Alfie Evans' parents lost their appeal to take their terminally ill 23-month-old boy to Italy to continue life support against the wishes of his doctors and judges, Britain's Court of Appeal ruled Wednesday.
Doctors say the toddler suffers from a degenerative neurological condition that has left him in a "semi-vegetative state" with almost no brain function. Medics caring for him at Alder Hey Children's Hospital in Liverpool have said further treatment is futile, and the toddler's life support was withdrawn Monday after a series of court rulings sided with the doctors and blocked further medical treatment.
Alfie's parents continued their fight to take him to Italy to be cared for at the Vatican's children's hospital, which has said it is willing to take him.
Three Court of Appeal judges rejected the parents' latest legal bid on Wednesday. Judge Andrew McFarlane said nothing had changed since a previous court ruling that Alfie's treatment should end.
High Court Justice Anthony Hayden dismissed the parents' case on Tuesday, and said his ruling represented "the final chapter in the life of this extraordinary little boy."
It wasn't immediately clear whether Alfie's parents would seek another appeal.
The months-long legal battle between Alfie's parents, backed by a Christian pressure group, and his doctors has drawn interventions from the pope and Italian authorities, who support the parents' desire to have their son treated in Italy.
Paul Diamond, attorney for Alfie's father Tom Evans, said Evans accepted that his son would die but wanted palliative care in line with his Catholic faith.
Alfie's father says the boy has continued to survive with no assistance after life support was withdrawn, and that doctors had subsequently resumed providing oxygen and hydration. On Wednesday he said Alfie was being given food again after 36 hours without it.
"Alfie is doing still as well as he can. He's fighting," Evans told ITV television.
A lawyer for Alfie's mother Kate James told the court Wednesday that the child was "struggling" and needed immediate intervention if he is to survive much longer.
Doctors say it is hard to estimate how long Alfie will live without life support, but that there is no chance he will get better.
Under British law, it is common for courts to intervene when parents and doctors disagree on the treatment of a child. In such cases, the rights of the child take primacy over the parents' right to decide what's best for their offspring.
Emotions have run high over the case, with a band of supporters known as "Alfie's Army" protesting regularly outside the hospital, at times trying to storm the entrance.
The hospital increased its security, and police said they were monitoring social media posts about the case for malicious communications.
McFarlane, the judge, said Tom Evans had attempted to bring a private prosecution for conspiracy to murder against three of Alfie's doctors.
Diamond said Alfie shouldn't be "kept prisoner" since there is "alternative" care for him.
"We submit there is a likelihood of Alfie having some pleasure in life," he said. "That is beyond our knowledge."
Judge Eleanor King retorted that the evidence did not show this was the case.
"The evidence is that he is unlikely to have pain, but that tragically everything that would allow him to have some appreciation of life, or even the mere touch of his mother, has been destroyed irrevocably," she said.
Alfie's case has drawn international attention, with officials in largely Catholic Poland and Italy implicitly criticizing Britain's courts and state-run National Health Service.
Polish President Andrzej Duda tweeted Wednesday that "Alfie Evans must be saved!"
"His brave little body has proved again that the miracle of life can be stronger than death," the president wrote on Twitter. "Perhaps all that's needed is some goodwill on the part of decision makers. Alfie, we pray for you and your recovery!"
Pope Francis has met Alfie's father and made appeals for the boy's parents' wishes to be heeded, saying only God can decide who dies.
Italy has a military plane on standby to transport Alfie to Rome if the courts allow it. Alfie has also been granted Italian citizenship to facilitate his arrival and transport.
About 100 supporters gathered outside the hospital. Some tied blue and purple balloons to trees.
Alder Hey hospital chairman David Henshaw and chief executive Louise Shepherd issued an open letter defending the staff from a "barrage" of abuse.
"We have endured attacks upon our motivation, our professionalism and our ethics. It has been a very difficult time," they said in a statement. "Having to carry on our usual day to day work in a hospital that has required a significant police presence just to keep our patients, staff and visitors safe is completely unacceptable."
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