Best Interests (2023) s01e04 Episode Script
Episode 4
1
..things that made her HER.
They want to switch
off her machines,
and we want to keep them on.
They say she's in a lot of
pain! She is still your child!
Yes! Yes, she is!
So you just left her and me?
That makes it sound
like I abandoned you.
Yeah, cos 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?
This programme contains some strong language and
some scenes which some viewers may find upsetting
BABY GURGLES Yeah!
You like that, do you?
HE CHUCKLES
Hey.
She finds wallpaper funny.
Does she? Are you
sure that's OK?
The steam and
Ah, I think 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.
Ah, it's a bit cold.
Yeah, we'll just wrap up,
won't we? We'll wrap up.
You going to make sandwiches?
I'm not going to make
sandwiches, sexist!
We'll buy sandwiches. Ah.
I'll get you a sausage
roll if you're lucky.
Oh, I'm in! THEY LAUGH
BABY GURGLES Ah! She
finds that funny too.
Ah, no, no! Ah!
RADIO: factors at play
when the life of a
young child is at stake.
Looking at the
papers this morning,
this makes the front page
on nearly every single
ANDREW SIGHS
Ready?
Yeah.
It's going to be
OK. Yeah, yeah.
Mint? Ah, I just
brushed my teeth.
You need a mint, mate.
You keep them.
Nicci! Nicci! Nicci! Nicci!
REPORTERS CLAMOUR
We're just going to go straight
in, thank you very much.
Pre-match huddle?
Yeah. OK.
A 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. Yeah,
we met Mr Richardson.
Good lawyers, but so are we.
We're going to save
Marnie's life, Mrs Lloyd.
We're going to 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 judgment,
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,
treatment can no
longer be of use?
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
neuromuscular 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 OK?
Sure.
May 24th.
Marnie presented
with an infection.
Yes. Um, 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 in 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 judgment?
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 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.
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, that 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.
Mm.
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 judgment on you?
The grounds of, um
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 OK?
Great.
You've had no further trouble?
I'm fine.
That was a good morning for us.
I'm sure it feels like that.
PHONE BUZZES
Hey.
Hey there.
Mind if I?
Uh, no. Not at all.
Is it allowed?
It's allowed.
How do you think it's
going? Honestly? Yeah.
Horribly.
These things are usually
..not collegiate, but there's
a certain level of respect.
However this turns out,
look after yourself, OK?
Ah, yeah, it's
just an egg stain.
Sorry?
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.
OK. I can get some more.
What? 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 CLEARS THROA
I've nothing to
hide. Thank you.
Your wife gave up her job
when Marnie was diagnosed?
And I'm very grateful for that.
Rather she kept herself
focused on Marnie.
Well, her job wasn't
very understanding.
You kept working?
Yes. Uh, 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?
To be honest, the
question wasn't asked.
What sort of hours do
you work, Mr Lloyd?
9.30 till 6.00 most days.
And your business, accountancy,
has grown since Marnie was born?
Yes.
So, occasionally you have meetings
in the evenings, at weekends?
I have always um
..have made a lot of
time for my family.
So any suggestion you've
buried yourself in work
My Lady! I am not here to
represent Mr Lloyd, but as he's
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 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 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.
Um
I had
I had a couple of beers, sure,
but I had the monitor with me
and I couldn't anticipate
Was it a COUPLE of beers?
I Um
Perhaps four or five.
Were there drugs involved?
Maybe I'd smoked some
weed. I do occasionally.
It doesn't impact my judgment.
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 don't want to make
this decision. I
I just um
I feel obliged to.
No further questions.
Where does that
obligation come from?
The obligation to
make that decision?
I looked at her and, um
..I, um
It's a difficult thing,
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 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, look, I don't
really care how it sounds.
No further questions.
Uh, I'm going to catch
the bus home, OK?
Oh. Well, Grandad was
going to give us a lift.
Er, yeah, I'm going
to catch the bus.
Just need some space.
OK.
I'm so sorry this is so late
in the day. Oh, that's OK.
I'm just pleased to finally
be getting to talk to you.
I think I can help you.
Great.
So, what's your opinion 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 say we give her that time
and get her tracheostomised
and supported.
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 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,
cos it's in the shop.
Got it.
CAR ENGINE STARTS
You look like a fucking statue.
Yeah.
You want to talk about it?
I had
I had thoughts. I had
thoughts things
..would be easier without her.
I had those thoughts.
Of course you did. You knew
how hard it was with me.
No. That's not true.
I loved being your big brother.
I quite liked being
your little brother.
MUSIC: Animal Nitrate by Suede
Er, right now it isn't,
but drug use changes
all the time.
We're not here to guess as to
what treatments might work.
I agree. Please refrain from
guesswork, Dr Pankerman.
We're here to establish facts.
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.
15 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.
KATIE: Hey.
I followed you.
Oh.
Well, that's kids for you.
One day they don't want to know,
next day they're
following you to church.
Go ahead, Mum. Pray.
I'm just just here.
No, it's OK.
Maybe you'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
Mum that's not my problem.
Was he the best they could do?
SHE SIGHS
I thought
Would you trust him with Marnie?
No.
I don't think she'd want this.
Sorry.
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?
Um
Er, that's a big question.
Take your time.
I can't um
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 had 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 didn't know that she
would get the help
..to survive.
And then we made it out
the other side and
..and suddenly
My point is that, um
..people say that they care
about disabled people, but
..always, all the time
..I see different.
Marnie's my, er
Marnie's 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 didn't need to try,
I was already brave.
Well, I'm not you.
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 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.
HE BREATHES RAGGEDLY So we
begin with the evidence
It's a panic attack. It'll pass.
GASPING: It's just a
panic attack. It'll pass.
I've had them before.
Is he all right?
It's all right.
He's just having a panic attack.
He's had them before. Thank you.
ANDREW SOBS
All right. Deep
breaths, come on.
You're OK. It's all right.
And so, for all those reasons,
I will make the declaration
sought by the hospital
NICCI GASPS, SOBS
that the continuation of
life-sustaining treatment
is not in Marnie's
best interests.
NICCI SOBS
INDISTINCT CHATTER
We'll sort it with Derek and talk
about a potential appeal. Derek?
Yes, absolutely.
Look, it's hard
now, I know, but
INDISTINCT CHATTER
Can we go? Let's just go.
HE EXHALES
DOORBELL
No, I'll get it.
Hello. Hi, Tom.
Is, um?
Hello. Hi.
I was just writing to you.
Saying what?
Sh shall I leave?
Well, no. We'll just
We'll go for a walk.
I always like a walk.
All right? Yeah.
OK.
They want me to appeal.
Of course they do.
I shouldn't have told
them about your drinking.
I'm ashamed that I did that.
I should You needed to win.
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're sure?
Morning!
This is an unexpected bounty.
Yeah, well, they're mostly
ones you've sold us.
What's brought this on?
Um, 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.
Um
I'm afraid, as I
understand it, she has to.
Oh.
I, um 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'd die in the ambulance.
Right.
What they have said is once they've
turned off all the machines and,
you know, let her go
..um
..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, um, well, we could explore
the, um the transplant option.
Right.
What do you think?
I decided I'd leave
that question to you.
Oh.
Well, thank you
for researching it
but I want us
to decide together.
Yeah. Um
I mean, I genuinely
I'm not sure on this. Um
I think Marnie
would quite like to
be back in her own bed
..and, um
..and I think Marnie would quite
like to be useful, you know,
to other people.
Katie?
Me?
Yes, please.
Um
I think
I think transplant.
Could they do it quickly? They
could make that happen, yeah.
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 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.
With the morphine she's on,
I don't believe
she'll feel any pain.
Have 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 want to say.
OK.
KATIE WHISPERS
Are you ready?
Are the transplant team ready?
Yes.
Um, so, um 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.
OK.
Then I-I think we're ready.
OK.
SOFT BEEPING
SNIFFLING
There we go.
There we go, lamb.
Goodnight. Sleep tight.
I love you. I love
you. I love you.
Was that the wrong thing to say?
No.
LIGHTER IGNITES
Well, I'll, um
Get in the van.
I don't know where we're going
but we're going there together.
Right? I agree with her.
OK. Thanks.
I'm going to miss
her so much.
You know I will too, right?
You even thinking you
need to say that just
..makes me feel like
such an arsehole.
We made her happy and
..and that's
Well, she made us happy,
too. She really did.
REAR DOOR OPENS
So, where to?
I could be hungry.
You could? Mm. Well,
that's shocking.
That's a great idea. Um
..the Italian place
by the library?
Yeah. Good.
Music? You want some music?
Oh. I, er
Your dongle, it's,
uh it's busted.
You broke my dongle?
Yeah. Yeah, I snapped it.
I snapped it in anger.
Well, shall I sing
something, then?
KATIE CHUCKLES
Uh I've got my music.
Oh, she's got her music.
Let's hear it,
then. All right.
MUSIC: 20/20 by Rimon
Whoa, whoa Woo, ooh
Whoa, whoa Woo, ooh, ooh
Whoa, hmm
I see your sunlight through
the window, it's magic, uh
My thoughts and body were
just caught by this traffic, uh
You watched time pass while
I kept myself distracted, uh
Will you forgive now
that I'm paying attention?
Uh, I see your sunlight through
the window, it's magic, uh
My thoughts and body were
just caught by this traffic, uh
Where did our time go?
Encounters beautiful
Only you are the one to
break the shackles of my burden
Are the one to show
me glory in the moment
Cannot pay you back
Even if I could, I can
only fall on my knees
Show my gratitude
for your deeds
I see your sunlight through
The window, it's magic, uh
My thoughts and body were just
Caught by this traffic, uh
You watched time pass while
I kept myself distracted. ♪
..things that made her HER.
They want to switch
off her machines,
and we want to keep them on.
They say she's in a lot of
pain! She is still your child!
Yes! Yes, she is!
So you just left her and me?
That makes it sound
like I abandoned you.
Yeah, cos 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?
This programme contains some strong language and
some scenes which some viewers may find upsetting
BABY GURGLES Yeah!
You like that, do you?
HE CHUCKLES
Hey.
She finds wallpaper funny.
Does she? Are you
sure that's OK?
The steam and
Ah, I think 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.
Ah, it's a bit cold.
Yeah, we'll just wrap up,
won't we? We'll wrap up.
You going to make sandwiches?
I'm not going to make
sandwiches, sexist!
We'll buy sandwiches. Ah.
I'll get you a sausage
roll if you're lucky.
Oh, I'm in! THEY LAUGH
BABY GURGLES Ah! She
finds that funny too.
Ah, no, no! Ah!
RADIO: factors at play
when the life of a
young child is at stake.
Looking at the
papers this morning,
this makes the front page
on nearly every single
ANDREW SIGHS
Ready?
Yeah.
It's going to be
OK. Yeah, yeah.
Mint? Ah, I just
brushed my teeth.
You need a mint, mate.
You keep them.
Nicci! Nicci! Nicci! Nicci!
REPORTERS CLAMOUR
We're just going to go straight
in, thank you very much.
Pre-match huddle?
Yeah. OK.
A 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. Yeah,
we met Mr Richardson.
Good lawyers, but so are we.
We're going to save
Marnie's life, Mrs Lloyd.
We're going to 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 judgment,
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,
treatment can no
longer be of use?
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
neuromuscular 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 OK?
Sure.
May 24th.
Marnie presented
with an infection.
Yes. Um, 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 in 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 judgment?
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 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.
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, that 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.
Mm.
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 judgment on you?
The grounds of, um
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 OK?
Great.
You've had no further trouble?
I'm fine.
That was a good morning for us.
I'm sure it feels like that.
PHONE BUZZES
Hey.
Hey there.
Mind if I?
Uh, no. Not at all.
Is it allowed?
It's allowed.
How do you think it's
going? Honestly? Yeah.
Horribly.
These things are usually
..not collegiate, but there's
a certain level of respect.
However this turns out,
look after yourself, OK?
Ah, yeah, it's
just an egg stain.
Sorry?
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.
OK. I can get some more.
What? 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 CLEARS THROA
I've nothing to
hide. Thank you.
Your wife gave up her job
when Marnie was diagnosed?
And I'm very grateful for that.
Rather she kept herself
focused on Marnie.
Well, her job wasn't
very understanding.
You kept working?
Yes. Uh, 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?
To be honest, the
question wasn't asked.
What sort of hours do
you work, Mr Lloyd?
9.30 till 6.00 most days.
And your business, accountancy,
has grown since Marnie was born?
Yes.
So, occasionally you have meetings
in the evenings, at weekends?
I have always um
..have made a lot of
time for my family.
So any suggestion you've
buried yourself in work
My Lady! I am not here to
represent Mr Lloyd, but as he's
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 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 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.
Um
I had
I had a couple of beers, sure,
but I had the monitor with me
and I couldn't anticipate
Was it a COUPLE of beers?
I Um
Perhaps four or five.
Were there drugs involved?
Maybe I'd smoked some
weed. I do occasionally.
It doesn't impact my judgment.
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 don't want to make
this decision. I
I just um
I feel obliged to.
No further questions.
Where does that
obligation come from?
The obligation to
make that decision?
I looked at her and, um
..I, um
It's a difficult thing,
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 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, look, I don't
really care how it sounds.
No further questions.
Uh, I'm going to catch
the bus home, OK?
Oh. Well, Grandad was
going to give us a lift.
Er, yeah, I'm going
to catch the bus.
Just need some space.
OK.
I'm so sorry this is so late
in the day. Oh, that's OK.
I'm just pleased to finally
be getting to talk to you.
I think I can help you.
Great.
So, what's your opinion 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 say we give her that time
and get her tracheostomised
and supported.
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 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,
cos it's in the shop.
Got it.
CAR ENGINE STARTS
You look like a fucking statue.
Yeah.
You want to talk about it?
I had
I had thoughts. I had
thoughts things
..would be easier without her.
I had those thoughts.
Of course you did. You knew
how hard it was with me.
No. That's not true.
I loved being your big brother.
I quite liked being
your little brother.
MUSIC: Animal Nitrate by Suede
Er, right now it isn't,
but drug use changes
all the time.
We're not here to guess as to
what treatments might work.
I agree. Please refrain from
guesswork, Dr Pankerman.
We're here to establish facts.
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.
15 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.
KATIE: Hey.
I followed you.
Oh.
Well, that's kids for you.
One day they don't want to know,
next day they're
following you to church.
Go ahead, Mum. Pray.
I'm just just here.
No, it's OK.
Maybe you'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
Mum that's not my problem.
Was he the best they could do?
SHE SIGHS
I thought
Would you trust him with Marnie?
No.
I don't think she'd want this.
Sorry.
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?
Um
Er, that's a big question.
Take your time.
I can't um
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 had 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 didn't know that she
would get the help
..to survive.
And then we made it out
the other side and
..and suddenly
My point is that, um
..people say that they care
about disabled people, but
..always, all the time
..I see different.
Marnie's my, er
Marnie's 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 didn't need to try,
I was already brave.
Well, I'm not you.
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 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.
HE BREATHES RAGGEDLY So we
begin with the evidence
It's a panic attack. It'll pass.
GASPING: It's just a
panic attack. It'll pass.
I've had them before.
Is he all right?
It's all right.
He's just having a panic attack.
He's had them before. Thank you.
ANDREW SOBS
All right. Deep
breaths, come on.
You're OK. It's all right.
And so, for all those reasons,
I will make the declaration
sought by the hospital
NICCI GASPS, SOBS
that the continuation of
life-sustaining treatment
is not in Marnie's
best interests.
NICCI SOBS
INDISTINCT CHATTER
We'll sort it with Derek and talk
about a potential appeal. Derek?
Yes, absolutely.
Look, it's hard
now, I know, but
INDISTINCT CHATTER
Can we go? Let's just go.
HE EXHALES
DOORBELL
No, I'll get it.
Hello. Hi, Tom.
Is, um?
Hello. Hi.
I was just writing to you.
Saying what?
Sh shall I leave?
Well, no. We'll just
We'll go for a walk.
I always like a walk.
All right? Yeah.
OK.
They want me to appeal.
Of course they do.
I shouldn't have told
them about your drinking.
I'm ashamed that I did that.
I should You needed to win.
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're sure?
Morning!
This is an unexpected bounty.
Yeah, well, they're mostly
ones you've sold us.
What's brought this on?
Um, 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.
Um
I'm afraid, as I
understand it, she has to.
Oh.
I, um 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'd die in the ambulance.
Right.
What they have said is once they've
turned off all the machines and,
you know, let her go
..um
..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, um, well, we could explore
the, um the transplant option.
Right.
What do you think?
I decided I'd leave
that question to you.
Oh.
Well, thank you
for researching it
but I want us
to decide together.
Yeah. Um
I mean, I genuinely
I'm not sure on this. Um
I think Marnie
would quite like to
be back in her own bed
..and, um
..and I think Marnie would quite
like to be useful, you know,
to other people.
Katie?
Me?
Yes, please.
Um
I think
I think transplant.
Could they do it quickly? They
could make that happen, yeah.
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 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.
With the morphine she's on,
I don't believe
she'll feel any pain.
Have 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 want to say.
OK.
KATIE WHISPERS
Are you ready?
Are the transplant team ready?
Yes.
Um, so, um 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.
OK.
Then I-I think we're ready.
OK.
SOFT BEEPING
SNIFFLING
There we go.
There we go, lamb.
Goodnight. Sleep tight.
I love you. I love
you. I love you.
Was that the wrong thing to say?
No.
LIGHTER IGNITES
Well, I'll, um
Get in the van.
I don't know where we're going
but we're going there together.
Right? I agree with her.
OK. Thanks.
I'm going to miss
her so much.
You know I will too, right?
You even thinking you
need to say that just
..makes me feel like
such an arsehole.
We made her happy and
..and that's
Well, she made us happy,
too. She really did.
REAR DOOR OPENS
So, where to?
I could be hungry.
You could? Mm. Well,
that's shocking.
That's a great idea. Um
..the Italian place
by the library?
Yeah. Good.
Music? You want some music?
Oh. I, er
Your dongle, it's,
uh it's busted.
You broke my dongle?
Yeah. Yeah, I snapped it.
I snapped it in anger.
Well, shall I sing
something, then?
KATIE CHUCKLES
Uh I've got my music.
Oh, she's got her music.
Let's hear it,
then. All right.
MUSIC: 20/20 by Rimon
Whoa, whoa Woo, ooh
Whoa, whoa Woo, ooh, ooh
Whoa, hmm
I see your sunlight through
the window, it's magic, uh
My thoughts and body were
just caught by this traffic, uh
You watched time pass while
I kept myself distracted, uh
Will you forgive now
that I'm paying attention?
Uh, I see your sunlight through
the window, it's magic, uh
My thoughts and body were
just caught by this traffic, uh
Where did our time go?
Encounters beautiful
Only you are the one to
break the shackles of my burden
Are the one to show
me glory in the moment
Cannot pay you back
Even if I could, I can
only fall on my knees
Show my gratitude
for your deeds
I see your sunlight through
The window, it's magic, uh
My thoughts and body were just
Caught by this traffic, uh
You watched time pass while
I kept myself distracted. ♪