Why was the NHS able to prevent Charlie Gard&#39;s parents from taking their child to the US? The European Court of Human Rights decided today that the parents of Charlie Gard, a British toddler with a life-threatening and (as his British doctors say) non-treatable disease, can not take him to the US for experimental treatment. All the UK courts had turned them down previously; this was the last resort and it's looking like Charlie will now be taken off life support. I got in an argument on Twitter over whether this is somehow symptomatic of a Single-Payer healthcare system, on the basis that a state-run judiciary is more likely to rule in favour of a state-run healthcare system, placing the opinions of NHS doctors above the parents' right to decide what's best for their child. My argument was that it doesn't have anything to do with the type of healthcare system at all, that this is some sort of custody conflict decided by the courts - but I don't really know what is going on! There was ample media reporting, but nothing I found provided insight into what actually went down here in terms of technicalities. On what legal basis is the NHS able to prevent parents from taking their sick child to another country? To put it bluntly - why couldn't the Gards simply take the 1.3 million pounds they had raised through GoFundMe, hire a private medical transport service, and give the hospital the two-finger salute on their way out? Did the NHS (or the hospital) take custody of the child away from the parents? Or does the NHS get to decide upon the welfare of its patients once they are in the system? Why were the parents not able to take Charlie away on their own recognizance, like (presumably) adults can refuse treatment and leave the hospital?
Such sad and tragic circumstances, my sympathy to all involved. General I do not know the specifics of English law as it applies but I believe it is similar enough to New South Wales, Australia that the general overview that follows is not likely to be far wrong. Before a court intervenes there has to be a dispute and someone with standing must bring an action to the court. We can surmise that a dispute arose about the best medical treatment for the child between the child's parents and the child's medical professionals - if there was unanimity there would have been no legal proceedings. Ultimately this is an issue of the welfare of the child. Medical professionals are under a legal obligation to report issues of child welfare to the relevant authorities. In the UK, the government authority responsible for child welfare is the Department of Education. We can presume that they intervened in accordance with their policies and procedures and their understanding of the law and the dispute could not be resolved. It is likely the DoE that brought the matter to the courts or the parent's disputing a DoE decision. The court will decide such issues in the best interest of the child. In deciding what that is, they will consider all the evidence including the parent's wishes, the child's wishes (not relevant in this case but it can be for older children), other relatives, medical opinion etc. They will also consider what the law is, including precedent and make their decision. If you read the linked article about the high court trial the judge is quoted as saying: “It is with the heaviest of hearts but with complete conviction for Charlie’s best interests that I find it is in Charlie’s best interests that I accede to these applications and rule that GOSH may lawfully withdraw all treatment save for palliative care to permit Charlie to die with dignity.” “I dare say that medical science may benefit objectively from the experiment, but experimentation cannot be in Charlie’s best interests unless there is a prospect of benefit for him.” “Charlie’s parents have sadly but bravely acknowledged and accepted that the quality of life that Charlie has at present is not worth sustaining, for he can only breathe through a ventilator, and although they believe that he has a sleep/wake cycle and can recognise them and react to them when they are close, they realise that he cannot go on as he is lying in bed, unable to move, fed through a tube, breathing through a machine.” “Understandably, Charlie’s parents had grasped that possibility, they have done all they could possibly have done, they have very publicly raised funds. What parents would not do the same? But I have to say, having heard the evidence, that this case has never been about affordability, but about whether there is anything to be done for Charlie.” “But if Charlie’s damaged brain function cannot be improved, as all agree, then how can he be any better off than he is now, which is a condition that his parents believe should not be sustained?” This decision was reviewed by the European Human Rights Court who “endorsed in substance the approach” taken by the British courts and declared “the decision is final”. Is it &quot;symptomatic of a Single-Payer healthcare system&quot; Probably not. Almost universally, child welfare cases are decided on the &quot;best interests of the child&quot;. This judge in this case within this legal and cultural system decided as he did - and I do not doubt that it was a difficult and emotional task. Change the judge, change the case, change the law and change the culture and you may change the decision but, then again, maybe not. Perhaps in a place with a different culture towards health care, the medical practitioners would not have formed the opinion that the experimental treatment was not in the best interest of their patient and there would have been no dispute that required government intervention. Legal basis Governments can pass laws that impact the people in their jurisdiction. The UK government has passed laws that allow them to interfere in the normal relationship of parental authority. The UK government is not unique - all countries have such laws. Further, the UK government controls who enters and leaves their borders and in what circumstances. Did the NHS (or the hospital) take custody of the child away from the parents? Almost certainly not - this was not a custody battle. Or does the NHS get to decide upon the welfare of its patients once they are in the system? Of course. Every medical professional/hospital/clinic everywhere in the world has a legal and moral responsibility to provide treatment in the best interests of their patients. They will get sued if they don't. Why were the parents not able to take Charlie away on their own recognizance, like (presumably) adults can refuse treatment and leave the hospital? Because an adult can decide for themselves, a child cannot. Other people have responsibility for deciding for the child and when, as here, people with overlapping responsibilities (parents and medical professionals) have divergent views, the government intervenes through executive or judicial action.
The "Privacy Rule" (45 CFR Part 160 and Part 164, Subparts A, E) don't forbid this. Sect. 164.502 states the general rule: (a) Standard. A covered entity or business associate may not use or disclose protected health information, except as permitted or required by this subpart or by subpart C of part 160 of this subchapter. "Health information" is defnes in part 160 as any information, including genetic information, whether oral or recorded in any form or medium, that: (1) Is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and (2) Relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual. Your picture would not constitute health information (and anyhow, they are allowed to gather health information, just not freely disseminate it – the pictures on the wall were presumably with permission). There is no general law (which would be state law) against taking a person's picture (though commercially exploiting someone's picture would require permission, via the concept of personality rights), and it is directly required in a number of instances (for identification purposes – school ID, driver's license, passport, voting in some states). It is an unusual requirement and since they scanned your driver's license it is especially inexplicable. Assuming that this is just a story they tell all patients because they want before and after pictures (which you would have to consent to, if you didn't already in one of those "sign here" flurries), saying that this is for "security purposes" would be untrue, but I don't think it's actually illegal. Taking but not using a photo would not cause you harm, so if you had let them take the picture, there would not be a basis for suing. If they use it for advertising without permission, that would be a problem.
Yes in general Generally, almost all western jurisdictions (be they civil law or common law) have some way to get medical records into evidence, be that via subpoenaing, or by discovery requests or court orders. In most cases, the party that brings the suit is also the patient or their legal representative, and they give (or imply) consent to the use of the records. And in cases where the defendant's medical records are required, usually, the defense wants those in too to prove some condition. And then there are cases where the state or their representatives brings the charge. They usually can bring a warrant or court order to obtain the documents. Then there are Medical records that had been made specifically on the behest of the state. Here, the warrant is usually filed to obtain the samples or access to the body to be investigated, the record itself forms the basis for the investigators to proceed - and is not under client-doctor confidentially in the first place. It had been made specifically for the state and it is a state-owned medical record, be they made on request of the executive power (police) with a warrant signed by a judge or on behalf of the judicative after a court order to evaluate capacity (see below). However, medical records can generally only be obtained if the records are relevant to the case at hand and only to the degree necessary: You can't request the medical records about a person's fertility status in a case that discusses damages for his broken arm. As a result, the medical record available in court might be only an extract from the original, with irrelevant passages sealed or redacted. Unlike many people think, it's quite common to get some medical records into court in some way or another: As the basis of injury cases If you have a case of physical injury, the injuries themselves need to be proven in court. This is done generally by getting the medical records - thus they can be subpoenaed by a party, usually the injured party here. Then a medical expert can discuss them, be they a court-appointed one or paid by either of the parties. In this category also fall mandatory reports of certain types of wounds or situations. As such, the treating doctor has to provide a medical report with enumerated types of injuries, like bullet wounds or where child abuse might be the reason. Very necessarily in malpractice cases Malpractice is pretty much injury on steroids: the injuring party made the records and would never want to give them up to the one suing them - if they could. Alice shall remove Appendix. It goes haywire and the day after Charly needs to cut Bob open again. Now Bob sues Alice for malpractice. Bob needs medical records from both Alice, the doctor who botched it, and Charly, who was fixing Alice's error. Generally, both records are subpoena-able to the degree relevant and necessary, and indeed the opposing medical opinions on the operation and records form the very basis of the case for either side. Without the ability to subpoena the - in this case unmodified - records from the injuring doctor, proving - or defending - a case of malpractice would be impossible: the very truth of the allegation should be in the medical records. It's routine in cases around death What is the very last medical record a person can ever get? An autopsy record! That's a very sensitive medical record, but they routinely are used in homicide cases. Oftentimes, the investigators also subpoena the medical records of the victim from their doctors to corroborate the autopsy record, while the defense might subpoena them to try and disprove it. Even in civil cases, like the OJ-Simpson civil damages case, autopsy and medical records from an accompanying criminal case can and will be &quot;pulled&quot; (copied over) from the other trial's docket. Regularly in child protection cases Whenever child protection is on the line, be them protective orders or who a child will live with after the child protection service (whatever its name is) is in on a case, then medical records are often required to bolster one side. Those records could be medical records from quite many doctors, be they physicals or psychological evaluations... Sometimes the medical records required here are only created due to court-ordered medical or psychological evaluation by a doctor. Whenever incompetence defense is called When the lawyer claims temporary incompetence or insanity, courts generally order a psychological evaluation. These medical records are evidence, but usually don't need to be subpoenaed: they have a waiver form to be disclosed to the court almost built-in. Are they available to the public? Medical records are part of truth-finding, but they are also quite sensitive. As a result, most medical records can not be gotten from the court and enter the dockets under seal. Another option is, that they enter the docket partially or even mostly redacted, with passages blackened.
The government has the choice They can prosecute the child for a crime in the adult system and the defendant then has the right to a jury, or they can refer the matter to the juvenile justice system (JJS) in which case any sentence is administrative and rehabilitative, not criminal and punitive. Some jurisdictions have removed certain classes of crime from the JJS and others allow the prosecutor or the JJS judge to refer the matter to the adult system. You may argue that this is a distinction without a difference, however, SCOTUS did not agree in McKeiver v. Pennsylvania (1971). The fifth amendment says &quot;No person shall ... be deprived of life, liberty, or property, without due process of law&quot; and SCOTUS was satisfied that the JJS provided that. They were also satisfied that because the prosecution was not criminal, the sixth amendment's right to a jury trial was not engaged. The JJS was established around the turn of the 20th century out of a belief that juveniles were more amenable to rehabilitation and that juvenile crime was a product of lack of parental supervision and societal influences whereas adults made a conscious choice to be criminals. In theory, the idea was to create a more sympathetic and less adversarial system to allow orders that were aimed to promote rehabilitation rather than punishment. Its success in that regard has been, at best, mixed. With the rise in crime in the US (but also worldwide) from the 1970s to 1990s, it became more politically beneficial to be &quot;tough on crime&quot; and more children were diverted from the JJS to the adult system - especially if they were people of colour. Even though crime rates have crashed since the turn of the 21st century, this is still many politicians' go-to response.
Given there was no answer here, I will state what I know about child abuse response, but note I am not a lawyer nor am I in Illinois, so my statements are likely generalized for most US states (individual laws vary by state, and I reside in Pennsylvania). In most US states, the police and child/youth services (that's what it's called in Pennsylvania but all states have similar services) work side by side and a complaint by the child to a police officer will have an emergency action taken to protect the child. The child is identified as a victim and the police and child/youth services have the obligation to protect the child and to keep them from harm. This is the main goal of police and children/youth services - to keep the child safe and act in the best interest of the child. Usually, a complaint to a child abuse center can take time to process. When a police complaint comes in it is more immediate, with police having more 'influence' with CYS (child/youth services). Especially when the child is in deadly danger (they were just stabbed, after all), the police may arrest the mother or abusive sibling or intervene therein to remove the child from the parents care with CYS-equivalent services working to find suitable alternative living situations for the child as a result of a order of removal/protection authorized by a judge. (PA at least had emergency situation response plans for these situations where a judge is just a phone call away). As well, the child will likely be made a ward of the state if the courts determine the mother cannot care for the child or is a threat as such (not caring enough to stop the brother may count), insomuch that the child may be removed from the dangerous situation and placed in the care of a willing relative or if none can be found will be placed in temporary foster care in a safer environment. Note that nothing happens rapidly without the initial complaint to the police. At age 16 the child is likely going to be taken more seriously (compared to a 12 year old, for example), and has the right to be allowed to reach out to hospital staff to ask to speak to a police officer - otherwise it takes a child abuse complaint from someone who knows the child and situation and that can sometimes take longer to process (though, the distance factor in the original question may make a complaint from overseas given a lower priority due to not knowing the person on a more personal in-person level)
Not much. Consider the following: The father can not force the mother to abort the pregnancy. Ex post facto agreements of non-payment are, in all likelihood, unenforceable. The father will be obligated to pay child support under the laws of the state with jurisdiction over the paternity. The abortion angle won&rsquo;t work. Setting aside commentary regarding the politics or ethics of abortion. I think we can agree it is a highly charged and emotional topic for some people. I point to the fact it always seems to be an issue during Supreme Court nominations and presidential elections. Given the explosive nature of the issue of whether abortions should be legal or not (in the case where the mother does not want to carry full term) could you imagine how much more dynamite it would add to the debate if the question were whether or not to allow the father to force the mother to terminate the pregnancy against the mother's wishes! One can only imagine how much more bombastic the abortion debate might then become. You can&rsquo;t escape child support (most likely). To give you a sense of how difficult it is to escape the obligations of child support. Consider the following... A Kansas man was ordered to pay child support when he thought he was being a sperm donor only and signed numerous agreements with the lesbian couple he thought he was helping. In that case, the court justified its ruling on the grounds that a doctor was not involved in the insemination process. But nothing prevents future courts from making the same ruling in cases where a doctor is involved in the insemination process. Especially if that state either withdraws from the The Uniform Parentage Act, amends it, repeals it, or never adopts it in the first place. Sperm Donors and Child Support: Even in cases in which the donor is known, but holds himself out as unknown, some courts have held the donor legally obligated to pay child support. Read more here. Ex post facto agreements are problematic. Now that you've edited the question, the above link is even more useful for providing a possible avenue to try (albeit unlikely to work): a non-payment agreement. The discussion in that link describes that even if you could somehow convince the mother to go along with it, it is unlikely (though not impossible) to be enforced by the courts. It depends on the facts (e.g., intercourse vs. in vitro), circumstances (e.g., relationship vs. no relationship between the parties), timing (e.g., before vs. after the agreement), etc. of the impregnation itself. Notwithstanding all the above, if you still have questions, you might consider floating an idea of an approach you think you might try (in a separate question) and get reactions to that specific proposal.
"Explanations relating to the Charter of Fundamental Rights" on the website you linked to is very clear that the Charter of Fundamental Rights only means the EU institutions can't discriminate based on age, and that EU law is not allowed to be age discriminatory. It doesn't mean that individual acts of age discrimination are illegal: In contrast, the provision in Article 21(1) does not create any power to enact anti-discrimination laws in these areas of Member State or private action, nor does it lay down a sweeping ban of discrimination in such wide-ranging areas. Instead, it only addresses discriminations by the institutions and bodies of the Union themselves, when exercising powers conferred under the Treaties, and by Member States only when they are implementing Union law. The practice of youth and senior discounts is older than the charter of fundamental rights. The charter will be interpreted in the light of continuity, it definitely wasn't the intention to outlaw price discrimination. There are specific laws that make price discrimination based on certain principles legal, e.g. UK equality act: Age discrimination - when discrimination is allowed in the provision of goods or services
Generally, in non-emergency situations, the state with jurisdiction over parenting issues related to children including relinquishment and adoption is vested in the courts of the "home state" of the child. A child's "home state" is defined by statute by a coordinated definitions set forth in parallel laws at the state (the Uniform Child Custody Jurisdiction And Enforcement Act in 49 states) and federal (the Parental Kidnapping Prevent Act) level. This definition of "home state" provides a fairly precise definition of something that approximately matches your intuition regarding the state where the child resides in most cases. There is also an international treaty with a similar home state definition. The state where the child was born ceases to be relevant at the point at which that state ceases to be the child's "home state". But, once a state's courts take jurisdiction over parenting issues for a child, the barrier to divest that state of jurisdiction is higher than it would be if there was no prior litigation. So, the state establishing the child support decree would often be the "home state" in the fact pattern set forth in this question. I will refrain from discussing the substantive law of voluntary relinquishment following an acknowledgment of paternity and payment of child support at length in this post as it is beyond the scope of what was asked. Suffice it to say that this is generally disfavored and is sometimes impossible. Also, the actions that could lead to involuntary termination of parental rights (even for mere non-support) also often have parallel felony criminal sanctions associated with them.