It all started with an asthma attack.

Israel Stinson was an adorable toddler with a sweet smile and unruly hair. But on April 1, he began having trouble breathing. After he was taken to a northern California hospital, the unthinkable happened: Israel suffered a heart attack. After 40 minutes of CPR, doctors were able to restart his heart. But nearly an hour without oxygen had left him brain dead, they determined.

That’s when the battle began.

Stinson’s parents did not believe the doctors. Nathaniel Stinson and Jonee Fonseca went to court to demand that Israel be kept on life support in the hope he recovered.

“Israel’s medical chart … said he was deceased. But Israel is ALIVE!” Fonseca wrote. “God is telling me not to let go.”

When courts ruled against them, the parents flew their son to Central America in a desperate attempt to find him treatment.

The four-month saga came to an abrupt end Thursday, however, when a judge issued a surprise ruling against the parents. The 2-year-old was taken off a ventilator and quickly stopped breathing.

This time there was no disagreement.

“He’s gone,” his mother tearfully told the Sacramento Bee Thursday afternoon.

After Israel’s parents posted emotional but controversial videos of their son’s condition online, the tragic case drew national attention and sparked debate over conflicting medical, legal and religious definitions of “death.” What doctors dismissed as Israel’s involuntary muscle twitches, the family saw as intentional responses.

The debate echoes previous cases, some of which became causes célèbres. The most famous was that of Terri Schiavo, a woman with brain damage whose parents fought for years to keep her alive until a judge ultimately granted her husband’s wish to have her feeding tube removed. In 2013, 13-year-old Jahi McMath was declared brain-dead after a tonsillectomy went tragically wrong. Her family is still fighting to keep her on life support.

Thursday’s events are unlikely to dampen the decades-old national debate.

A pro-life group representing Israel and his family pro-bono told The Washington Post the outcome was “cruel” and potentially criminal.

“In no circumstances ever, ever should somebody be put to death without due process of law,” said Alexandra Snyder of the Life Legal Defense Foundation, adding that the family felt state law entitled them to consult another doctor before Israel was taken off life support.

Children’s Hospital in Los Angeles told the Bee it could not comment because of “privacy regulations.” Israel had already been declared brain dead by three doctors at two hospitals, Snyder admits, although she said the family questioned those diagnoses.