In an opinion piece for the Guardian, Mehrunisha Suleman discusses how clinical teams consider complex ethical decisions in fraught and tragic cases such as 12-year old Archie Battersbee.
When they are brought to hospital, clinical teams will do their utmost to care for and treat a patient if there are any signs of life. The professional duties of clinical teams, their ethical standards and the UK legal system all currently include a presumption in favour of prolonging life.
The questions they would be looking to answer include: what is the extent of the patient’s illness or injury? How is their underlying health? Do they have physical reserves that will help their recovery? How likely are they to recover? If they can recover, what will be their quality of life? If they are unlikely to recover, then what is their current condition? What are the likely benefit and burdens associated with the medical interventions they are currently receiving.
Clinical teams also assess what a patient’s wishes would be and whether they would have a preference for medical intervention being continued or withdrawn. Adults can make their wishes known through advance directives or lasting power of attorney. Children, who are legally unable to avail themselves of such tools, rely on their parents to make decisions on their behalf and to help clinical teams understand what their wishes would be.
In cases where there are disputes between families and clinical teams, and the decision is then referred to the courts the ethical question that is often most pertinent is whether medical intervention should continue.
In the current case of Archie Battersbee, UK courts have once again had to rule on an incredibly fraught case about the withdrawal of life support from a child. These decisions are immensely complex, and often include experts considering information that isn’t in the public domain.
What does need closer inspection is how cases like Archie’s and others that have recently been brought to the courts (those of Charlie Gard, Alfie Evans and Tafida Raqeeb, to name a few) move beyond the sphere of medical decision-making and careful deliberation among healthcare teams, patients and families, to the stark arbitration of our legal system.
The full opinion piece is available to read on the Guardian website.
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