12-year-old on life support raises questions about who decides life and death

On April 7, Hollie Dance returned to her home in Essex, UK, to find her 12-year-old son Archie Battersbee unconscious with a bandage on his head.

She believes the boy was participating in an online challenge, but there’s no way to know for sure as Archie never regained consciousness.

In fact, his doctors say the boy, a keen gymnast and a boxer passionate about mixed martial arts, has suffered a catastrophic brain injury and has no chance of recovery.

They suggested ending the treatment that now keeps Archie’s heart beating, but the boy’s parents are fighting doctors’ advice, demanding that their son be kept on a ventilator and feeding tube.

Disagreements between doctors and patients’ families are rare when it comes to deciding whether to end life support for children, and the Archie Battersbee case has sparked a debate over who has the right to make these extremely difficult decisions and how we distinguish death from death. life .

How to decide when to end life support?

“The medical profession has a professional, ethical and legal duty to treat patients in their best interests,” Mark Bratton, an expert in medical ethics and law teaching at the University of Warwick School of Medicine, told Euronews Next.

“And the courts have defined best interests too broadly to include a person’s well-being, which is not just a medical issue, but also a psychological, emotional, and even spiritual issue.

“When patients can decide for themselves, there is no problem because the patient makes a decision and the doctors have to treat them in their best interest. In the case of children, it is complicated by the fact that parents are deeply involved – as they should be – and parents are considered good judges of their children’s best interests, and therefore much weight is given to parents’ opinions. But parental rights are not absolute.”

In the case of Archie Battersbee, the doctors’ decision collides with the boy’s parents’ choice to give their son more time. So, who decides in this case?

A ‘neutral arbitrator’: judicial courts

“Where there is an impasse, the only way to resolve the disagreement is to take the case to court, which, as a neutral arbitrator, focuses solely on the best interest of the patient,” Bratton said.

In Archie’s case, all court hearings so far have concluded that life-sustaining treatment should be withdrawn because it is not an option in the boy’s best interest to continue with him.

“The life-sustaining treatment poses some sort of harm to Archie because it is so invasive,” said Bratton, who is also the Medical Ethics Adviser to the Bishop of Coventry.

“There is no realistic prospect of recovery. He is catastrophically damaged and it is in his best interest to remove the ventilation,” she added.

“In the first Supreme Court judgment, which was decided by Ms. Judge Arbuthnot, she found that Archie’s mother, Holly Dance, in particular, was taking an unrealistic view of her condition.

“All the judges were very supportive of the plight of Archie’s family. It’s unimaginable. And they can only express the deepest sympathy. But at the end of the day, they have a very clear legal principle to follow and apply. And for all judges in all court cases that point in one direction, this life-supporting treatment must be withdrawn.”

Prolong life or prolong death?

Archie’s case has raised a deeply uncomfortable and disturbing question: is the boy alive or is he already dead?

Death and life seem to be quite defined, opposite terms, and even in medicine, the concepts are not so clearly – or unanimously – defined.

“It’s not just a matter of medical expertise, it’s also a matter of good ethical judgment,” Bratton said. “How do you distinguish between prolonging life or prolonging death?”

In the UK, death is defined as when someone is recognized as being brain dead. But in Archie’s case, despite the boy being unconscious and claiming to be unable to one day recover from a catastrophic lack of oxygen in his brain, this diagnosis could not be clarified.

“One of the complexities of the Archie Battersbee case, which was reflected in the first Supreme Court judgment, is the definition of death,” Bratton said.

“Now, in our jurisdiction, this is not an issue dictated by law, but dictated by long-standing medical practice. You are considered dead if the various criteria for diagnosing brainstem death are met.

“The difficulty in Archie Battersbee’s case is that, for various reasons, they could not apply the diagnostic test for brainstem death. Judge Arbuthnot ruled that despite his inability to apply this test, the preponderance of medical evidence suggested a preponderant degree of probability that he was likely, in fact, brain dead,” added Bratton.

“That was the first part. But she then went on to say that if he is not, in fact, brain dead, then his best interests dictate that life-sustaining treatment should be withdrawn. This was appealed to the Court of Appeal, and the Court of Appeal said that she was wrong to make this determination of brainstem death given her lack of ability to apply the necessary diagnostic test.”

According to court reports, Judge Arbuthnot found that Archie died at noon on May 31, 2022, shortly after MRI scans performed the same day led doctors to conclude that the boy’s brainstem function had failed. irreversibly stopped.

“But as she had not applied the correct standard of evidence, which they felt should be beyond a reasonable doubt and not in the balance of probabilities, the result was that they referred the case back to the Supreme Court for reconsideration, but under the jurisdiction of a different judge, Mr. Judge Heydon,” Bratton said.

In this appeal case, Judge Heydon also ruled that doctors could legally end Archie’s life-support treatment in the boy’s best interests, mentioning how his lack of brain activity was causing some of his other organs to fail and saying that the boy in the hospital bed was no longer the same excited boy in the photos before his injury shared by the media.

“You have this ethical complexity,” says Bratton.

“Whether you’re prolonging life or prolonging death. Now Archie’s mother believes there is room to prolong his life because she believes, contrary to the great weight of medical evidence, that Archie’s condition is stable and therefore there is room to wait and see.

“But medical experts are saying that it is not stable and that he will inevitably die, sooner or later – and later, not much later. Because his body is basically shutting down.”

The withdrawal of Archie’s treatment was supposed to happen on Wednesday morning, but was again delayed by a new appeal from Archie’s parents to keep him “alive”, an appeal made this time to the European Court of Human Rights.

However, on Wednesday night, the court refused to hear the casesaying that it “would interfere with national court decisions to allow (Archie’s) life-support withdrawal to continue.”

“It’s all very disturbing, and a person’s heart can only go to the parents in the face of a terrible situation, which you don’t wish on anyone. But of course, when you’re in that situation, you’re not necessarily in a position to look at things objectively,” Bratton said.

“And there are mechanisms in society for neutral decision-making that, while taking into account the feelings of all parties involved, focus on the central question, which is: what is in Archie’s best interest to do? ”

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