Archie Battersbee - Thread 3

[BongoJim]

Follow on from previous full thread

www.mumsnet.com/talk/in_the_news/4596573-archie-battersebee-case-thread-2?page=1

But if doctors are allowed to conduct a brain stem test without needing consent from family, at a time they feel it should be done, a court has far better information to make a proper decision at a much earlier stage than we are now

with maybe a protocol around when this rule could be invoked. Such as specific clinical criteria and a second opinion

What I don't understand, and what probably hasn't helped the family come to any acceptance, is why it's been reported on in a such a "neutral" (struggling to find the right word here) fashion in the media?

Archie is regularly referred to as "brain damaged" or in a "coma" - massively minimising the fact he is brain stem dead. Hollie is quoted as saying he will recover, there are therapies that could help, he's going to be euthanised/murdered etc, without any pushback from interviewers or corrections in articles.

If I was someone who knew nothing about the case, I would also think he should have more time, based on this alone.

There was a case recently which was mentioned by Hollie as another case of hopsital plating god etc at the time. Was of a girl who was declared brain dead,mum wasn't going to accept it. Hadn't been to court yet not sure if that was likely but she got a independent doctor in who confirmed what was already known and so she let her go.

Maybe if she was allowed someone outside the hopsital she would've accepted it? Or not who knows as from sounds she feels they're all in on it. Know said about 5 doctors have seen and reached the same conclusion but not sure if theyre part of that hopsital or not.

I accept and agree it's not actualy 1%.

I said 1% in response to the 99% quoted in a post replying to mine.

ie: As pp said - in other words - even one case is too many.

Probably because the medical team aren’t arseholes and want to preserve Archie’s right to privacy/dignity

Can I ask a really stupid question?

I keep seeing mention of Archie's heart stopping or him dying at any moment, ie before the machines are turned off. But if the machines are what are keeping him alive, keeping his heart beating, breathing for him and all that, how can that happen?

I'm no medic so I don't understand how all the machines work.

@1blossomtree i was thinking that this morning watching BBC Breakfast.

No one said the word dead.

But as discussed up thread, legally, unbelievably, he isn't dead. So they can't say it.

The reporting this morning was very stilted. They use minimal language.

@Zilla1
The second is that we collectively agree a word for a state that is clearly dead but mechanically supported. Using the words alive or living for someone who is dead is providing a hook for the understandably desperate and for those behind them who may not be acting in good faith.

If a person is described as ‘brain dead’ they are exactly as you describe. They are legally dead. They will never regain consciousness and can only breathe because a machine is doing it for them. Brain dead = dead. A person cannot live if their brain is dead.

Archie’s parents are refusing to believe that he is brain dead. They don’t seem to understand that without the artificial life support which is doing everything for him, he cannot survive.

It is desperately sad.
.

I didn't realise he was depressed I haven't seen his online profile messages.

That's really sad.

MH treatment for adolescents is really lacking.

A ventilator artificially pumps oxygen and air into a patients windpipe into their lungs to keep them going. I'm sure this helps with blood flow in the body as well because the body is still processing oxygen so the heart keeps beating much like someone not on life support breathes normally and their heart beats. You can have heart failure if you breathe normally so no reason your heart won't fail on a ventilator. Thats my very basic understanding of it.

Will look back at the discussion above.
I thought that brain dead = legally dead.

@MsBallen thanks - I think I was under the impression that there was something that was artficially causing his heart to beat, on top of the vent pumping oxygen. Not good at biology!

@EntertainingandFactual i'll see if i can find the bit where we were taking about it.

It's grim.

So yes, legally dead

www.nhs.uk/conditions/brain-death/

Thank you!
I’m confused now! (See my post above!)

The ventilator does not make his heartbeat. His heart will continue to beat as long as its receives oxygenated blood, The ventilator just pushes air in and out of his lungs because he can no longer do that himself.
He is also on vasopressin which forcefully increases his BP by stopping him from peeing out all his body fluids and contracting small blood vessels to increase the amount of blood in the bigger vessels.
If your BP becomes too low, you get reduced blood flow to the heart, brain, kidneys and liver. Reduced blood flow means not enough oxygenated blood to the heart so it dies.
Sometimes there comes a point where the body no longer responds to the artificial drugs, once that happens his BP will drop and his heart will give up.
He is also at risk of sepsis due to invasive lines or if his liver fails then clotting disorders meaning he could haemorrhage.

We'd have to have an awful lot of panels to cover every type of condition, and I'm not sure that any doctor would want to pronounce without examining the patient themselves. Which brings us back to what happened in this case, where five different independent doctors reviewed Archie and the evidence, and his parents still didn't accept their views. If the panel's decision then has to go to court, the entire court appeal system would be available and we would have a repeat of what happened in this case.

I do think there probably needs to be a review on the medical side of the protocols around pronouncing brain stem death. I agree that MRI scans should never be routine, but there has to be a way of dealing with this when it is impossible to do the standard tests.

I think it might have been thread 2 ....

The machines aren’t making his heart beat, hearts just beat. They will beat on a tray waiting to be transplanted, heart cells will beat in a Petri dish.

The machines are pushing air into his lungs and forcing oxygen around his body, hearts need oxygen like other body parts so without oxygen for some minutes the heart will stop.

However, other things can make a heart stop, as well as just lack of breathing. Abnormal heart rhythms are one, Archie is at risk of this because his body salts are tricky to manage because of his large fluid losses.

Large fluid losses is another, either blood or, with Archie, from the high volume urine loss that would happen when his medication was stopped. The heart would beat faster to try to compensate but eventually just fail due to the lack of circulating blood volume.

Sepsis does something similar, by lowering blood pressure and slowing the heart from toxins.

Anything that affects the lungs and this oxygen to the organs, a severe pneumonia could kill him, both from the sepsis affect and the damage to the lungs.

I think because of the motivations of the CLC this particular case has become more complex in terms of terminology.

Medically he is brain dead and therefore legally dead. However, because of the situations surrounding permissions and continued decline, he hasn't met the clinical 'requirement' to demonstrate brain stem death - or rather the window during which this would have been possible to prove has now closed. Judge A then felt that additional evidence supported declaration of brain stem death.

This then had to be overturned as a judgement because (I think?) of potential avenues that CLC could take this and then judges reverted to making a decision in "best interests".

So, brain stem death has (legally) now been relegated behind best interests so we're in a paradox where he is brain dead but not brain dead.

Maybe if she was allowed someone outside the hopsital she would've accepted it? Or not who knows as from sounds she feels they're all in on it. Know said about 5 doctors have seen and reached the same conclusion but not sure if theyre part of that hopsital or not.

My understanding is that the second opinions came from doctors in other hospitals.

OK it was thread 2, around the 30/07/2022 15:23 area.

Too dead to test to be dead means he's not dead. But in legal terms.

But then if he's been declared brain dead, and brain dead is legally dead - then he IS legally dead?!

@myrtleWilson ah!

Thank you for managing to explain that!

What could usefully be looked at as a result of this case is the position generally of unregulated legal advisers. The Solicitors' Regulation Authority tried to investigate CLC after the Evans case but could get nowhere because they didn't employ any solicitors. It's a wider problem generally - in the SEN world, for instance, there is quite a lot of concern about advisers who simply set themselves up as SEN law experts but who actively harm a child's case because they simply don't know whet they're doing. By contrast, there is a requirement that immigration advisers undergo training and pass various tests so some degree of regulation must be possible.

The problem arises partly because legal aid is so inadequate, but it goes beyond that. The Law Society and Bar Council should perhaps look together at lobbying for some sort of professional regulation system that would cover the activities of organisations like CLC.

He's not legally dead.
The court decision that he was (based on the MRI) was overturned on appeal.

Legally he is in a coma on life support, and that's what the judgements all say.

The doctor's can't check whether he is brain dead or not, the court rejected an alternative way of diagnosing this. So legally he is still alive.