Original subtitles

I couldn't see her any more.

I couldn't see the things that made her... her.

They wanna switch off her machines

and we wanna keep them on.

They say she's in a lot of pain.

-She's still your child! -Yes! Yes, she is!

So, you just left her and me.

That makes it sound like I abandoned you.

Yeah, 'cause you did.

However you feel about what your parents are doing,

it's not about picking sides.

Of course it is.

And I'm on Marnie's side.

We believe we can suggest a bias

in the treatment Marnie has received

from Samantha Woodham.

She perforated an artery.

It sounds pretty deadly to me.

Marnie, she's complicated,

but, you know, she's, er, she's joyous.

I really miss you.

-Do you think you'll win, Nicci? -Any change in her condition?

Can I just go and see my daughter?

Can't we do better than this?

Yeah! You like that, do you?

-Hey. -She finds wallpaper funny.

-Does she? -Yeah.

Are you sure that's okay? The steam and...

Ahh, it's fine.

-Yeah? -Yeah.

Should have probably done it before she got here.

She loves it.

Look at that smile.

I was thinking maybe a picnic?

Oh, it's a bit cold.

Yeah, we'll just wrap up, won't we?

We'll wrap up.

You gonna make sandwiches?

I'm not gonna make sandwiches, sexist.

-We'll buy sandwiches. -Ahh.

I'll get you a sausage roll if you're lucky.

I'm in!

Huh?

She finds that funny too.

Ah, no! Ah! No! Ah! Ah!

...when the life

of the young child is at stake.

Looking at the papers this morning,

this makes the front page

on nearly every...

Ready?

Yeah.

-It's gonna be okay. -Yeah, yeah.

-Mint? -Ah, I just brushed my teeth.

You need a mint, mate.

You keep them.

-- Nicci! -- Nicci! Nicci!

We're just gonna go straight in.

Thank you very much.

Pre-match huddle?

-Yeah. Okay. -Rundown of who's here.

Francesca Camara, representing the hospital

and Dr Samantha Woodham.

She's very good.

Beatrice Shrigley, working with Greg Richardson

and the Children and Family Legal Services team

representing Marnie.

Right. Yeah, we met Mr Richardson.

Good lawyers, but so are we.

We're going to save Marnie's life, Mrs Lloyd.

We're gonna do something special here today.

Yeah. Good.

How long have you been Marnie's paediatric consultant?

I have observed Marnie in PICU for close to seven years.

She's a patient I know very well.

And will you tell us what you think

the best treatment is for her now?

I am sorry to say that I think we should stop all treatments.

I believe the life-sustaining treatments

we are currently giving are causing her to suffer

without any prospect of helping her.

How would you describe

Marnie's current interaction with the world?

She will never, in my medical opinion,

leave ventilated breathing support.

She shows little response to stimuli,

and her brain scans show irreversible damage.

So, her conscious experience?

In my judgement right now,

she has very little, if any, conscious experience.

No further questions.

How many children have you treated like Marnie?

No case is alike,

but I have treated

maybe 20 or 25 children with severe muscular dystrophy.

How many end up in a situation where, in your opinion,

the treatment can no longer be of use?

I, I couldn't tell you that exactly.

How many have died in your care?

Six.

The deterioration in each case

was similar to what we've seen with Marnie?

No cases are alike.

And Marnie's specific condition is unique.

In fact, as you say, it is as yet undiagnosed.

As happens frequently with neuro muscular disorders.

But, as it is undiagnosed, how can you be 100% sure

that continuing treatment is futile?

I am as certain as I can be.

And if I were to tell you that there are doctors

who believe they can treat Marnie?

Marnie's conscious experience,

another complicated area, is it not?

Yes.

Have there been examples, to your knowledge,

of children with severe brain damage who recover?

I do not believe it is likely

there will be any miracle improvement.

Of course, you must have your beliefs.

Let us discuss pain.

Ventilation itself isn't painful, is it?

No, but suctioning is very unpleasant.

-And how often does that happen? -Several times a day.

And if Marnie has "very little, if any" conscious experience,

in your opinion, how would she feel pain

in these isolated, suctioning incidents?

There are autonomic responses from Marnie

that do, I'm afraid, suggest pain.

You cannot have it both ways, Dr Woodham.

Either she doesn't have a conscious experience,

in which case she isn't in pain, or she does.

You're wrong.

We have seen a series of reactions

from spasms to changing heart rates,

which do suggest that, while her conscious experience

is extremely limited,

her pain response is still there.

Let me take you back to 2016.

If that's okay?

Sure.

May 24th, Marnie presented with an infection.

Yes, erm, I, I would need to consult my notes.

You had to put in a central venous catheter. A central line.

Yes, and it went wrong.

You perforated an artery.

-Which led to distal ischemia. -Yes.

You needed to call in a vascular surgeon

to repair the damage.

This incident was referred up to the consultants group,

and it was seen to be an unfortunate complication

of a competently performed procedure.

"Competently performed"?

How can something be "competently performed"

when it almost leads to ischemia?

That is what they concluded.

We are human beings.

And... I am sorry it happened,

and I am grateful

there was no damage to Marnie in the long term.

What do you know of unconscious bias

in the medical profession?

Well, it's something that we're all concerned with.

A doctor on a raft is told only seven people

can survive on the rations they have.

He has to make a decision as to who to save.

He or she.

I do beg your pardon, Dr Woodham.

How does he or she make the judgement?

We do not ration care in this country.

You're denying that during COVID

there was rationing of care for disabled people.

There was a prioritisation.

Who do you prioritise?

Now, we happen to have some correspondence

that was passed to us at a very late notice.

My Lady.

I apologise enormously, My Lady. It was this morning.

I emailed the court as soon as I received it.

I received no email.

Do you have copies for the others?

Yes, My Lady.

My Lady, we have no means of verifying this document.

We can ask the witness.

Erm...

Did this email come from you?

How did you get this?

-Yes. -Then I'll allow it.

This is a correspondence between you and a bed manager

about how to move people out of PICU

in preparation for the COVID outbreak, dated February 2020.

They ask you what they should do about Bed 16,

and you reply, "Bed 16 shouldn't be there.

"The parents have been clinging to hope

"without there being any."

I was expressing a medical opinion.

I regret how it sounds.

Do you believe that

sometimes for patients, as a doctor,

the best thing to do is to let them die?

That was another child

and another set of circumstances.

It was a busy time.

Lots of people to save?

Yes.

How irritating, then, to have a bed

taken up with this disabled child

which determined parents are there to protect.

I do think the sanctity of life is important.

But sometimes, as doctors,

we're unable to preserve a meaningful life,

and, in that case, it is cruel to prolong the dying process

with treatments that do not benefit them.

Where is that stated?

Is that in the Good Medical Practice Guidelines,

-as laid out by the GMC? -My Lady.

Mr Frederick, your questioning here is inappropriate,

as I believe you're well aware.

Dr Woodham, you do not need to answer,

but you may, if you wish.

Hmm.

Marnie is in pain.

She's unable to communicate.

And I am no longer helping her.

I am just prolonging her death.

When the other doctors decided that you had had

an "unfortunate complication" in perforating Marnie's artery

and almost leaving her with another disability,

on what grounds did they do so?

-Sorry? -On what grounds

did they make their judgement on you?

The grounds of, er... I'm sorry, I...

They gave you the benefit of the doubt, Dr Woodham.

Just as you have failed to give Marnie the benefit of the doubt.

-No. -In fact, and instead,

what Marnie has faced every day in your care

is your prejudice that this little girl

and her little life are taking up space

-in your precious PICU. -No.

I am sorry that you're getting emotional.

That was not my intention.

But there is, of course,

a lot of emotion attached to this case.

She is my patient.

And I have always given her the finest care.

In your opinion.

No further questions.

You doing okay?

Great.

You've had no further trouble?

I'm fine.

That was a good morning for us.

I'm sure it feels like that.

Hey. Hey there.

-Mind if I... -Er, no. Not at all.

-Is it allowed? -It's allowed.

How do you think it's going?

-Honestly? -Yeah.

Horribly.

These things are usually, er, not collegiate.

There's a certain level of respect.

However this turns out, look after yourself, okay?

Er, yeah, it's just an egg stain.

Sorry?

On, on the tie. It's just an egg stain.

I know what drinking looks like.

I know what drinking smells like.

Have you got any lunch?

Er, no.

Okay. I can get some more.

What? No, no, no, no, no. No.

You can, and you will.

My favourite flavour. Cheese and onion.

-My favourite. -Good.

Mr Lloyd,

would you consent to a few questions from me?

I've, I have nothing to hide.

Thank you.

Your wife gave up her job when Marnie was diagnosed?

And I'm very grateful for that. Yeah.

Rather she kept herself focused on Marnie.

Well, her job wasn't very understanding.

You kept working?

Yes, I, er...

We needed the money.

Do you remember who was earning more

when Marnie was born, your wife or yourself?

Er, she was.

So, a better economic decision

might have been for you to give up your job

and for your wife to keep on going.

You're right.

Can you explain why, then,

you were the one to keep your job?

I think, to be honest, the question wasn't asked.

What sort of hours do you work, Mr Lloyd?

Nine-thirty till six, most days.

And your business, accountancy, has grown since Marnie was born.

Yes.

So occasionally you have meetings

in the evenings, at weekends...

I... I always, erm,

have made a lot of time for my family.

So any suggestion you've buried yourself in work...

My Lady, I'm not here to represent Mr Lloyd,

but as he is representing himself

and perhaps unused to the court situation,

I do feel obliged to say these questions

do feel unnecessarily intrusive.

Agreed.

Would you consider yourself a good father, Andrew?

I'd hope that I'm a good dad.

I, I don't believe

this line of questioning is fruitful.

I'm not going to be helped

by intrusive questions of Mr Lloyd.

If you have any questions about Marnie's quality of life,

-please ask them. -Apologies, My Lady.

I'm not looking to be intrusive.

Just drawing a picture as to the family dynamic

so as to get a better sense of

who might best represent Marnie's interests.

Mr Frederick, I have no doubt

that everyone involved in this case firmly believes

that they are putting Marnie's best interests first.

It's not a competition.

Parenting a child with Marnie's needs

must be extremely trying.

There are difficulties,

but, er...

immense pleasures, too.

She's a beautiful girl.

Has the pressure ever overwhelmed you?

Frequently.

There have been moments when you have made mistakes

looking after her, haven't there?

The time that Marnie was left alone,

with her temperature rising while you

were in your garden drinking.

Erm...

I'd, I had a, I had a couple of beers, sure,

but I had the monitor with me.

And I, I couldn't anticipate.

Was it a couple of beers?

I, erm...

Perhaps, er, four or five.

Were there drugs involved?

Maybe I'd smoked some weed. I do. Occasionally.

It doesn't impact my judgement.

To be clear, at that moment,

she required hospitalisation.

I...

I think we've both made mistakes, haven't we, Nicci?

Is this another mistake, Mr Lloyd?

You're aware that if you do this,

there is no coming back.

Am I aware that my daughter will be dead?

Yes. I'm... aware of that.

I, I don't want to make this decision. I...

I just, I just, erm...

I feel obliged to.

No further questions.

Where does that obligation come from?

The obligation to make that decision?

I looked at her and, erm...

I, erm...

You know, it's a difficult thing, erm,

watching your child in pain.

Especially when you believe she won't get better.

That is supposition on the basis of no medical training.

But I have studied. My wife and I both have.

We're, we're specialists.

You know, I believe one thing, and she believes another.

And I believe that hers is on the basis of...

a wish that I wish I shared.

The obligation comes from love.

And if that doesn't sound...

Well, I, I don't really care how it sounds.

No further questions.

Erm, I'm gonna catch the bus home, okay?

Oh. Granddad was gonna give us a lift.

Er, yeah, I'm gonna catch the bus.

Just need some space.

Okay.

I'm so sorry

-this is so late in the day. -Oh, that, that's okay.

I'm just, I'm pleased to finally be getting to talk to you.

I think I can help you.

That's great.

So what's, what's your opinion on,

on what's best now for Marnie?

Marnie needs time.

We need to be able to chart whether any recovery

from the hypoxic brain damage is possible.

We need to see what treatment might be best for her condition.

So I'd say we give her that time

and get her tracheostomised and supported.

I can't, er...

I can't tell you how, how good it feels

to hear a doctor say it.

Medicine's an observational sport.

Too many give up on that observation too quickly.

There are many that believe that risdiplam

might have an impact across

a spectrum of neuromuscular disorders.

Yeah, I said... I said, I said the same.

And the important thing from the court's perspective

is not that such a thing is probable,

but that it's possible.

But you've had success with children like Marnie?

Mrs Lloyd, I've had success with all kinds of children

that medical science would otherwise have discarded.

What's in the picnic basket?

I don't know yet, 'cause it's, it's in the shop.

Got it.

You look like a fucking statue.

Yeah.

You wanna talk about it?

I had... I had thoughts.

I had, I had thoughts things...

would be easier without her.

I had those thoughts.

Of course you did, yeah.

You knew how hard it was with me.

No, it's not true.

I love being your big brother.

I quite like being your little brother.

-Dance with me. -No.

Come on. Dance with me.

-Fuck off. -No, no, dance with me.

Come on.

All in the hips. All in the hips.

Guessing you'll be sleeping here.

Thanks. Yeah.

I'll bring in a cup of tea at seven.

Once upon a time,

there was a button

called Little Button

and she lived with her mum,

Mummy Hat,

and her dad, Daddy Shirt,

and her sister, Sister Shoe,

in a room above a factory.

One day,

one day she went to the beach...

and she...

You wait there, okay, sweetheart?

Okay, I'll, er... I'll finish it off.

I've got this. You take your time

and then we'll climb up the hill, okay?

-I'm sorry. -It's all right. It's all right.

Yeah, it's all right.

Hello. Hello, sweetheart.

You okay?

You know, I've even got a story about Sister Shoes.

I have.

It's okay.

Could you explain to us why the doctors are wrong?

Marnie has a congenital muscular dystrophy.

Her specific form has never been diagnosed.

It's hard to diagnose and therefore hard to treat.

But I believe that treatments are possible.

For instance, an experimental treatment

called risdiplam might have an impact.

My Lady, that drug is not licenced for use

by NICE, the FDA or the EMA for Marnie's condition.

Er, right now it isn't. But drug use changes.

-All the time. -We are not here to guess

as to what treatments might work.

I agree. Please refrain from guesswork, Dr Pankerman,

we're here to establish fact.

My, my point is not that a cure is available.

My point is that it "might be" available.

We will investigate and make cases for treatments.

And, while we do so, we'll keep Marnie alive.

No further questions.

Talk me through your qualifications in PICU.

Fifteen years qualified.

I'm an attending physician that works mainly in neurology.

Sorry, you misunderstand me.

I know it's another country's medical system,

so it's complicated, but paediatric medicine,

what is your specialism there?

Unlike Dr Woodham,

who is a generalist, I'm a neurologist.

I work with all ages.

I can understand the brain.

Have you examined Marnie's brain?

I haven't been to examine her face to face,

but I have looked at the scans.

So, this is just an opinion based on no direct examination?

Your medical system has prevented me

from examining Marnie.

As such, my opinion is provisional.

It is far from categoric,

but I do think the possibility exists.

To be clear to the court,

a second opinion was sought and given.

The consultant asked a friend of hers

from a neighbouring hospital to examine the girl.

Unsurprisingly, she agreed with the consultant.

Are you claiming that Professor Bradbury

has not complied with her duty to the court?

That's an extremely serious allegation to make.

What is your evidence for it?

No, I'm not saying that. I'm just saying that, often,

colleagues support each other.

Tell me, you have appeared in other proceedings

concerning medical treatment for minors, have you not?

-Yes. -How many cases,

where there is a decision to be made

about the future care of a child?

I don't know, maybe three.

Well, this was just a simple Google search.

We found evidence of you contributing

to seven trials on this basis.

Why do you think that is?

I'm happy to help.

To go against the establishment.

Not many are in my profession.

A bit of aggression

from them helps us, to be honest.

What did you recommend,

in all those cases, for the child involved?

Have you ever recommended that ventilation should cease?

No.

I found evidence they should live.

No further questions.

Hey, I followed you.

Oh. That's kids for you.

One day they don't wanna know,

the next day they're following you to church.

Go ahead, Mum, pray. I'm just...

just here.

That's okay.

Maybe I'll have a thunderbolt moment

and start believing in God.

Yeah?

Maybe I can be saved.

You know they're only doing

what they need to do to win this.

Yeah, I understand that.

I mean, what they're doing. They're... Dad doesn't. He...

Mum, that's, that's not my problem.

Was he the best they could do?

I thought...

Wou... Would you trust him

with Marnie?

No.

I don't think she'd want this.

I'm sorry. I, I don't.

You're a brave girl.

You're always so brave.

Mrs Lloyd, tell me why you oppose

the hospital in this action?

Because I believe my daughter should live.

Even though she's in pain?

I don't believe that.

You've seen the reports.

You've been present at Marnie being suctioned

where it's claimed a clear pain response has been present.

-I've never seen that pain. -My Lady...

If I'd have seen that pain, we wouldn't be here now.

I believe we can allow Mrs Lloyd

to have her own version of events, Counsel.

Why do you think the hospital disagrees with you?

Erm...

Er... That's a big question.

Take your time.

I, I can't, erm...

I can't tell you the amount of times

that you are encouraged,

as a parent of a disabled child, to just...

to just give up.

We had it all through this pandemic.

I have friends told that their kids wouldn't get machines,

and I always knew I had to keep Marnie safe

because if she did get the damn thing,

I didn't know that she would survive it,

because... I, I didn't know that she would get the help...

to survive.

And then we made out the other side

and... and suddenly...

My point is that, erm,

people say that they care about disabled people, but...

always, all the time...

I see different.

Marnie's my,

Marnie is my beautiful child

and it's an honour to be her mother.

So I've learned to put my shoulder down.

I just put my shoulder down and I just...

I just keep charging.

Ready?

You know what you used to say to me

any time I had something difficult to do?

No.

Mum would tell me to try to be brave.

You told me I, I didn't need to try,

I was already brave.

Well, I'm not you.

Do you want me to come?

You don't like crowds.

I will, though, if you want me to.

I can do this on my own.

-Are you all right? -Yeah.

-Hi. -Hi.

I like the smart threads. New?

Yeah. Well... ish.

We're here for you both.

Yeah. Well, we'd better go in.

All rise.

These cases are clearly never easy.

This case particularly so.

I recognise that the strong presumption

in favour of a course of action

that will prolong life is not an irrebuttable one.

It reflects the position that life, as precious as it is,

cannot be and indeed should not be

preserved at all costs

in the face of its natural conclusion.

But, equally, I recognise that Marnie Lloyd

is clearly an exceptional,

bright, happy and well loved child.

And it is plain from Dr Woodham's evidence

and the evidence given by Mr and Mrs Lloyd,

that Marnie's parents have been doughty defenders

of their daughter's best interests over many years

to her undoubted benefit.

The position adopted by Mrs Lloyd before the court

is eminently reasonable and wholly understandable.

It represents a continuation of the love and dedication

that she and her family

have shown to Marnie throughout her life.

This is a case of huge complication

and immense difficulty.

I'm going to break my thinking into four areas.

So, we begin with the evidence.

It's a panic attack. It'll pass.

It's just a panic attack. It'll pass.

I've had 'em before.

-Is he all right? -It's all right.

He's just having a panic attack. He's had them before. Thank you.

You're okay. Deep breaths, come on.

You're okay. It's all right.

...and so, for all those reasons,

I will make the declaration

sought by the hospital...

...that the continuation of life-sustaining treatment

is not in Marnie's best interests.

She's for the hospital.

We'll sort it out with Derek

and talk about a potential appeal. Derek?

Yes, absolutely.

Can we go? Let's just go.

No, I'll get it.

-Hello. -Hi, Tom.

Is, erm...

-Hello. -Hi.

I was just... writing to you.

Saying what?

Should I leave?

Well, no. We'll just... we'll go for a walk.

I always like a walk.

-All right? -Yeah.

Okay.

They want me to appeal.

Of course they do.

I shouldn't have told them about your drinking.

Er, I'm ashamed that I did that.

-I shouldn't... -You needed to win.

You, you, you were...

you are an excellent Dad.

I'm not saying you're right, and I'm not... but I'm...

But I'm, I'm stopping it.

You... you're sure?

Morning!

This is an unexpected bounty.

Yeah, well, they're mostly ones you've sold us.

What's brought this on?

Erm...

Well, you won't be seeing us again for a while.

She's a smasher, your Marnie.

I don't want her to die here.

Erm, I'm afraid,

as I understand it, she has to.

Oh...

I, erm, I asked the same thing back at the beginning.

I asked whether we could, you know, get her home.

And I was told that she would die in the ambulance.

Right.

What they have said is that

once they've turned off all the machines,

and, you know, let her go, erm...

They can put her in an ambulance for us

and we can get her home then and put her to bed.

She'd be, er, she'd be dead.

Or, erm,

well, we could explore the, the transplant option.

Right.

What do you think?

I decided I'd leave that question to you.

Oh! Oh!

Well, thank, thank you for, for researching it but...

I want us to decide together.

Erm...

I mean, I genuinely am not sure on this, erm...

I think Marnie would quite like to be back in her own bed.

And...

And I think Marnie would, would quite like to be useful,

you know, to other people.

Katie?

-Me? -Yes, please.

Erm...

I think...

I think transplant.

-Could they do it quickly? -They could make it happen.

Well, let's make it happen.

Will we hear it?

Will we hear it when she dies?

There might be some breathing.

But will it, will it sound like she's in pain?

That's unlikely.

Chances are she'll just pass.

Can we call it dying?

Not letting go or passing on, just...

just dying.

The morphine she's on,

I don't believe she'll feel any pain.

You got anything you want to say to her?

I think she knows how I feel.

I love you, Marnie.

I love you too.

I love you so much.

I've got something I wanna say.

Okay.

Are you ready?

Are, are the transplant team ready?

Yes.

Erm so, erm, what will happen?

Once we've taken out the breathing tube

we'll let her breathe on her own.

She may take a few breaths.

You will have a little time to hold her

then her heart will slow and...

then it will stop.

When that happens,

we need to get her next door straight away.

Okay, well, then I, I think we're ready.

There we go.

There we go, lamb.

Good night. Sleep tight.

I love you. I love you. I love you.

Was that the wrong thing to say?

No.

Well, I'll erm...

Get in the van.

I don't know where we're going, but we're going there together.

-Right? -I agree with that.

Okay. Thanks.

I'm gonna miss her...

so much.

You know I will, I will too, right?

You even thinking you need to say that just...

that makes me feel like such an arsehole.

We made her happy and, and that's...

-Well, she made us happy, too. -She really did.

So, where to?

I could be hungry.

-You could? -Mmm.

-Well, that's shocking. -That's a great idea.

Erm, the Italian place by the library?

Yeah. Good.

Music? You want some music?

Oh. I er, your dongle, it's er, it's busted.

You broke my dongle?

Yeah. Yeah, I snapped it. I snapped it in anger.

Well, shall I sing something then?

Er...

I've got my music.

Oh, she's got her music.

-Let's hear it, then. -All right.

Whoa

through the window, it's magic

just caught by this traffic

while I kept myself distracted

that I'm paying attention

through the window, it's magic

just caught by this traffic

the shackles of my burden

in the morning

I can only fall on my knees

for your deeds

through the window, it's magic

just caught by this traffic