Good morning. On 7 April, Archie Battersbee was 12 years old, and uncomplicatedly alive. He was a talented gymnast, and an enthusiastic follower of mixed martial arts, and he wanted to be baptised. He had a pet rabbit called Simian. He was meant to be going to see Batman that evening.
That day, Archie suffered a catastrophic brain injury. In the months since, whether he is alive has been a devastatingly difficult – and contested – question. His parents, Hollie Dance and Paul Battersbee, say that although he is not conscious he is still alive, and want him to be kept on a ventilator and a feeding tube until he dies a “natural” death.
But doctors and courts have consistently taken a different view. Staff at the Royal London hospital say that because Archie has no prospect of consciousness, and cannot breathe for himself, he has died. A judge concluded that he died at noon on 31 May based on MRI scans that day, and on appeal, another ruled that continuing ventilation was not in his best interests. Yesterday, a last-minute appeal to the supreme court failed. Now the Christian Legal Centre, which is supporting the family, says it is preparing an application to the European court of human rights. If it does not do so by 9am today, treatment will finally be withdrawn at 11am.
Behind the disagreements and technicalities that led to this point are a set of profound questions about what constitutes life, how to decide when it is over, and who can best represent the interests of a child. For today’s newsletter, I’ve spoken to Prof Dominic Wilkinson, director of medical ethics at Oxford University’s Uehiro Centre for Practical Ethics, about how hard those questions are to resolve – and how best to handle them without diminishing the value of the life that everybody wishes could go on. First, here are the headlines.
Five big stories
Taiwan | China said it will begin live fire drills close to Taiwan on Thursday in response to a visit from US House speaker Nancy Pelosi, who said in a press conference with president Tsai Ing-wen that the US is “committed to the security” of the island. Follow the latest on the live blog.
Conservative leadership | Liz Truss suffered a setback in her bid to become the next prime minister as she was forced into a U-turn on civil service pay. Truss claimed there had been “wilful misrepresentation” after it emerged that her promise to save £8.8bn would mean deep cuts for teachers and nurses.
Energy | Bumper profits of nearly £50bn shared by the world’s five biggest oil companies prompted calls for higher taxes on the sector. BP was accused of “unfettered profiteering” after it said underlying profits had tripled to $8.5bn (£6.9bn) between April and June.
Anglicanism | Justin Welby, the archbishop of Canterbury and leader of the Anglican church, sought to mollify conservative bishops around the world by “affirming the validity” of a 1998 declaration that gay sex is a sin. He also indicated he would not seek to discipline churches that conduct same-sex marriage.
Migration | 696 people tried to cross the channel on Monday, a record high for the year. The total number of asylum seekers making this journey across the channel this year is believed to be more than 17,000. Critics of the government used the figures to argue that its Rwanda policy is failing as a deterrent.
In depth: ‘These are the most difficult conversations anybody could have’
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How common are cases like this?
Although cases like those of Charlie Gard, Alta Fixsler and Archie Battersbee understandably draw considerable attention when they reach court, they are exceptional. “It’s quite common for parents to start from a position of disbelief and denial and hoping there’s a different answer,” said Dominic Wilkinson, who is also a consultant neonatologist and author of an acclaimed book on decision-making for critically ill children. “But with patience, compassion and careful communication, the majority realise in a fairly short space of time that the doctors aren’t making it up, that this is the only course available. Disagreements happen, serious disagreements are uncommon, and intractable disagreements are very rare.”
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What should happen when there is disagreement?
It isn’t surprising if parents find it hard to absorb such dreadful news. “These are the most difficult conversations anybody could ever have to have,” said Wilkinson. But there are some things that can help: “To have this conversation with somebody the parents know and trust, ideally. To have private space. To know what the parents’ existing understanding is. To compassionately explain the facts and any uncertainties. To understand from the parents what their priorities are, and what their fears are. And on the basis of all of that, to find a way forward.”
If agreement still cannot be reached, mediators or the view of a clinical ethics committee may help. (The government is said to be considering an expanded role for mediation in the future.) Only when such avenues fail does a court become involved. By this point, there is a chance that relations between hospital and family will be difficult.
“It may help to try to think about the courts not as adversarial, but as another way to try to resolve a very difficult impasse: ‘Because we can’t reach an agreement, we need somebody to help us,’” Wilkinson said. “This impartial third party will hear what you have to say, and what we have to say. We’ll hear experts that we can find, and if you would like experts that you find, we’ll hear them too. And then we’ll absolutely respect whatever the decision is.”
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What is the court’s role?
It’s difficult to read the various judgments in this case and not conclude that judges have tried very hard to keep the value of Archie’s life, and the perspective of his heartbroken parents, central to their thinking.
In one passage, Mrs Justice Arbuthnot wrote of a visit to his bedside. “A lovely looking young boy, Archie seemed very peaceful despite the fact that he was connected to a number of tubes and medical equipment,” she wrote. “From what I know, the mother has hardly left his side in the eight weeks since his accident. I saw the bedside chair which converts into a single bed which she has been sleeping on.” She says that “the devotion of the family is extraordinary, their dignity obvious”, and concludes: “The visit has allowed me to hold Archie in my mind’s eye … He has become much more real to me.”
At the same time, the court is asked to consider Archie’s “best interests”. “It’s not a very helpful term, in some ways,” said Wilkinson. “What anybody is desperately trying to achieve is what’s best for the child. And it is very difficult to come to terms with when it might mean his death.”
As this excellent analysis by the Guardian’s legal affairs correspondent Haroon Siddique sets out, that may be harder still when third parties with their own agendas become involved in the legal process.
Questions over what constitutes death can be complicated; Mehrunisha Suleman writes that they reveal “medicine more as an art than a science”. In this case, the usual test for “brain death” was impossible to conduct. But the evidence presented to the court by the doctors who have examined Archie is that he has no prospect of regaining consciousness or being able to breathe independently. Wilkinson wrote in a blogpost that there “is good reason to think that Archie has indeed died according to the UK code of practice”.
The courts have agreed with Archie’s doctors that, although he is unable to feel pain, his continuing treatment is causing unjustifiable physical deterioration that ultimately threatens his dignity – and, since there is “no hope at all of recovery”, it is not in his best interests to continue. In other words, as Mr Justice Hayden said in the high court: treatment now “serves only to protract his death, whilst being unable to prolong his life”.
His family continue to view this as an imposition of a concept of “dignity in death” which goes against their son’s burgeoning Christian beliefs. “Enforcing it on us and hastening his death for that purpose is profoundly cruel,” Hollie Dance said.
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What happens now?
Unlike other cases such as that of Charlie Gard, the issue here is not whether to attempt a new life-saving treatment, albeit with little chance of success, but whether to withdraw life-sustaining treatment, as the hospital says should happen, or maintain the current course until he dies, in Archie’s parents’ term, a “natural” death. (That word, says Wilkinson, does not have an agreed definition but appears to be “a way for their legal team to frame what the parents are asking for in a way the court might find acceptable.”)
Yesterday, Archie’s life support was due to be withdrawn at midday. That was delayed when the family lodged a supreme court appeal; the family says it will make a last-minute application to the European court of human rights to stop it going ahead at 11am today. Such circumstances can place a considerable burden on the medical professionals involved, and while the court of appeal noted in July that Archie’s mother reported a “brilliant” relationship with nurses, the original June judgment said that those “who have 24-hour care of Archie who have found the recent weeks an ethical strain that they have struggled with”.
In those circumstances, said Wilkinson, and however difficult it may be, “healthcare teams have to try very hard to maintain a compassionate, supportive relationship with parents”, whose suffering, in the end, vastly outweighs any other interests – except those of Archie himself. “I don’t think, in this case, there is any shred of doubt,” said Wilkinson. “There is no way of avoiding what lies ahead in this very sad process, and nothing to do except try to give him some dignity and peace at the end of his life.”
What else we’ve been reading
With oil and gas profits still growing exponentially, Hamilton Nolan emphatically explains that if we all don’t actively dismantle the oil industry, it will destroy us. Nimo
“Are men 10 times better at painting than women?” asks Mary Ann Sieghart – and while the question might seem like a rhetorical one, the art market implies that the answer is “yes”. Sieghart’s piece is a shocking account of what causes “the biggest pay gap I can think of”. Archie
Ryan Gilbey’s interview with Keith Allen is suitably uproarious (and it has a hell of a photo) – but there’s a certain pathos to Allen these days, too. “I saw myself becoming a David Niven figure,” he says. “A national treasure. But I couldn’t commit.” Archie
“Never again can broadcasters deny women’s sport airtime with the feeble excuse that nobody wants to watch it,” writes Gaby Hinsliff – but she also warns that England’s thrilling Euro 2022 triumph will require concerted political will if it is to have the legacy it deserves. Archie
Emma Graham-Harrison writes from the Kabul neighbourhood where the al-Qaida leader, Ayman al-Zawahiri, was reportedly killed by a US drone strike. Graham-Harrison paints a chaotic picture of the area, with many Afghan civilians left in fear of more violence. Nimo
Sport
Football | Demand for tickets for England’s match at Wembley against World Cup holders the United States caused the Football Association website to repeatedly crash on Tuesday. There were online queues of at least 30,000 after the match was announced.
Commonwealth Games | Adam Peaty bounced back from his shock 100m breaststroke defeat to win gold over 50m at the Commonwealth Games. Earlier, Laura Kenny won England’s first velodrome gold of the games with victory in the women’s 10km scratch race.
Football | Leicester have rejected a £50m bid from Newcastle for their midfielder James Maddison. It was the second offer from Newcastle but Leicester have made it clear that they are reluctant to let Maddison go for any less than £60m.
The front pages
It’s a busy Guardian front page today: Nancy Pelosi in Taiwan, analysis of the strike that killed al-Qaida’s leader, and Liz Truss’s pay U-turn. That’s not counting the lead story which is “Outrage as oil firms rake in huge profits while bills soar”. The Daily Mail bolsters Truss with its endorsement in an editorial, plugging that on the front, while its lead is “China’s chilling threat to US over Taiwan”. The Express offers up page one for its Tory pick as well – “Truss: only I can deliver growth Britain needs”. The Times has “60% of Tory membership prefer Truss for next PM” while the Telegraph says “Hacking warning delays Tory vote”. “So much for the legacy” – the i says even after the Lionesses’ Euro victory girls can’t get equal football lessons to boys in PE. “Heartbreak for Archie’s family” is the Metro’s splash on Archie Battersbee. “Brazen Profiteers” – the Mirror highlights the “B” and the “P” as it lashes out over oil company profits. The Financial Times’ top story is “Bain barred from UK contracts for ‘grave misconduct’ in South Africa”. The Sun is not quite finished with the Wagatha libel case. “I rang Coleen and said ‘What the f*ck is this?’ says Vardy” – the latter’s version, according to the paper, of what happened after the former branded her a leaker.
Today in Focus
Monkeypox: are we reacting fast enough to the crisis?
There are about 2,600 confirmed cases of monkeypox in the UK, with gay and bisexual men most at risk of becoming infected. Dr Will Nutland on the response so far
Cartoon of the day | Martin Rowson
The Upside
A bit of good news to remind you that the world’s not all bad
Photographer Manal Massalha captured a portrait of a Palestinian woman in her early 60s named Ifaf who had driven 14 miles to submerge herself in the Mediterranean Sea. Ifaf had big career dreams growing up: she wanted to study in higher education and work in medicine but her opportunities were limited. After spending most of her life supporting her family and travelling long distances to attend college after work, Ifaf has, in her later years, found solace and peace in the sea. In the striking image, she is in the water wearing her hijab – Massalha’s conversation with her made her rethink the way we understand and interact with different people and how, regardless of who we are, we find relief in the same kinds of places.
Sign up here for a weekly roundup of The Upside, sent to you every Sunday
Bored at work?
And finally, the Guardian’s crosswords to keep you entertained throughout the day – with plenty more on the Guardian’s Puzzles app for iOS and Android. Until tomorrow.
