Archie Case (12): When the courts decide the lives of our children

Dramatic scenes are taking place in London: 12-year-old Archie has been in a coma since April and is now brain dead. He suffered serious brain injuries in an accident at his home in Southend-on-Sea, possibly during an internet dare. The doctors who treated him proved brain dead and therefore see no chance of recovery – they want to end life-sustaining procedures. His parents, Holly and Paul, fight to keep them.

What is Archie’s case?

The parents want the 12-year-old to be moved to a death shelter, and filed an application to that effect in London’s High Court on Thursday. However, the hospital resumed treatment. If granted, the machines keeping him alive must be shut down.

Barts Health NHS Trust announced late on Wednesday in London that the parents had until 9:00 am an opportunity to take legal action against the hospital’s decision. Otherwise, life-sustaining measures will be discontinued at 11:00 AM. Parents are arguing right now

The fact that Britain’s highest court decides how to proceed may seem strange in this country. In England, there have already been many such cases in the past, where life-preserving measures have been terminated: for example Alfie (2), for which even Pope Francis campaigned for a cure.

Official UK pediatrician guidelines state that if there is no chance of recovery for the patient and you will only prolong the child’s suffering, the machines may be switched off.

Preserving life: ‘England is woven differently’

“England is woven differently,” says Nicholas Haas, chief of pediatric intensive care at the Hanner Children’s Clinic at LMU’s Grosshadern, in an interview with FOCUS online. There it is entirely possible for courts to decide on the recommendation of medical professionals what is in the best interests of patients. This includes patients with severe and subsequently impaired neurological damage, who are unlikely to recover from still minimal brain function.

However, according to Haas, people who are brain dead are not expected to wake up again because the brain has been irreversibly destroyed. The doctor explains that this can be tested reliably. If it is clear that patients are no longer able to lead a life worth living, life-sustaining measures should not be extended. For example, when a self-designed, happy, pain-free, or complete life is no longer possible.

This is currently the case with Archie as well: he is currently only kept alive by a breathing machine for him. According to “Sky News”, doctors have proven brain death – and therefore they are considering an end to the appropriate measures. You will follow the official instructions by doing so. Children are often escorted through a rehabilitation facility in their last days. In England, according to Haas, very expensive long-term treatment with life support machines, which take over, for example, ventilation of patients, are not planned.

This is how Germany deals with such cases

Haas explains that such cases are handled quite differently in Germany. The doctor appeared in court as an expert witness in a similar case a few years ago. At the time, it was about a seriously ill little boy, the boy Alfie (2). Dealing with parents who find themselves in a hopeless situation is also not easy for clinicians: “How do you handle it when children with disabilities are so dependent on devices, but you still want to enable them to live socially acceptable lives?” In patients who are dependent on care after a serious accident or illness and can no longer interact with their outside world.

In Germany, according to Haas, you should not only legally decide that the patient is no longer living a life worth living and then turn off the machines. This idea is enshrined in Basic Law and ultimately also rooted in Germany’s past: during the Nazi era, National Socialists systematically killed people deemed “unworthy to live” through euthanasia programs. For this reason, one cannot make half-hearted decisions about life and death in Germany today.

“I also said as an expert on the Alfie case in court: Because of our past, we therefore have a different way of dealing with such serious cases,” he continues.

In principle, decisions are always made in teams in Germany. This means that you must involve the parents. “In severely disabled patients who depend on life-sustaining measures, a common method should always be found how to bridge this time to irreversible brain damage or death,” Haas says. Usually, even in these difficult situations, parents are open to arguing in order to find a solution acceptable to all.

When parents in Germany adhere to life-sustaining measures

But even for parents who still stick to life-sustaining measures, a reasonable way must be found, explains the pediatric cardiologist. This is often associated with an unconscious feeling of guilt, for example if the child had an accident and severe brain damage as a result. “Parents in specifically such situations often need time to process this and take this step and make sure it is a hopeless situation, as well as especially for the patient who is no longer a self-limiting existence,” Haas says.

The Pediatric Intensive Care Physician explains that children with severe neurological impairment due to illnesses or accidents who have little chance of getting better are often cared for in rehabilitation facilities. This includes neurological rehabilitation, but also nursing facilities or later possibly palliative care centers especially for children.

There they are installed and set up so that they can also be taken care of at home with the family. “You then have an ICU at home, with the medical staff,” he says. “Most parents who take it upon themselves, after a period of close contact with their children, realize that there is nothing they can really do and they develop an internal willingness to let the child go.”

This very expensive treatment is covered by health insurance in Germany. It is generally accepted that this is also performed outside of hospitals and care facilities. However, in England, this is not planned and also impossible for ordinary patients. The British National Health Service (NHS) is funded solely by tax and is under great pressure. As a result, the NHS tends to withdraw life support much sooner.

“A well-trained network of palliative medicine”

According to the head of the pediatric intensive care department, Germany has a “well-trained network of palliative medicine.” Critically ill and disabled persons with life expectancy should be accompanied and supported as long as possible in order to lead a fulfilling and happy life with their families.

One of the palliative care centers is the Department of Pediatric Palliative Care at the Ludwig Maximilian University Hospital in Munich. Nicholas Haas regularly treats patients from this department there: “These children with severe problems often come to us in the intensive care unit, where it is really clear that the maximum treatment, such as resuscitation measures, is not what families want, and therefore it is not It’s not being carried out. But together with specialists who are very dedicated to palliative care, we’ve found excellent ways to deal with these children.”

Archie’s parents made a final appeal to the European Court of Human Rights in Strasbourg – but the latter refused to intervene in the case on Wednesday evening. Archie’s mother, Holly, was sad. “This is the end,” she told reporters in London. Now they hope he will at least be moved to a hospice.

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