mourners and supporters of his parents gathered at a nearby park to release balloons in his memory.
Sarah Evans, his aunt, told the crowd: “Our gorgeous little warrior took his last breath at 2.30 this morning.
“Our hearts are broken. We are absolutely shattered as a family. Thomas just wants to thank you all for the support you’ve all shown.”
She said the family had hoped to bring Alfie home on Saturday after he spent more than a year in hospital.
His mother, 20-year-old Kate James, said she was “heartbroken” and thanked people for their support.
Father Thomas Evans, 21, wrote on Facebook: “My gladiator lay down his shield and gained his wings at 02:30. Absolutely heartbroken. I love you my guy.”
Mourners released balloons to mark Alfie’s death (Getty)
Public figures and politicians from around the world paid tribute to the toddler as flowers, cards and toys were left outside the hospital.
“We fell in love with a little boy we never knew,” one card read. “Alfie will be forever engraved in our heart. Fly high little man.”
The Archbishop of Liverpool, Malcolm McMahon, appealed for well-wishers to give his parents space to grieve.
“All who have been touched by the story of this little boy’s heroic struggle for life will feel this loss deeply,” he added.
“Although the past few weeks have been difficult with much activity on social media, we must recognise that all who have played a part in Alfie’s life have wanted to act for his good, as they see it.
“Above all, we must thank Tom and Kate for their unstinting love of their son, and the staff at Alder Hey hospital for their professional care of Alfie.”
Pope Francis, who met Mr Evans when he flew to Rome in a bid to transfer his son to Italy for alternative medical treatment, said: ”I am deeply moved by the death of little Alfie. Today I pray especially for his parents, as God the Father receives him in his tender embrace.”
European Parliament president Antonio Tajani had also called for courts to allow Alfie to be taken to Italy, as well as Polish President Andrzej Duda and numerous American conservatives.
As several right-wing commentators accused the NHS of “murdering” Alfie, Mike Huckabee, the former Republican governor of Arkansas, said on Twitter: “Maybe he would have died even if UK govt had allowed his parents to take their own child to Italy to seek other treatment, but we’ll never know. Alfie is dead. Govt is not God.”
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The British government does not intervene in cases relating to medical ethics and was not party to several hearings where UK judges ruled that Alder Hey hospital was acting in Alfie’s best interests and banned him from leaving the country.
Doctors who gave evidence said a progressive neuro-degenerative disease had caused “catastrophic degradation of his brain tissue” and that further treatment would have been futile and “inhumane”.
Alfie started showing signs of development issues in the first seven months of his life and had been in hospital since December 2016 after suffering seizures.
Mr Evans questioned whether nerve cells in his brain could recover but experts testified that the tissue cannot regenerate.
Alfie’s parents lost several rounds of their legal battle in the High Court, Court of Appeal, Supreme Court and European Court of Human Rights before a “one last chance” challenge on Wednesday.
When it was rejected by Court of Appeal judges they pledged to work with doctors in the hope of taking him home and asked their supporters to “return back to your everyday lives”, but the case has made headlines worldwide and sparked angry responses on social media.
Alder Hey Children’s Hospital said staff had experienced “unprecedented personal abuse” as it found itself at the centre of a “social media storm”.
Merseyside Police is investigating allegations of intimidation against patients and staff and officers were stationed at the hospital after protesters attempted to storm inside and block a road.
A spokesman for Alder Hey said: “We wish to express our heartfelt sympathy and condolences to Alfie’s family at this extremely distressing time.
“All of us feel deeply for Alfie, Kate, Tom and his whole family and our thoughts are with them.
“This has been a devastating journey for them and we would ask that their privacy and the privacy of staff at Alder Hey is respected.”
