![]() He has been examined by several doctors and the evidence has been carefully evaluated in court. He has suffered devastating brain damage, including very severe damage to his brain stem.Įven if life-support measures were continued, there is sadly no prospect of Archie regaining consciousness or the ability to breathe. The rules set out by the code of practice in the UK allow for testing, including MRIs to be used in difficult cases. Can we be confident that he has irreversibly lost the capacity for breathing and consciousness? That is the key question in the UK. The first question is whether he is legally dead. There are two ethical questions that we might ask about cases like that of Archie. PA Images / Alamy Stock Photo Ethical questions The scans also showed visible evidence of necrosis (death) of part of the brain stem.Įlectric tracings of the brain showed no activity on April 14 and 20.Īrchie Battersbee’s mother, Hollie Dance, (centre-left) after speaking outside the Royal London Hospital in Whitechapel, east London. This was also seen in a repeat CT scan of the brain on May 11 and in another MRI on May 31. On April 15, a magnetic resonance angiogram showed no blood flow in any of the blood vessels in the brain. In Archie’s case, he had repeated brain scans. Or they may show an absence of electrical activity. These extra tests may, for example, show that the blood supply to the brain has stopped (if there is no blood going to the brain, there is no possibility of brain function). But the code of practice allows other tests to be used where standard testing is not possible. ![]() The UK doctors who examined Archie could not diagnose brain death in the usual way. In Archie’s case, brain stem testing, according to the UK code of practice, was not possible because when he was tested with a “peripheral nerve stimulator”, his muscles did not respond. And they shouldn’t be receiving any medicines that would sedate them or stop them from moving. For example, the patient’s body temperature must be above 34℃. But they also include rules and procedures to make sure that no conditions present might alter the results of brain stem tests. Those involve careful testing of reflexes that arise from the brain stem. There are strict medical criteria that are used for testing patients in intensive care suspected of being brain dead. When doctors observed this in the 1960s (at the start of modern intensive care), that led to the recognition of the concept of “ brain death”. Breathing machines in intensive care can sometimes keep the body going, even when this has happened. ![]() But if the brain develops very severe swelling, parts of the upper brain can end up squashing and destroying the brain stem. Patients can have severe brain damage without damage to the brain stem. It contains crucial nerve centres for controlling basic functions, including those that control breathing and awareness. The brain stem is an area at the junction of the brain and the spinal cord. Doctors can diagnose a patient as having died either where the patient’s heartbeat and breathing have stopped, or where there is evidence of irreversible cessation of brain stem functioning. ![]() It defines death as the irreversible loss of both the capacity for consciousness and the capacity to breathe. Instead, the diagnosis of death is made by doctors based on a code of practice. In the UK, there are no laws that say what death is or how it should be determined. The judge relied in part on a test (an MRI brain scan) that is not usually used. However, one difference in Archie’s case is that the standard tests for brain death were not possible. In the UK, courts have always concluded that treatment should stop. There have been other cases where parents or family members have not accepted a medical diagnosis of brain death. His parents disagree and are planning an appeal. On Monday, Mrs Justice Arbuthnot concluded that Archie was brain dead and that treatment should cease. 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. ![]()
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