A judge hearing the case of Alfie Evans has rejected the pleas of his family for the sick toddler to be flown to Italy for treatment.
But he asked doctors if "other options" are possible to allow his family to take the 23-month-old home after life support was withdrawn.
Alfie has been at the centre of a life-or-death treatment battle, with his parents, Tom Evans and Kate James, trying to stop his doctors at Alder Hey Children's Hospital in Liverpool from withdrawing life support in a sometimes acrimonious six-month dispute which has seen a series of court battles.
A "last-ditch appeal" by the Italian ambassador and the Pope, to grant Alfie citizenship of Italy to take him for treatment at a hospital in Rome, failed on Monday.
A late night court hearing heard by telephone by Mr Justice Hayden and lawyers for both sides confirmed his earlier decision permitting life-support, helping Alfie to breathe, to be withdrawn.
Mr Justice Hayden described the 23-month-old at the centre of a life support battle as "courageous" and a "warrior", but said the case had now reached its "final chapter", he told a High Court hearing in Manchester.
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He rejected claims by Alfie's father, Tom Evans, 21, that his son was "significantly better" than first thought because he had now been breathing unaided for 20 hours after doctors first withdrew life support on Monday night at Alder Hey Children's Hospital in Liverpool.
Mr Justice Hayden, speaking to lawyers representing Alfie's parents and Alder Hey Hospital, said: "If there were a more constructive attitude from the family might other options become possible, away from Alder Hey?
"I'm not suggesting this, I don't want it to be taken as an indication from me.
"One of the things Tom Evans said, if it can't be Italy or Munich, which it cannot be, was whether they could take Alfie home."
But a doctor treating Alfie, who cannot be named for legal reasons, said that for Alfie to be allowed home would require a "sea change" in attitude from the child's family, and they feared that in the "worst case" they would try to take the boy abroad.
He added: "It’s heartbreaking we’re here again arguing when all we want to do is the best for Alfie’s family”.
Mr Justice Hayden ruled out his family's wishes to take the child to the Bambino Gesu hospital in Rome, following interventions from the Pope and the Italian authorities.
Earlier on Tuesday Mr Evans claimed medics had been "gobsmacked" as his son continued to breathe for himself for 21 hours after medical intervention was withdrawn.
But Mr Justice Hayden cut down Paul Diamond, representing the parents, as he began the family's appeal hearing.
Mr Diamond said: "This really is an appeal, in our submission for common humanity and common sense..."
The judge interjected: "I don't think it's helpful to use emotive terms. As a barrister confine yourself to the law."
Mr Diamond gave a witness statement from Mr Evans, taken on Tuesday, to the court suggesting his son's condition is "significantly better" than had been previously believed.
Mr Diamond said the child had been breathing unaided for 19 hours.
He continued: "We do have a human being..."
Again the judge cut across him: "I don't need to be reminded we have a human being. You do not have the moral high ground in this court. It is treacherous terrain."
Mr Diamond handed the court a witness statement from Mr Evans in which he suggested his son's health was "significantly better" than first thought since life support was withdrawn at 9.17pm last night, as he was continuing to live and breathe.
But Mr Justice Hayden said in his ruling: "The sad truth is that it is not.
"With little, indeed no hesitation, I reject that.
"The brain cannot regenerate itself and there is virtually nothing of his brain left.
"There is, in truth, with great respect to the efforts of Mr Diamond, no substance to this application, which represents, at least within the court process, the final chapter in the case of this extraordinary little boy."
Instead the judge said Alfie's continued life was a "shaft of light" and a "special opportunity" for his parent to spend time with him - not the time for more legal manoeuvres.
And he criticised the "malign hand" of one of the family's advisers, law student Pavel Stroilov, who had, the court heard, been party to Mr Evans lodging a private prosecution of Alder Hey Hospital doctors, allegedly for murder.
The judge said, in fact, the hospital had provided "world class" care for the child.
The hospital's doctors and independent medical experts say there is no cure and no hope for Alfie.
Alder Hey doctors and independent medical experts say there is no cure and no hope for Alfie.
Medics say he has a degenerative neurological condition destroying his brain, and it is in his best interests to withdraw life support, but his parents want to take him abroad for treatment.