zhjhbkl0 April 28, 2018

LONDON—A gravely ill toddler at the center of an international controversy over end-of-life care and parental rights died Saturday at a hospital in northwest England, according to his father.

“My gladiator lay down his shield and gained his wings at 02:30,” Alfie Evans’s father, Thomas, wrote on Facebook. “Absolutely heartbroken.”

The case was the latest to raise a web of legal and ethical questions about the state’s role in disputes between hospitals and family members over treatment, and pit U.K. courts against Italian authorities and the Vatican.

The parents of the child, who had a degenerative neurological condition, fought a monthslong battle to stop the hospital where he was being treated from turning off his life support. The parents wanted to take their child for treatment in Italy, where Pope Francis and Italian officials said the parents should have the right to move their son to the Vatican’s children’s hospital. But U.K. doctors said Alfie had little brain function and further treatment would be ineffective and against his best interests.

In Britain, courts have the final say when parents and doctors disagree, and the rights of the child take precedent over parents’ right to decide the best course of action. U.K. High Court Justice Anthony Hayden this week said in a judgment that Alfie’s brain had been so corroded by the disease that it consisted only of water and cerebrospinal fluid, and that there wasn’t a prospect for recovery. The toddler’s life support was withdrawn this week after successive court rulings blocked further medical treatment.

An April 23 handout photo of Alfie Evans at the hospital. Photo: Alfies Army Official/Associated Press

The U.K. judge said Italy’s application for the toddler to go to Italy and granting him citizenship to facilitate the transfer was well-meaning but misconceived. He and his parents had no connection with Italy, and Italian jurisdiction shouldn’t supersede that of a British court, he said.

In his February ruling that treatment should be withdrawn, the judge wrote that the Evans family’s Catholic faith should be considered as a factor in determining the child’s best interests, and he included an extensive quotation from a speech by Pope Francis distinguishing euthanasia from the discontinuance of overzealous care.

According to the Catechism of the Catholic Church, causing death by act or omission to eliminate suffering is murder, but “discontinuing medical procedures that are burdensome, dangerous extraordinary or disproportionate to the expected outcome can be legitimate.”

Pope Francis met with Alfie’s father at the Vatican on April 18 and made several public statements on the case. On Monday, the pope tweeted an appeal that the “suffering of [the child’s] parents may be heard and that their desire to seek new forms of treatment may be granted.”

The Catholic bishops of England and Wales distanced themselves from the Vatican hospital’s offer of treatment and praised the Liverpool hospital, stating that “public criticism of their work is unfounded.” On Wednesday, the Catholic Archbishop of Liverpool told Britain’s Tablet magazine that doctors at the hospital were “doing everything that is humanly possible” for the child.

Less than a year ago, another U.K. case captured international attention after interventions from President Donald Trump and Pope Francis. The parents of Charlie Gard, a terminally ill 11-month-old, had wanted to take their son abroad for experimental treatment, but doctors in British and European courts argued that the brain-damaged baby couldn’t be effectively treated with further medical intervention and that keeping him on life support could be causing him pain. Pope Francis said the parents should be allowed to treat their child until the very end.

In the case of Charlie Gard, the parents ultimately gave up their fight to take the baby to the U.S. for experimental therapy to prolong his life, saying there wasn’t a realistic chance of saving him.

Write to Jenny Gross at jenny.gross@wsj.com and Francis X. Rocca at francis.rocca@wsj.com

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