Archie Battersbee thread 5

[henryhihat]

New thread...

Understand your point Accross

They do have to put it bluntly I think. Many years ago, I got a call at work from my poor distraught sister and found out that Dad had had a heart attack a few hours earlier. He had been socialising with a load of medics and fortunately/unfortunately they got him breathing again at 10 minutes. The consultant wanted to speak to me (and only me) as eldest child/NOK.

When I made contact 15 minutes later, she spelled out exactly what was going on, that he had no hope of recovery and they needed to disconnect from life support. She was very, very direct. Once she realised that I completely accepted the situation she became much warmer and said if I needed to get there it would be OK. I was 6/7 hours drive away and I didn't want to prolong it (she said he was showing signs of distress) so I didn't, although my brother and sister who were closer did. I've never doubted for a second that I did the best thing for Dad.

My thoughts are with everyone else who has been in a similar situation, especially the parents of children

It obviously isn't in his best interests to be moved anywhere, but his mum is obviously feeling like the hospital is a negative and toxic space and if she has any control left over the situation she must feel she should be able to choose where he dies.

If the hospice is refused, i wonder if they could arrange hospice at home type care but within the hospital, have hospice staff supporting the family and have neutral/different medical staff actually carrying out the treatment withdrawal. Just anything to make the situation a little less toxic for all involved.

It's a truly horrendous situation that shouldn't have been played out for this long. The tiny soul needs to be laid to rest, not plastered all over the news, there is nothing dignified about any of it.

DFA (Dignity For All) are asking about VT ( Ventricular Tachycardia)

So there's a strong possibility he could have a cardiac arrest and pass as his Mother calls "at the Will of God"

I'm not sure what qualifications hospice staff have with regards actually having any input in his current medical needs.

I wouldn't imagine from my experience even their qualified nurses can make and draw up infusions or be qualified to withdraw them.

I do think it would be good to have hospice staff there and maybe even allow the family some choice over the staff who withdraw. Although whether that's fair on staff is another with I am question.

Ethical question even

Haven't seen that! What does that all mean?

She would very likely break a few ribs if she tried chest compressions with the mouth to mouth.

I wonder if anyone has pointed that out to her

I think the below statement from the bbc article has clinched this case once and for all:
The Christian Legal Centre, which supports the family, said the application, submitted on Thursday morning, asked for Archie to be moved to a hospice and for palliative oxygen to be given once his ventilator is removed.

it’s going to be a clear-cut refusal based on that statement.

There will be no palliative oxygen because there will be no breathing.

The CLC have I think clinched this one finally and seen to it that this is at an end.

DFA don’t seem any better than CLC IMO.

How on earth do they know whether Archie is in VT? Holly certainly isn’t going to have given them that information.

I’m assuming he’s being treated by the NHS not privately. When our children our dying we including our ambulance service will go out our way to get them into the place where they and their parents want them to die (usually their own homes) and but this is different from transferring a critically unwell child these are transferred by a paediatric specialist team which NHS not private they would lack the necessary expertise. If the staff looking after him thought it was in his best interest and realistic to transfer him to a hospice I have absolutely no doubt that they would move heaven and earth to get him there but I think very sadly in Archie’s case it’s not realistic. I also suspect that the relationship beteeen staff and patients has broken down so badly that sadly parents are not listening to the medical staff and/or trusting what they say.
Please don’t underestimate the effects this case has on staff over the years I have been involved in many children who have sadly died I never forget them, we are in a privileged position we are paid to literally care for children and their families often at the worst times in their lives and this is a very special thing to do by the nature of the job we become emotionally involved and this takes a toll on us this case will take a huge emotional on all the staff who’ve cared for Archie.

Haven't seen that! What does that all mean?

Unknown. The DFA admin posted the question.

There's no way of knowing if this is in response to information about Archie's condition and frankly, if it is they shouldn't be making it public.

It's a hard thing to hear CPL593H and I am sure some Drs are better than others at delivering the message .
My Dad' consultant told me (over the phone) very straight but with much sympathy and kindness that my Dad was on EoLC. When I asked "how long" he said "Well I don't expect him to last the weekend" (it was a Fri afternoon)

As it happened my Dad being a tenacious little demon, he hung on till Wed lunch !
But even expecting it ( he was 83 and admitted via A&E) its still a shock .

I wasn't suggesting there was doubt in this case, just pointing out that doctors can actually do the wrong thing, sometimes deliberately. I wonder how Ian Paterson's patients feel about the unnecessary mastectomies he performed, the worry, the chemo. This case has gone too far but I don't think it is wrong to question HCPs.

With my mother I'm not sure if she made the suggestion to the nurse, they came from the same country and would chat when my mother was able to and my mother wouldn't have wanted it to drag on. Still not for the nurse to do but we never raised it with anyone for the reasons above.

I wonder when the high court will give their decision? I hope they tie up any loose ends in their order so that there are no more avenues to exhaust so that Archie can be at peace and his family can start to grieve properly instead of being in limbo.

The palliative doctors and nurses at the hospital will be tainted to her as they are part of the hospital.

I think the hospice will have more than one doctor, the one where my MIL died certainly did.

I don’t think that would work. As I’ve learned from others on this thread and previous iterations of it (thanks nolongersurprised !), clinicians have a strict code of practice for diagnosing brain stem death. It involves doing the prescribed series of tests that couldn’t be done on Archie. No doctor was willing to diagnose brain stem death and pronounce Archie to be dead based on the scans, because their code of practice on this is very clear.

Mrs Justice Arbuthnot (“the lady judge!”) declared Archie to have died based on the scans, and this was overturned on appeal essentially by agreement of all parties, but the reasoning is that courts should not diagnose death where doctors will not. This has got to be right because the court is entirely dependent on doctors’ evidence in making such decisions. It would be relatively far reaching for a court to extend where death can be diagnosed when the medical bodies which exist to regulate such matters have not.

Practical problems with extending how you can diagnose brain stem death to include MRI scans is that they are not available at every hospital. The current tests are capable of being done in almost if not all clinical settings . It could lead to people demanding the scans as well as the 6 tests etc. however even if it is a good idea to allow brain stem death to be diagnosed via scans, it should be medical professional bodies that decide this based on a proper review and analysis, not the court because of the unusual facts of this case.

The other thing is that it doesn’t usually present a problem because where the tests can’t be done, most families will accept evidence that their loved one’s brain has not had a blood supply for three months and is rotting as sufficient to agree to withdraw treatment, so the argument doesn’t usually need to be had.

Apologies to the doctors in the thread if I have misunderstood or misrepresented any of the wisdom they have imparted! But that’s what I’ve picked up.

Thinking about it and the request for oxygen etc, it seems clear that Holly is under the impression that once the life support is removed they will have time to spend with Archie. Days even, it doesn’t seem to have occurred to her that death will be instant.

While they will presumably be given time while the infusions are removed etc, the instant the tube is removed it will be over.

So who has given her the idea that there will even be time? Or is she going off previous cases e.g. Alfie Evans and Charlie Gard?

Yes it’s inappropriate because it’s clearly intended to imply something. If it was a genuine query it is easily googled.

Joshua Rosenberg suggests that, even if the family does appeal, the hospital may have to go ahead with extubation to comply with their duty to act according to Archie’s best interests.

Screenshot:

“I'm not sure what qualifications hospice staff have with regards actually having any input in his current medical needs.”

As hospice staff deal with End-of-life patients on a daily basis, they are experts in this field and have a great deal of knowledge. I wouldn’t doubt their professionalism and expertise at all.

However, I am surprised a hospice has agreed to take him, considering all the risks in moving him as suggested previously. Unless they consider that the hospitals responsibility.

Joshua Rosenberg suggests that, even if the family does appeal, the hospital may have to go ahead with extubation to comply with their duty to act according to Archie’s best interests.

I sincerely hope they do. Inevitably there would be litigious consequences from the family et al but I like to think the Trust would be bomb proof here.

I would think the greater concern for a hospice other than the circus that will no doubt arrive with the child will be family members interfering with the removal of equipment and attempting to perform cpr. I think the biggest cause of the protracted end has been that although he has gone, his physical body remains and still resembles him. Hence the belief that he is still 'in' there somewhere.

It delays the formal, final end. And enables her to have the last say, to have ‘won’ something. I agree, though. A hospice move absolutely isn’t necessary.