Despite discordance between physicians and family members regarding prognosis in brain injury patients, Archie’s case is exceptional, a palliative care expert argues.
Conflicts between families and medical teams are not uncommon in palliative care settings.
However, in Archie Battersbee’s case, his parents had battled through the courts to continue his life-sustaining treatment after he suffered a catastrophic brain injury in April.
He was found unresponsive at home with a ligature around his neck. The clinical team at Barts Health NHS trust gave him round-the-clock intensive care to support vital functions in favour of prolonging life, but he never regained consciousness.
Once the scans showed the irreversible brain damage, the medical team concluded that prolonging treatment was no longer in Archie’s best interests. Doctors said that Archie was brain-stem dead, and therefore could not survive without life support.
His parents, on the other hand, believed he could recover and took Barts to court.
“The disagreement between the family and the medical team happens due to a lack of communication,” says Dr Ollie Minton, Macmillan consultant and honorary senior lecturer in palliative medicine.
“It comes down to how that decision could have been arrived at easily, but clearly, the clinical team would not have reached this decision lightly.”
Although evidence suggests that discordance is common between physicians and family members regarding brain injury patients’ likelihood of recovering, Minton says that cases like Archie’s are rare.
“This is an exceptional case, not the rule. Most disagreements are resolved within a second opinion and where there’s a clear falling out between what the clinical team and what the family wants, most of the time we use mediation.
“Generally, agreement with mediation should be resolved locally without using the legal system where possible. It’s very sad that [in this case] the legal team got involved.”
The prospect of moving the 12-year-old to a hospice was soon dismissed after Archie’s parents lost a High Court bid.
“Although it may sound plausible on one level, within the slightest bit of knowledge, you just know that you couldn’t have moved him,” Dr Minton says.
“It is possible to move people [with brain injury] from intensive care to a hospice, but it clearly wasn’t in his case. He was too clinically unstable and completely dependent on intensive care to be moved.”
After a four-month legal battle, Archie’s life support was withdrawn after the European Court of Human Rights refused to intervene, following multiple hearings at the Court of Appeal and the Supreme Court in the UK.
The inquest which opened on Friday at Essex Coroner’s Court heard that the cause of death was “catastrophic hypoxic ischaemic brain injury secondary to strangulation”.
Although a grief reaction is inevitable in such cases, Minton thinks that not rushing decisions is an important lessons to learn.
“Repeated communication, repeated meetings and second and third opinions are essential,” the palliative care expert says. “Where there are disagreements it is important to continue to have that dialogue open.
“Most teams will ensure that every aspect of possibility of recovery is covered, but second opinions could significantly minimise ethical dilemmas.”
