Press release: Battersbee appeal at European Court declined
Press release: Battersbee final* appeal rejected
by Dominic Wilkinson
In the latest legal hearing, in a long running dispute about treatment for brain-injured 12 year old Archie Battersbee, the Court of Appeal yesterday rejected his family’s request to delay stopping treatment until a UN committee had reviewed his case.
Why was the appeal rejected?
Archie’s parents had previously mounted a series of legal appeals against a decision by Justice Hayden in mid-July that it would be best for Archie to stop the life support machines that are keeping him alive. That included an appeal to the highest court in the UK, the Supreme Court.
Yesterday, the Court of Appeal concluded that it would be wrong to further delay the decision. The UN committee had no legal status in UK law, and therefore would not change the decision about what would be best for Archie.
What is the underlying issue?
Archie sustained profound brain damage from lack of oxygen in early April, when he was found at home with a ligature around his neck. All medical experts who have examined him have agreed that he has absolutely devastating brain damage, from which there is no possibility of recovery. Indeed, the doctors treating him initially believed that the brain damage was so severe that he was brain dead. However, the Court of Appeal in another hearing back in June found that Archie could not be declared brain dead (because the usual testing for brain death was not possible). But even if he is not brain dead, there remains a question about whether it is right to keep him alive.
How common are these disputes?
Tragically, for a small number of children who become critically ill each year, medicine reaches its limits. For children like Archie, doctors cannot make them better, and advanced medical techniques and technologies may end up doing more harm than good. Sometimes, all medicine can do is to prolong the inevitable.
It is entirely understandable that loving parents would struggle to understand or accept this news. Many parents might not initially accept the advice of doctors that it may be best to let their child go.
But in the vast majority of cases, with patience, compassion, careful explanation and empathic support, parents and doctors are able to come together to agree on what would be best for a seriously ill child.
In a small number of cases, medical teams may need external help to reach an agreement. For example, they may draw on a clinical ethics committee, or independent mediation, or may seek second opinions from specialists in other hospitals. In a tiny proportion of cases, if parents and doctors cannot agree what would be best, for a child who is stuck on life support in an intensive care unit, the right thing to do is to ask the court to help. The court in the UK has an important role in resolving disagreements about treatment. The court does not side with either doctors or parents. It focuses exclusively on what would be best for the child (the child’s best interests).
Why all the legal appeals?
The UK legal system allows decisions to be appealed to higher courts. In these cases about treatment for children, it is very rare for higher courts to reach a different decision than the initial judges. In cases, like the Charlie Gard case, or Archie’s case, parents may seek appeals repeatedly in the hope that the court decision will be overturned, or perhaps as a way of buying extra time.
In Archie’s case, it appears that his parents may have run out of options, though it is theoretically possible that they will attempt to appeal again to the Supreme Court, or appeal to the European Court of Human Rights. Even if those appeals do go ahead and delay things further, they are extremely unlikely to change the ultimate decision.
Sadly, the underlying situation for Archie remains unchanged. The best, and only course of action that can help him now, is to let him go.
Press Release: Court of Appeal decision in Dance & Battersbee (respondents/appellants) v Barts Health NHS Trust
by Dominic Wilkinson
Archie is legally alive, and the legal decision about whether it is in his best interests to keep him alive now needs to be revisited in the High Court.
Today, the Court of Appeal made a decision in the case of Archie Battersbee to send the case back to the High Court to examine what should happen next in his medical treatment.
Two questions
There are two separate questions. First, is Archie legally dead. Second, should life support machines continue?
Should Parents be Able to Decline Consent for Brain Death Testing in a Child?
by Dominic Wilkinson
In the recently reported case of Archie Battersbee, a 12 year old boy with severe brain damage from lack of oxygen, a judge declared that he had died on 31st May. This was almost eight weeks after his tragic accident, and five weeks after doctors at his hospital first applied to the court for permission to test him. His parents have appealed the ruling, and the appeal hearing is likely to be heard in the Court of Appeal next week.
If the judgement is correct that Archie is, sadly, legally dead, it is extremely likely that this has been the case for more than a month and potentially now more than two months. One of his doctors testified that in the view of the specialists looking after him it was likely that Archie’s brain stem had died between 8th and 26th April. While it would not be unusual for doctors and families to take a few days to discuss and then proceed with formal testing, this length of delay is extremely unusual in the UK. The delay in making a definite determination in Archie’s case is because his parents declined consent for brain death testing.
But that might lead us to ask: should parents be asked for consent to testing in these cases? Continue reading
Archie Battersbee: How the Court Reached its Conclusion
PA Images / Alamy Stock Photo
Dominic Wilkinson, University of Oxford
London’s high court has heard the tragic case of 12-year-old Archie Battersbee, who suffered severe brain damage after an accident at his home in Southend, Essex, in early April.
On Monday, Mrs Justice Arbuthnot concluded that Archie was brain dead and that treatment should cease. His parents disagree and are planning an appeal.
There have been other cases where parents or family members have not accepted a medical diagnosis of brain death. In the UK, courts have always concluded that treatment should stop. However, one difference in Archie’s case is that the standard tests for brain death were not possible. The judge relied in part on a test (an MRI brain scan) that is not usually used. Continue reading
Cross Post: Is This the End of the Road for Vaccine Mandates in Healthcare?
Written by Dominic Wilkinson, Alberto Giubilini, and Julian Savulescu
The UK government recently announced a dramatic U-turn on the COVID vaccine mandate for healthcare workers, originally scheduled to take effect on April 1 2022. Health or social care staff will no longer need to provide proof of vaccination to stay employed. The reason, as health secretary Sajid Javid made clear, is that “it is no longer proportionate”.
There are several reasons why it was the right decision at this point to scrap the mandate. Most notably, omicron causes less severe disease than other coronavirus variants; many healthcare workers have already had the virus (potentially giving them immunity equivalent to the vaccine); vaccines are not as effective at preventing re-infection and transmission of omicron; and less restrictive alternatives are available (such as personal protective equipment and lateral flow testing of staff). Continue reading
Cross Post: Vaccine Mandates For Healthcare Workers Should Be Scrapped – Omicron Has Changed The Game
Written by Dominic Wilkinson, Jonathan Pugh and Julian Savulescu
Time is running out for National Health Service staff in England who have not had a COVID vaccine. Doctors and nurses have until Thursday, February 3, to have their first jab. If they don’t, they will not be fully immunised by the beginning of April and could be dismissed.
But there are reports this week that the UK government is debating whether to postpone the COVID vaccine mandate for healthcare staff. Would that be the right thing to do?
Vaccine requirements are controversial and have led to worldwide protests. Those in favour have argued that it is necessary and proportionate to protect vulnerable patients by making vaccination a condition of employment for healthcare staff. But critics have argued that vaccine mandates amount to a violation of human rights. Continue reading
Cross Post: Pig’s Heart Transplant: Was David Bennett the Right Person to Receive Groundbreaking Surgery?
Dominic Wilkinson, University of Oxford
The recent world-first heart transplant from a genetically modified pig to a human generated both headlines and ethical questions.
Many of those questions related to the ethics of xenotransplantation. This is the technical term for organ transplants between species. There has been research into this for more than a century, but recent scientific developments involving genetic modifications of animals to stop the organ being rejected appear to make this much more feasible.
Typical questions about xenotransplantation relate to the risks (for example, of transmitting infection), treatment of the animals, and the ethics of genetic modification of animals for this purpose. Continue reading
Cross Post: Why the UK Shouldn’t Introduce Mandatory COVID Vaccination
Written by Julian Savulescu, Dominic Wilkinson, and Jonathan Pugh
As coronavirus infections surge across Europe, and with the threat of the omicron variant looming, countries are imposing increasingly stringent pandemic controls.
In Austria, citizens will be subject to a vaccine mandate in February. In Greece, meanwhile, a vaccine mandate will apply to those 60 and over, starting in mid-January.
Both mandates allow medical exemptions, and the Greek mandate allows exemptions for those who have recently recovered from COVID.
Other countries, including Germany, may soon follow suit, and the European Commission has raised the need to discuss an EU vaccine mandate. In contrast, the UK health secretary, Sajid Javid, has been clear that the UK will not consider a general mandatory vaccination policy. Continue reading
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