Image copyright Kate James Image caption Alfie Evans was taken off life support on Monday evening 
 
 The parents of seriously ill toddler Alfie Evans have launched a further appeal in a bid to take him abroad for treatment. 
 
 A High Court judge said the 23-month-old may be allowed home from Alder Hey Children's Hospital, where his life support was withdrawn. 
 
 But Mr Justice Hayden refused to allow Tom Evans and Kate James to move their son to a hospital in Rome. 
 
 The Court of Appeal judges have retired to consider their decision. 
 
 At the start of the hearing, three senior judges heard Alfie, whose life support was removed on Monday, was "struggling". 
 
 Jason Coppel QC, representing Ms James, said she had told him her son needed "immediate intervention". 
 
 'Clutching at straws' 
 
 Paul Diamond, acting for Mr Evans, told judges he had spoken to his client before the hearing, who had told him to "save my boy". 
 
 "He would leave no stone unturned... He is clutching at straws," he said. 
 
 Mr Diamond argued that there had been a "significant change of circumstances" because Alfie was still breathing after life support treatment stopped on Monday evening. 
 
 He said an "alternative" was available, and a military air ambulance was on standby "at the request of the Pope". 
 
 "We submit there is a likelihood of Alfie having some pleasure in life," Mr Diamond said. 
 
 But appeal judge Lady Justice King disagreed. 
 
 She said evidence showed that, while Alfie was unlikely to feel pain, "tragically everything that would allow him to have some appreciation of life, or even the mere touch of his mother, has been destroyed irrevocably". 
 
 Michael Mylonas QC, for Alder Hey Children's Hospital, said Mr Diamond had accepted "categorically" before the appeal court and before Mr Justice Hayden that "there is no new medical evidence to contradict the evidence" that was before the High Court in February. 
 
 "It was never suggested that death would be instantaneous." 
 
 He said Alfie has previously survived six to 10 days without a ventilator and it has "never been said to [his] family that Alfie would die immediately or before sundown". 
 
 Mr Mylonas said the "tragedy" for the parents was that Alfie looked like a normal child. 
 
 Outside court, two people believed to be German air ambulance staff were escorted from Alder Hey by police. 
 
 They were seen speaking to members of the Evans family. 
 
 Media playback is unsupported on your device Media caption Tom Evans plans to lodge an appeal as Alfie "is not struggling, he is fighting". 
 
 On Tuesday, his parents, backed by the Christian Legal Centre, brought a fresh application for Alfie to be moved from Liverpool to the Vatican-linked Bambino Gesu Hospital in Rome. 
 
 At a further hearing in Manchester, Mr Evans claimed his son had fared "significantly better" than expected after life support was withdrawn, suggesting his health had improved. 
 
 But Mr Justice Hayden rejected this, saying: "The sad truth is that it is not." 
 
 Instead, the judge said, Alfie's continued life was a "shaft of light" and a "special opportunity" for his parents to spend time with him - not the time for more legal manoeuvres. 
 
 He also criticised the "malign hand" of one of the family's advisers, law student Pavel Stroilov, who had, the court heard, been party to Mr Evans lodging a private prosecution of Alder Hey Hospital doctors, allegedly for murder. 
 
 Media playback is unsupported on your device Media caption BBC News went to meet the people calling themselves 'Alfie's Army' 
 
 He said the hospital had provided "world class" care for the child. 
 
 The best Alfie's parents could hope for, Mr Justice Hayden said, was to "explore" the options of removing him from intensive care either to a ward, a hospice or his home. 
 
 Roger Kiska, from the Christian Legal Centre, told the Victoria Derbyshire programme the judge's comments were "highly inappropriate". 
 
 Mr Kiska said the judge was speaking of "a private prosecution of anyone who delivered medicine, drugs, which would hasten Alfie's death, which is de facto euthanasia and a crime in this country". 
 
 A doctor, who cannot be named for legal reasons, said for Alfie to be allowed home would require a "sea change" in attitude from the child's family. 
 
 He told the court they feared that in the "worst case" they would try to take Alfie abroad. 
 
 Media playback is unsupported on your device Media caption Tom Evans says Alfie has been breathing without support 
 
 The toddler has been in Alder Hey since December 2016 with a rare undiagnosed degenerative neurological condition. 
 
 Medics have said Alfie's brain has been destroyed by his illness, and it is in his best interests to withdraw life support. 
 
 In a statement released after the hearing, Alder Hey Children's Hospital said its "top priority 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." 
 
 Mr Evans and Ms James had hoped Alfie could be taken to the Bambino Gesu Hospital in Rome, which has links to the Vatican, where his care could continue. 
 
 They have lost a series of legal challenges against a High Court ruling in February that Alder Hey could withdraw ventilation. ||||| LONDON -- The parents of a terminally ill British toddler whose case has drawn support from Pope Francis plan to return to the Court of Appeal Wednesday in hope of winning the right to take him to Italy for treatment. High Court Justice Anthony Hayden on Tuesday rejected what he said was the final appeal by the parents of 23-month-old Alfie Evans, who suffers from a degenerative neurological condition that has left him in a "semi-vegetative state." 
 
 The judge said his ruling "represents the final chapter in the life of this extraordinary little boy." 
 
 But Alfie's parents, who are backed by a Christian pressure group, have been granted a chance to challenge that ruling at the appeals court Wednesday afternoon. 
 
 Getty 
 
 The months-long legal battle between Alfie's parents and his doctors has drawn interventions from the pope and Italian authorities, who support the parents' desire to have their son treated at the Vatican's children's hospital. 
 
 Doctors from Alder Hey Children's Hospital in Liverpool, where Alfie has been treated since December 2016, say he has little brain function and further treatment is futile. The toddler's life support was withdrawn Monday after a series of court rulings blocked further medical treatment. 
 
 Alfie's father Tom Evans said Alfie continued to survive with no assistance, and that doctors had subsequently resumed providing oxygen and hydration. 
 
 The family's lawyer claimed in court Tuesday that Alfie was doing "significantly better" than previously believed. 
 
 But the judge said "the sad truth" is that Alfie's condition had not improved. 
 
 REUTERS/CTV 
 
 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. 
 
 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 sent a military plane to Britain to transport Alfie to Rome if the courts allow it. Alfie has also been granted Italian citizenship to facilitate his arrival and transport. ||||| This is an undated hand out photo of Chris Gard and Connie Yates with their son Charlie Gard provided by the family, at Great Ormond Street Hospital, in London. The president of the United States has... (Associated Press) 
 
 This is an undated hand out photo of Chris Gard and Connie Yates with their son Charlie Gard provided by the family, at Great Ormond Street Hospital, in London. The president of the United States has... (Associated Press) 
 
 LONDON (AP) — A terminally ill British child has attracted the attention of both the president of the United States and the pope. More than 1.3 million pounds ($1.68 million) has been raised to help 11-month-old Charlie Gard travel to America for treatment. 
 
 But little has changed for baby Charlie, who suffers from a rare genetic disease that has left him brain damaged and unable to breathe unaided. The life support he is receiving at a London hospital soon will be turned off over the objections of his parents, who want to take him to the United States for experimental therapy they believe could prolong his life. 
 
 A succession of judges has backed specialists at Great Ormond Street Hospital who say the treatment won't help Charlie and may cause him to suffer. Britain's Supreme Court ruled it's in the boy's best interests to be allowed to die with dignity. The European Court of Human Rights last week rejected an appeal from Charlie's parents, Chris Gard and Connie Yates, exhausting their legal options. 
 
 They have been spending time with Charlie before he is taken off life support. 
 
 By wading into the case in recent days, President Donald Trump and Pope Francis have given Gard and Yates new hope and shined an international spotlight on an ethical debate that pits the rights of parents to decide what's best for their children against the authorities with responsibility for ensuring that people who can't speak for themselves receive the most appropriate care. 
 
 "The world is watching," reads the headline across the top of charliesfight.org, the website dedicated to Charlie's cause. "Two of the most powerful men in the world want to give Charlie Gard his chance." 
 
 Great Ormond Street Hospital said Tuesday there were no new updates in Charlie's care. 
 
 Trump tweeted Monday that he would be "delighted" to help Charlie, who is suffering from mitochondrial depletion syndrome, which causes progressive muscle weakness. The president's comment came after Pope Francis issued a statement saying the parents' rights to treat their son "until the end" should be respected. 
 
 The Vatican children's hospital studied whether it was possible for Great Ormond Street to transfer Charlie to Rome. But Bambino Gesu hospital President Mariella Enoc said she was informed that the board of the London hospital said Charlie cannot be moved for legal reasons. 
 
 However, the matter was still being examined Tuesday. 
 
 "I was contacted by the mother, who is a very determined and decisive person and doesn't want to be stopped by anything," Enoc told reporters. 
 
 Vatican Secretary of State Cardinal Pietro Parolin has said the Holy See will do everything it can to overcome legal obstacles to bringing Charlie to Bambino Gesu for treatment. 
 
 "Overcome these problems? If we can do it, we will do it," Parolin said. 
 
 The fight over keeping Charlie alive is not about money. Charlie's parents have used a crowdfunding website to raise the money needed to pay for his treatment in the U.S. Instead, it revolves around an ethical debate about what's best for the child. 
 
 Under British law, it is normal for courts to intervene when parents and doctors disagree on the treatment of a child — such as cases where a parent's religious beliefs prohibit blood transfusions. 
 
 The rights of the child take primacy, rather than the rights of parents to make the call. It is a principle that applies even in cases where parents have an alternative point of view, according to Britain's Court of Appeal. 
 
 And Britain's courts have been consistent in this case. Three courts agreed that the experimental treatment would be futile and may "well cause pain, suffering and distress to Charlie." The parents then took their case to the European Court of Human Rights, which refused to intervene and endorsed the British judges' decision. 
 
 "This was a decision about what is best for this child," said Claire Fenton-Glynn, an academic at the University of Cambridge who studies children's rights. "This is an incredibly difficult decision for the court, and it's not one that the doctors or the court have taken lightly." 
 
 "It's this terrible, terrible situation," she said. "It's a horrible thing to have to decide." 
 
 In the United States, such disputes are normally negotiated between parents and doctors, according to Arthur Caplan, head of the division of bioethics at New York University Langone Medical Center in New York City. A family's ability to afford endless care usually poses a bigger obstacle than ethical disagreements. 
 
 Even the Vatican had difficulty with Charlie's case, as was clear in the conflicting messages that at first came from the Holy See. The pope's top bioethics official initially suggested that while the parents' wishes should be respected, they must also be helped to accept the limits of medicine. 
 
 After an outcry from conservatives, Pope Francis issued a statement of his own, insisting on the need to respect the wishes of the parents to "accompany and treat" their son to the very end. 
 
 Caplan said Charlie's situation is a reminder that medicine and technology can't fix everything, even in wealthy countries with cutting-edge technology. 
 
 "It is a strong belief in the U.S and U.K. that medicine has one more trick up its sleeve," Caplan said. "It's like an article of faith. But it's almost never true at the end of life."
– A UK High Court judge may have deemed his decision Tuesday "the final chapter" in the case of little Alfie Evans, but Alfie's parents aren't ready to accept that ending. The BBC and Guardian report on the court's ruling that the seriously ill 23-month-old—who suffers from a rare degenerative neurological disorder and who was taken off life support Monday—can now return home from Alder Hey Children's Hospital or be placed in hospice, but that his parents, Tom Evans and Kate James, can't bring him to a Rome hospital for further treatment. Although Justice Anthony Hayden described the toddler as "a fighter, resilient, courageous and a warrior," he doesn't think further treatment will make any difference in Alfie's condition and that his parents should take this "special opportunity" to spend time with him, not waste it on what he sees as futile treatment and legal battles. Hayden also rejected claims by Alfie's father that the boy was doing "significantly better" after Alfie was said to have breathed without machinery for 20 hours after being taken off life support. "The brain cannot regenerate itself and there is virtually nothing of his brain left," Hayden argued. Alfie's parents are appealing Hayden's decision and tell the BBC they have an appointment at the appeals court set for Wednesday. They'd like Alfie to receive care at Bambino Gesu Hospital, which has ties to the Vatican. "I'm not giving up because Alfie is breathing away," Evans says. "He is not suffering, he is not struggling; he is fighting." Both Pope Francis and Italian authorities have supported the family's desire to bring Alfie to Rome, with the pope saying "only God can decide who dies," per CBS News. (Alfie's case is reminiscent of that of baby Charlie Gard, who died last summer.)