A High Court judge made the devastating call this evening — but has asked doctors if it is possible to consider letting the 23-month-old tot go home.
Mr Justice Hayden described Alfie as "a fighter" as he raised the possibility of allowing the tot home or to a hospice for parents Tom Evans and Kate James to be with him in his final days.
He earlier told the emergency High Court hearing in Manchester: "If there were a more constructive attitude from the family might other options become possible, away from Alder Hey?", adding that taking Alfie home had been suggested.
But a doctor replied that a "genuine fear" among hospital staff of angry demonstrators supporting Alfie's family would make the move "impossible" at the current time — adding it could take three to five days to put a plan in place.
Alfie's parents have been embroiled in a lengthy battle for their son – who has been in a "semi-vegetative state" for more than a year and is currently only receiving oxygen – to continue getting treatment.
Doctors argued that was is in Alfie's best interest to end his life support — a view consistently backed by the courts.
On Alfie's future care, the judge added: "The options of palliative care are to be discussed with Alfie Evans' parents with the objective of promoting a removal from hospital if possible.
"All this is to be predicated on the premise that the plan is to promote the best options for end of life care."
The judge rejected as "disrespectful the principles of international diplomacy" Italy’s efforts to grant Alfie Italian citizenship so that he could be flown to the Bambino Gesu Children’s Hospital in Rome.
And he slammed some supporters of Alfie’ parents – who were not in court – for giving them "misleading" advice that he said had damaged their relationship with the hospital.
He branded one man a "fanatic" who believed he knew better than the law — and warned the demonstrator had come "perilously" close to being held in contempt of court.
Last night Alfie's life support was switched off following court approval, but medics were left "gobsmacked" that the sick tot had continued to breathe for a further 19 hours before he was given only oxygen.
Alder Hey insisted during today's hearing that doctors had explained that he could survive for hours or even days after his ventilator was withdrawn.
Refusing to accept the case for changing Alfie’s care plan, Mr Justice Hayden said: “There is capacity for something of his brain stem to generate breathing.
“But there is no sense of touch or taste or hearing and the brain remains predominantly water.”
Paul Diamond, representing Alfie's family, argued that it was not in Alfie's best interests to be left at Alder Hey.
He said Alfie should be flown abroad — with an air ambulance gifted by the Italian government ready to take him following support by Pope Francis.
But frustrated at the emotive language used in court by the Evans' barrister, Mr Justice Hayden said: "You do not have the moral high ground in this court".
Responding to the ruling, Alder Hey said: "This evening the High Court again ruled that it is in Alfie's best interests to continue with the end of life care plan developed by the clinical team who have cared for him throughout.
"Our top priority therefore remains in ensuring Alfie receives the care he deserves to ensure his comfort, dignity and privacy are maintained throughout.
"This includes working closely with Kate and Tom as they spend this precious time together with him.
"We would be grateful if respect and consideration is shown to all our staff, patients and families at the hospital at this difficult time."
The hearing today had been seen as a glimmer of hope for the tot's family after they lost their last appeal at the High Court on Monday.
They had pleaded the tot be permitted to travel to Italy for treatment for his degenerative neurological condition which docs have so far been unable to identify.
A spokesperson for the Christian Legal Centre, which has been assisting parents Tom and Kate, said: "Alfie has survived much longer than the doctors predicted, lending support to the request from Alfie's parents for Alfie to be seen by medical experts in Italy."
Dad Tom, 21, said this morning his son is still breathing and fighting against all odds, telling Good Morning Britain: "He is still working, he's doing as good as he can."
The family desperately asked for prayers of support today, saying: "Nearly 19 hours breathing on his own with just oxygen and water. Please please please continue to pray!!"
A hopeful Tom said that it had only taken a few minutes to realise that Alfie was breathing on his own after being taken off life-support last night.
Mum Kate James also shared a photo of her little boy asleep in her arms, writing: "Alfie has been allowed oxygen and water!! How amazing is he.
"No matter what happens he has already proved these doctors wrong. How beautiful does he look."
Tom had initially claimed that staff at Liverpool's Alder Hey Hospital were "refusing" to give Alfie oxygen, saying in a Facebook live video: "Alfie has sustained his life… He is needing oxygen but the hospital won't give him any.
"I don't know what to do. He's not suffering.
"He is losing his colour and his fingers are going slowly blue but he is able to sustain his life."
A heartbreaking picture was also posted on the supporter's Twitter page, Alfie's Army, showing the little boy sleeping peacefully without any tubes.
Alder Hey today begged concerned members of the public to stop calling the hospital for updates.
The hospital later issued a statement saying that "every action and decision is taken in the best interests of the child, and decisions on care, including the withdrawal of treatment, are always made with the involvement of parents."
They added: "We feel it is important for the public to know that decisions to withhold or withdraw treatment from a child are not made lightly."
Supporters had tried to storm the hospital on Monday after Tom accused doctors of murdering him following the ruling by the European human rights judges.
Ranks of police struggled to keep a crowd of hundreds at bay yesterday as emotional Tom vowed to bring private prosecutions against medics who had wanted to withdraw his son's life support.
He told well-wishers: “Doctors need to know they are murdering my son. It’s a straight up clean execution. I won’t stand back and allow you to do this. I’m putting a private prosecution in.”
Tom also claimed he and Alfie's mum Kate James, 20, were being treated like "dogs" and had to sleep on the floor.
Supporters dubbed Alfie's Army have tied balloons outside the hospital
Last week Tom went to the Vatican to meet the Pope — revealing that air ambulances were ready to whisk the toddler for treatment in Italy.
The family had pinned their hopes on receiving support from the Pope, with Alfie yesterday given Italian citizenship.
Pope Francis vowed to give the tot treatment in Rome, tweeting: "Moved by the prayers and immense solidarity shown little Alfie Evans, I renew my appeal that the suffering of his parents may be heard and that their desire to seek new forms of treatment may be granted."
But specialists have maintained that it's kinder to let Alfie, who has a degenerative brain condition, die peacefully.
High Court judge Mr Justice Hayden ruled earlier this year doctors could withdraw life-support, and accepted evidence from Alder Hey specialists that flying Alfie to a foreign hospital would be pointless and wrong.
The ruling was backed by Appeal Court judges, and last week the Supreme Court dismissed a bid to stop medics from withdrawing life support.
On Monday, the European Court of Human Rights said an application by Alfie's family was "inadmissible" and it would not intervene.
ALFIE'S LIFE: The young tot is just 23-months-old but is still fighting for his life
May 9: Alfie is born in Liverpool to parents Tom Evans and Kate James.
December: Alfie is taken to Alder Hey Children's Hospital after suffering seizures. He will spend the next 12 months there.
December 11: The hospital and family disagree over Alfie's treatment, with his parents saying that the hospital applied to the High Court to remove parental rights and withdraw ventilation.
December 19: The High Court case begins with Mr Justice Hayden saying he will make a decision on what is best for Alfie
February 1: A hearing begins at the High Court in Liverpool in which lawyers acting for the hospital claim further treatment for Alfie is unkind and inhumane.
February 2: One of Alfie's doctors tells the judge there is "no hope" for the youngster, who is in a semi-vegetative state from a degenerative neurological condition doctors have not been able to definitively identify.
February 20: Mr Justice Hayden rules in favour of hospital bosses, saying he accepted medical evidence which showed further treatment was futile.
March 1: Three Court of Appeal judges examine the case.
March 6: Court of Appeal judges uphold the decision of Mr Justice Hayden.
March 8: Alfie's parents ask for the case to be considered by Supreme Court justices.
March 20: Supreme Court justices decide the case is not worth arguing and refuse to give the couple permission to mount another appeal.
March 28: The European Court of Human Rights also rejects a request from the family to examine the case
April 16: Alfie's parents argue he is being wrongly "detained" at Alder Hey and make a habeas corpus application. Judges at the Court of Appeal in London rule against them.
April 17: Mr Evans and Ms James ask Supreme Court justices to consider their case for a second time.
April 18: Mr Evans flies to Rome and meets with Pope Francis.
April 20: The Supreme Court rules against Alfie's parents for a second time.
April 23: Alfie is granted Italian citizenship.
His life support is turned off at 9.17pm.
April 24: Alfie is still breathing on his own, according to his father
Judges said yesterday there was "no reason for further delay", adding: "The hospital must be free to do what has been determined to be in Alfie's best interests.
"That is the law in this country. No application to the European Court of Human Rights in Strasbourg can or should change that."
They continued: "Alfie looks like a normal baby, but the unanimous opinion of the doctors who have examined him and the scans of his brain is that almost all of his brain has been destroyed.
"No one knows why. But that it has happened and is continuing to happen cannot be denied.
"It means that Alfie cannot breathe, or eat, or drink without sophisticated medical treatment.
"It also means that there is no hope of his ever getting better."
A spokesperson for Alder Hey today reassured patients and families that the hospital was operating as usual.
The hospital added in a statement: "Alfie’s parents have done everything in their power to do what they think is best for him even though that is contrary to the views of the doctors.
"That has inevitably prolonged the period over which he has been given treatment that was determined in February not to be in his best interests.
"We understand that this decision is very distressing for Alfie’s family at this very difficult time."
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