Tough moral challenges behind decision to remove Archie Battersbee's life support, says expert
Archie Battersbee has been comatose ever since being discovered unresponsive in April at his Southend, Essex, home with catastrophic head injuries. First, it was believed to be a 'freak accident' but later, the family suspected that the boy was found in that state because of a dangerous online challenge.
The 12-year-old had been kept on life support at the Royal London Hospital in Whitechapel in east London using a ventilator and medication therapies, but a High Court judge decided that the life support should be withdrawn.
His parents, Hollie Dance and Paul Battersbee, heard the decision of taking him off life support from the European Court of Human Rights on August 4. They had attempted to delay the withdrawal of his ventilator one more time and had battled tirelessly for the judgment to be reversed.
According to Mehrunisha Suleman, director of medical ethics and law education at the Ethox Centre at the University of Oxford, diagnostic professionals, their moral principles, and the UK judicial framework all presently provide an insinuation in favor of extending life. However, following the initial life-saving medical assistance, physicians must evaluate the patient's prognosis.
In an interview with The Guardian, Suleman said, "The questions they would be looking to answer include: what is the extent of the patient's illness or injury? How is their underlying health? Do they have physical reserves that will help their recovery? How likely are they to recover? If they can recover, what will be their quality of life? If they are unlikely to recover, then what is their current condition? What are the likely benefit and burdens associated with the medical interventions they are currently receiving?"
"Clinical teams also assess what a patient's wishes would be and whether they would have a preference for the medical intervention being continued or withdrawn," she added.
According to Suleman, healthcare teams should decide that the ventilator must be turned off only when they believe the person is deceased or when they believe continuing treatment would be unethically damaging.
She stated, "'Best interest' decisions involve delicate deliberations on the patient's condition and are some of the hardest decisions that clinical teams are required to make." Because it can be difficult to determine how much pain an unresponsive patient is experiencing, groups of doctors constantly watch scans and tests, often for months.
"Such consideration and careful titration reveal medicine more as an art than a science. There is no litmus test or easy read-out of what to do when a patient is unconscious and requires artificial means to stay alive. In the case of children, in the UK, 'best interests' decisions are weighted even more heavily towards sustaining life," Suleman said.
She added, "As such, a decision to withdraw intervention from a child is likely to rely very heavily on a clinical team's judgment of such intervention being harmful and providing no chance of enabling a life through unsupported means."
The Archie Battersbee case serves as an example of how difficult and tragic keeping unresponsive patients on life support can be and how choosing the best moral route of conduct could be quite challenging for people concerned.