This guide will take you through how to answer potential medicine interview questions on the Archie Battersbee case. Please bear in mind this article touches on a particularly difficult and sensitive ethical case.
Potential Interview Question: Describe what happened in the Archie Battersbee case to the examiner.
Archie’s Condition
In April 2022, Archie Battersbee was found in his home with a ligature around his neck. He sustained brain damage and was later determined to be brain-stem dead. Archie was placed on mechanical ventilation.
The Expectations of Archie’s Parents
Due to the fact that Archie’s heart was still beating, Archie’s parents felt that he had a chance of recovery. His parents sought the support of the Christian Legal Centre. They expressed that their beliefs were that it would be God’s decision as to whether Archie recovered. They wanted Archie to remain on mechanical ventilation and Archie’s mother said that he had grabbed her hand, and was a ‘natural born fighter’. The parents held out hope for a recovery, hence they appealed to the United Nations to move Archie to hospice care.
The Expectations of Archie’s Doctors
Various tests and scans over the following months were carried out in order to determine that Archie was brain-stem dead. Archie’s doctors determined that his organ systems were slowly shutting down and felt there was no chance of recovery; by keeping Archie on ventilation they felt they were prolonging the inevitable and causing suffering. Universally, it is safe to say doctors set out to improve people’s quality of lives and act in their best interests. Archie’s doctors did not feel mechanical ventilation was in Archie’s best interests.
The Outcome
After a lengthy legal process, the High Court Family Division ruled that Archie should be removed from life support in August 2022.
Potential Interview Question: Describe the ethical dilemmas presented in the Archie Battersbee case. Or, Describe the issues of capacity and autonomy presented in the Archie Battersbee case.
Autonomy
To have autonomy means to have the right or condition of self-governance.
Archie’s parents were responsible for his medical decisions in this case as Archie was a child, although some children can be deemed Gillick Competent, under the Mental Capacity Act 2005 and Gillick Competence guidelines, Archie would not be deemed to have capacity or to be competent. Some of the things that constitute not having capacity under that act, or someone not being Gillick Competent are being unable to understand information relevant to the decision, retain it, and use or weigh it up as part of the process of making the decision. Due to his condition, Archie would not have been able to be involved at all so all care decisions would go to his parents.
It becomes difficult when parents and doctors disagree and I would heavily recommend you have a read of this article here. In short, a collaborative approach should be taken, and the doctor should relay that like the parents, they are trying to act in the patient’s best interests. They should explore the ideas, concerns and expectations and try to get to the root of the issues, reassuring the patients that they have consulted other specialists and physicians in order to reach a recommendation. When this fails, we see, like in the Archie Battersbee case, legal professionals needing to be involved in order to work with both parties and act in the patient's best interests.
Beneficence & Non-maleficence
Doctor’s take a hippocratic oath which expresses that they will do no harm, although an ethical signpost and not legally binding, this must come into play when making decisions, and encompasses the pillar of Non-Maleficence, which similarly means to do no harm. Archie’s organ systems were shutting down and his doctors felt they were prolonging the inevitable, leading to suffering.
On balance, the parents felt a cure was a possibility. Their faith plays a part in this, in that they believed it was God who should determine if and when Archie died, not his doctors, they likely felt harm was being done by removing life support and that it went against their own religious convictions.
Beneficence means doing good and would infer acting in the patient’s best interest in order to support them. I think it’s clear that both healthcare professionals and Archie’s parents were trying to act in their best interests however the views were conflicting.
Justice
Justice as a pillar means considering the greater fairness across the board, whether something is within the best interests of the patient but also legal. Great pressure was put on both the healthcare professionals and the families when the media became heavily integrated into this case. The legal system was heavily involved, to ensure the legality of the eventual decision to withdraw Archie’s life support. The greater fairness across the board was heavily considered throughout with healthcare professionals, the legal system and Archie’s parents collaborating to ultimately find the outcome which would be in Archie’s best interests; this being withdrawing life support.
Potential interview question: What are the two legal definitions of death in the UK?
There are two definitions of death in the UK, cardiopulmonary death and brain-stem death.
Cardiopulmonary death: The heart and lungs cease to function
Brain stem death: The brain stem ceases to function
Brain stem death is only ever considered when any reversible causes of brain damage have been reversed, unfortunately in Archie’s case the brain damage was via an irreversible cause. The hyperlink in the title details more on brain stem death and is really worth a read for your interview.
The heart can beat as long as it has a supply of oxygen. Because Archie’s heart was still beating his parents felt that Archie had a chance of recovery and were in the view that he should be moved to hospice care. Brain stem death however is irreversible and there is no treatment for this.
Sometimes those with brain-stem death make small movements due to spinal reflexes - for example the hand holding discussed earlier - this can be extremely difficult for families.
Potential Interview Question: How does the media affect cases like the Archie Battersbee case?
In terms of healthcare the media can be both positive and negative. It can spread awareness of current issues but in this case might have led to public distrust. Battles of autonomy, capacity and legal battles with parents can be perceived as the parents having their autonomy taken away. The GMC’s Good Medical Practice details that healthcare professionals should be ensuring they maintain trust in the profession.
The Health and Social Care Act 2022, states that parents' wants and wishes should be taken into account, and this is absolutely a part of providing good care. The parents getting to express their story to the news and display their wants is completely within their autonomy and rights. On balance, the media could also be portrayed as damaging, for example some reports suggest that there were 8 security guards around Archie’s room at some times; this must have been fairly distressing for both the family and the staff.
Archie’s mother believed that the ligature was tied around Archie’s neck when performing a TikTok challenge called the ‘Blackout Challenge’. The media therefore has a massive interlinking into the case. If this was the case, one could suggest that the failures of TikTok to protect users from such dangerous content played a part in a tragic death.
Concluding Thoughts
I hope this was helpful in exploring some of the ethical issues in this case and provided insight.
When answering any questions surrounding this case it is important to remain empathetic to all involved, remembering this was a real patient and family, and to maintain a professional demeanour.
Information regarding the events of the case was sought from the BBC News Archie Battersbee case folder. Should you wish to learn more, this is a good place to start.
If you would like to cover further questions surrounding the case or talk this through with a tutor you can do so here.