Consultant Editor Brian Nyatanga Editor Sean Boyle Group Classified Manager Daniel Doherty Circulation Director Sally Boettcher Associate Publisher, Medical Education Tracy Cowan Production Manager Larry Oakes Publishing Director Andrew Iafrati Managing Director Anthony Kerr Chief Executive Officer Ben Allen Editorial enquiries: email@example.com Sales enquiries: firstname.lastname@example.org Editorial Board AUSTRALIA Donna Drew Clinical Nurse Consultant in Paediatric Oncology and Palliative Care, Sydney Children’s Hospital Jason Mills University of the Sunshine Coast, Queensland Jane Phillips Professor of Palliative Nursing and Director of the Centre for Cardiovascular and Chronic Care, University of Technology, Sydney BELARUS Anna Garchakova Director, Belarusian Children’s Hospice BELGIUM Tine De Vlieger General Coordinator for Palliative Care, University of Antwerp IRELAND Julie Ling CEO of the European Association for Palliative Care, Our Lady’s Hospice, Dublin ITALY Valentina Biagioli Research Fellow in Nursing and Allied Health Professional Development, Continuing Education and Research, Bambino Gesù Children’s Hospital, Rome, and Lecturer, Campus BioMedico University, Rome NORTHERN IRELAND Sonja McIlfatrick Professor of Nursing, University of Ulster SWITZERLAND Philip Larkin Kristian Gerhard Jebsen Chair of Nursing Palliative Care, Professer, Centre hospitalier universitaire vaudois, University of Lausanne
UGANDA Julia Downing Honorary Professor in Palliative Care, Makerere University, Kampala UNITED KINGDOM Bridget Johnston Professor and Florence Nightingale Foundation Chair of Clinical Nursing Practice Research, University of Glasgow and NHS Greater Glasgow and Clyde Daniel Kelly RCN Chair of Nursing Research, Cardiff University Diane Laverty Nurse Consultant in Palliative Care, St Joseph’s Hospice, London Carole Mula Macmillan Nurse Consultant in Palliative Care and Professional Lead Nurse for Division of Clinical Support Services, Christie NHS Foundation Trust, Manchester Brian Nyatanga Senior Lecturer, University of Worcester Julie Skilbeck Senior Lecturer, Sheffield Hallam University Dion Smyth Lecturer-Practitioner in Cancer and Palliative Care, Birmingham City University Anna-Marie Stevens Nurse Consultant in Symptom Control and Palliative Care, Royal Marsden NHS Foundation Trust, London UNITED STATES Jennifer Baird Harvard-Wide Pediatric Health Services Research Fellow, Division of Medicine Critical Care, Boston Children’s Hospital Patricia Berry Professor and Director of Hartford Center of Gerontological Nursing Excellence, Oregon Health and Science University
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The ending of a life
Archie Battersbee, the 12-year-old boy who became the subject of an intense ethical debate surrounding the continuation of life support, had his medical support-system withdrawn on Saturday 6 August 2022. Although his parents sought approval for the continuation of medical treatment from both local courts and the UK’s supreme court, their final appeals were dismissed, as such life-sustaining treatment was deemed to be operating ‘against his best interests’ (Siddique, 2022).
The case draws attention to the complex emotional, religious and ethical discourse that can be interwoven into the fabric of end-of-life care, and highlights how subjective and personal the experience can be for loved ones. Archie’s case incorporated a lengthy court battle between his parents and medical officials at the Royal London Hospital in Whitechapel. The case speaks to the gap between how family members and healthcare professionals can disagree as to what constitutes an individual’s ‘best interests’, what form a ‘good death’ should take and how best to proceed with palliative treatment should an individual who lacks capacity have experienced a serious injury.
As highlighted by Santatzoglou et al (2017), the UK’s health policies and laws surrounding liability and practice in the end-of-life stage have conventionally focused on the criminalisation of euthanasia, rather than the ‘good death’ concept. Although the study explicitly refrains from commenting on whether euthanasia should be legalised or directly equated with a ‘good death’, the authors argue that there needs to be a greater interface between the law, policy and beliefs and wishes of loved ones, to ensure that decision-making is informed, reflective of specific circumstances and humane for all involved. The tension between such factors has been directly exemplified in the case of Archie, whose parents’ legal campaign unswervingly countered the advice of healthcare practitioners and sought to allow Archie the opportunity to die in accordance with their Christian values at a time of ‘god’s choosing’ (Bubola, 2022).
Similarly, Barber (2016) discussed how the ‘ending of a life’ has become an inevitable by-product of contemporary life, as health conditions that can severely impact on quality-of-life, such as stroke, accidents, heart attack and cancers, have become more common. The study identifies the discrepancy between the ending of a life, ‘legality’ and ‘right and wrong’, with the ending of life in some instances, such as abortion or euthanasia, not necessarily considered ‘wrong’ or ‘right’. When viewed in relation to Archie’s case, the tensions between personal morals, practice and medical guidelines are further compounded, as healthcare practitioners at the Royal London Hospital argued that further medicinal treatment would ‘do more harm than good’, while Archie’s parents viewed the doctors’ approach as a ‘choreographed execution’ (Bubola, 2022).
Collectively, the interplay between medical practice and personal morality needs to be explored further in relation to the ending of a life. The provision of a ‘good death’ is a fundamental tenement of palliative care and the concept needs to be continually reaffirmed and re-examined in relation to circumstance, context and social values. IJPN Sean Boyle Editor, International Journal of Palliative Care and Journal of Kidney Care Barber C. Ethics, end of life and end of a life. British Journal of Healthcare Assistants.
2016;10(8):1–4. https://doi.org/10.12968/bjha.2016.10.8.394 Bubola E. Archie Battersbee, gravely ill 12-year-old, dies after removal of life support. The
New York Times. 7 August 2022. tinyurl.com/nytabijpn (accessed 14 August 2022) Siddique H. Archie Battersbee: court refuses to postpone withdrawal of life support. The
Guardian. 1 August 2022. tinyurl.com/absupp (accessed 14 August 2022) Santatzoglou S, Lillie AK, Wrigley A, Ashby S, Read S, Moore A. Law, ethics and end-of-life care: the policy and practice interface in England. International Journal of Palliative Nursing. 2017;23(5):1–5. https://doi.org/10.12968/ijpn.2017.23.5.213
International Journal of Palliative Nursing August 2022, Vol 28, No 8