In April 2014, Tania Clarence smothered three of her four children, Olivia, Ben and Max, all of whom had spinal muscular atrophy type 2 (SMA2), at the family home in New Malden (see earlier entry). At trial, she pled guilty to manslaughter due to diminished responsibility and received a hospital order (which means indefinite detention in a psychiatric institution). In March 2015, newspapers were reporting that Clarence had started receiving home leave. This past week, the Kingston and Richmond Safeguarding Children Board published the results of its Serious Case Review (SCA), in which the family was anonymised (exactly why is not clear, given that all of the family’s names, including the surviving daughter’s, are in the public domain), which reveals among other things the mother’s continual failure to co-operate with medical interventions that could have guaranteed the children a longer and healthier life.
The report also alluded to difficulties the couple had relating to medical and social work staff because of their cultural background (they are from South Africa) and class. This prompted an article by Ian Birrell in the Daily Mail, who suggested that the Clarences were “a devoted couple who weren’t trusted to judge what was best for their children with disastrous consequences” and who were “scorned as pushy middle-class parents after rejecting advice from the professionals, leading to a breakdown in their relationship with them”. It’s a quite astonishing piece of self-victimisation, although pretty typical for the Daily Mail, which (like the Telegraph) never shies away from criticising social workers when they interfere in middle-class family life, rather than that of the lower orders.
Reading the SCR report (PDF), I was reminded of another recent case in which a woman had a disabled baby placed with her with a view to adoption and then made plainly bad decisions about her medical care, declining routine checks and monitoring, refusing recommended pain medication and trying to obtain sedation despite it being dangerous, administered oxygen without training and discharged her from hospital against medical advice. Ultimately, the child was returned to foster care and a judge ruled that the would-be adopter “presented a real and serious risk” to the child and “it would not be safe to place a child or vulnerable adult in her care”. When I read of this case, I recognised the woman as someone I used to follow on Twitter. She has told friends that the child died and has “bereaved” on her Twitter profile (one of the many lies she has told, including about me). But removing Tania Clarence’s children despite her persistent obstruction of attempts to guarantee their health was not so easy, because they were her natural children and keeping them together in foster care would have been nigh-on impossible and because doctors, naturally, did not imagine that she had murder in mind.
One of the issues which caused conflict was the family’s (in particular, the mother’s) refusal to allow Olivia, the older girl with SMA, to have a gastrostomy. Birrell agreed with them as he faced pressure to have his disabled daughter fitted with one:
We felt that food was one of her pleasures, as well as a form of communication allowing us to interpret her moods.
Watching her eat chocolate cake with enthusiasm today, I am glad we stuck to our guns. Just as we did when we refused to allow another doctor to place her on a complicated high-fat diet to prove a pet theory on diet and epilepsy.
Of course, it’s wrong to deny a disabled person the pleasure of eating by fitting them with a feeding tube for their carers’ convenience. But a stomach tube doesn’t stop anyone eating by mouth; what it does is allow them to actually be nourished so that they have more energy for other things, which may include eating pleasurable foods like chocolate cake. But the report also reveals that the family refused assistive devices because they clashed with the decor, and refused interventions that would have improved the children’s health because they wanted to give them a “good quality of life” rather than merely prolong it. They were still, clearly, working on the basis that the children were terminally ill and had not faced up to the fact that the children could live long and productive lives, and that they were in it for the long haul as well as the children. It is significant that Tania killed the children after her husband (who the couple agreed would deal with the doctors as regarded major decisions like this) agreed to the gastrostomy and to spinal surgery which was necessary to check their scoliosis.
The doctors knew that SMA type 2 is not a condition that is typically fatal in infancy and that there was no reason for the children to die young, or to be sentenced to a lifetime of severe pain and respiratory problems, just because of their parents’ hard-set ideas or because they did not want to be parents of disabled children. People with SMA are not intellectually impaired and have been known to get degrees and work in skilled and responsible jobs. It is not autism where severe challenging behaviour is often exhibited and the parents could be injured, particularly as the child grows. There are many people who complain that parents of disabled children have to deal with huge numbers of doctors, therapists, social workers, bureaucrats and so on, much as do disabled people themselves, usually to secure care, treatment or assistive equipment such as wheelchairs for themselves or their disabled relatives so they can enjoy a full life, or enjoy their right to family life free of the constraints (or abuse) of institutional life. In this case the criticism is misplaced as the professionals were trying to keep the children alive while their parents appeared intent on letting them die. Kingston, by the way, is the home of Baroness Jane Campbell. The staff would have had experience of SMA type 2.
The complaint that professionals could not deal with them because they were seen as pushy or middle class was a common one (repeated, for example, by another parent in today’s Telegraph, whose children do not have SMA). What the report actually says is that professionals were cowed by their wealth and status and were not as aggressive in protecting the children’s interests from their parents because of that. If everyone is so biased against the white middle classes, why did this woman get such favourable treatment from the ‘justice’ and mental health systems after she killed her children? It’s preposterous. I suspect that if she had been a shouty, inarticulate woman from a council estate with a fake tan, she would be doing a triple life sentence now for murder. It was a miscarriage of justice and a dereliction of duty for the prosecution to accept a plea of diminshed responsibility and not to allow the claim to be tested in open court; it reflects a disdain for the value of the children’s lives and an excessive sympathy for an articulate, well-to-do white woman and, perhaps, a fear of negative publicity from precisely the quarters that are now crying “poor Tania”. Usually a person convicted of manslaughter through diminished responsibility and sentenced to a hospital order stays there for years, sometimes longer than if they had been convicted of murder. Tania Clarence got home leave less than six months into her sentence and less than a year after the crimes; if her ‘mental illness’ cleared up after such a short time, it is possible that it was not so severe as to constitute diminished responsibility in the first place. It is possible to be mentally ill and still culpable.
I’m not a parent, but I know many parents of disabled children and adults and I’m well aware that the role is stressful. However, there are whole forums where that issue can be discussed. In a case like this, where the facts reveal that the perpetrator’s attitude towards their children’s disability and life expectancy may have been as much a factor as stress, if not more so, it is not appropriate to empathise with the perpetrator and not with the victims, who were tiny and defenceless children. The rush to sympathise with the parent that we always see in such cases shows how little value society places on the lives of disabled people, even children; that they are worth less than a parent’s right to a stress-free life or never to feel harassed by doctors or officialdom. There should be an inquiry into the absurdly lenient treatment of Tania Clarence, and the staff at Kingston and Great Ormond Street hospitals that fought valiantly to guarantee Olivia’s, Ben’s and Max’s life and health should be praised, not dismissed as ignorant, interfering busybodies.
(I tried searching for pictures of the children to illustrate this entry. The only one I could find was of the two boys with their father. There seems to be none of Olivia anywhere.)
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