A severely brain-damaged child at the centre of a right-to-life legal fight has a tolerable quality of life, is able to feel pleasure and has "a good smile", her consultant told the High Court yesterday.
Giving evidence at the start of a fresh review of her case, Charlotte Wyatt's doctor said it was "remarkable" that she had beaten a 5 per cent chance of survival.
The consultant, who can only be referred to as Dr K, said that a major respiratory infection and collapse was the most likely condition which might precipitate a crisis.
His concern was over whether agreement could be reached with 23-month-old Charlotte's parents on treatment should such a crisis occur.
Mr Justice Hedley, sitting in London, is being urged by devout Christians Darren Wyatt, aged 33, and his wife Debbie, aged 24, who is heavily pregnant with their fourth child, to discharge a "non-ventilation" declaration he made in October 2004.
The order means that doctors would not be acting unlawfully if they decided not to ventilate Charlotte artificially in a life-threatening situation after concluding that it would not be in her best interests to do so.
Mr and Mrs Wyatt say that the condition of their daughter has improved to such an extent that she has now "crossed an invisible line", meaning that the use of artificial ventilation in certain circumstances would be justified.
They argue that her life is not intolerable and that ventilation which saved her life and could maintain her current state was in her best interests.
Dr K said: "Charlotte has a tolerable quality of life now and I believe she feels pleasure.
"She has a good smile. That is significant. While all this is going on we are very pleased that she isn't suffering in any way. That's fantastic."
Although Charlotte still had very severe chronic lung disease, her chances of getting through this winter were much improved.
The Wyatt's counsel, David Wolfe, told the judge that "the overwhelming medical consensus is that there are situations in which it would be appropriate to ventilate her if she needed it".
He argued that last year's order " can no longer stand" and told the judge: "Debbie and Darren are content for the court to make a declaration that in the very unlikely event of her suffering a cardiac arrest it would be lawful for doctors not to ventilate her; but no wider than that."
Despite the gloomy prognosis last year, Charlotte, who is two on October 21, survived against the odds and medical opinion and is said to have made "remarkable progress" despite serious brain, lung and kidney damage.
She weighed just one pound and was only five inches long when she was born three months prematurely in October 2003 at St Mary's Hospital in Portsmouth.
Medical opinion accepted by Mr Justice Hedley when he made his order last year, and when he continued it in April this year, was that it was not in Charlotte's best interests to be ventilated if she contracted an infection or suffered some other crisis which was likely to lead to her death and which could not be treated by drugs.
He heard that doctors thought the process of ventilation might itself kill Charlotte and deprive her of a peaceful death in the arms of her parents and that, even if she survived it, the process would be painful and would not result in any improvement in her underlying condition - and might make it worse.
The judge ruled that in the event of respiratory collapse, all treatment up to but not including intubation and ventilation would be in Charlotte's best interests "but nothing further".
However, he stressed that the order remained subject to review.
In August the Court of Appeal rejected an appeal by Charlotte's parents over his April decision to continue his order.
Dr K said that his concern was over circumstances in which the parents would very much want ventilation while the medical staff would feel they were going to inflict a futile treatment that was not in Charlotte's best interests.
His position was that without a court declaration he would not feel able to refuse ventilation in almost any circumstances.
The hearing continues.