Aspiring medical students need to be prepared to discuss hot topics like medical ethics during their medical school interviews. One recent and relevant case is the Archie Battersbee case, which has important ethical implications for medical professionals and patients alike.
This case raised important ethical issues surrounding the withdrawal of life-sustaining treatment. Combine your reading here of medicine interview questions and model answers with medicine interview tutoring or 1-1 mock interviews to boost your answers and delivery.
Summary of the Archie Battersbee Case
Archie Battersbee was a 12-year-old boy who tragically passed away in 2022
Archie suffered traumatic brain injuries following an accident at his home in April 2022 and was placed on life support in a hospital
Following testing, doctors believed Archie to be dead and wished to withdraw his life support whereas Archie’s parents wanted treatment to be maintained
Archie’s case was brought before the High Court, Court of Appeal, High Court (again), Supreme Court, United Nations, and European Court of Human Rights
After an extended series of legal battles, Archie’s life support was withdrawn at the Royal London Hospital with family members by his side
What should you know about Archie Battersbee for Medical Interviews?
What happened to Archie Battersbee?
A timeline of events reveals that Archie was first admitted to Southend University Hospital on April 7th 2022, before being transferred to the Royal London Hospital one day later.
This admission followed an accident at home involving strangulation, and an inquest later ruled that Archie’s eventual cause of death was catastrophic hypoxic brain injury secondary to strangulation.
Archie’s mother, Tanya Battersbee, initially believed that her son was participating in a dangerous, viral online TikTok challenge known as the ‘Blackout Challenge’, where participants try to lose consciousness through various dangerous strategies.
This belief held by his mother led to some speculation that Archie had intentionally caused his injury by participating in this challenge.
Police investigation of his phone revealed no evidence to support this, and some argued that Archie Battersbee may have suffered from an accident, however, it was found that he received threatening online messages that constituted cyberbullying. The role that this may have played in his death is not known.
However, a coroner concluded that the accident happened during a ‘prank or experiment’ gone wrong with a friend that led to his injury. The report written by the coroner stated that Archie had placed a belt around his neck to experience a ‘high’ before passing out. Unfortunately, Archie did not regain consciousness.
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What were the legal disputes in Archie Battersbee’s case?
After transfer to the Royal London Hospital, Archie’s doctors relayed to his family that they believed him to be brainstem-dead, meaning that there would be no hope of recovery from his coma and Archie would be dependent on life-support machines forever.
Doctors wished to conduct a brain stem death test, but Archie’s family did not consent to this and the case was taken to the High Court. It was ruled that the test could be conducted, however,
Archie did not respond to a precursor test known as a peripheral nerve stimulation test so practicalities prevented it from being carried out.
A further case was taken to court about whether Archie could have an MRI scan, which he eventually had. After hearing more evidence from the scan, a judge ruled that Archie had died and had brain death. The case was later reconsidered following a successful appeal to the Court of Appeal, however, the new judge also ruled that life support ought to end in Archie’s best interests.
Archie’s parents later contacted the UN to hear the case, however, UK courts refused to postpone the withdrawal of treatment for this because the UN legislation in question did not apply to the UK. An appeal to the European Court of Human Rights was also rejected.
On August 6th 2022, Archie’s life support was withdrawn.
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What medical ethical issues are raised by the Archie Battersbee case?
Various ethical issues are raised by the case of Archie Battersbee. It’s important to think about:
Who should have the right to make medical decisions for children?
The case of Archie Battersbee raises the question of who should make decisions about a child’s treatment - their medical team or their parents/guardians.
The BMA states that parents have the right to make decisions about their children’s treatment, except in cases where these decisions are not in the child’s best interests.
They recognise that parents know their children best, and therefore can make personal decisions based on what is best for their specific child. Of course, this then raises questions about what exactly is meant by the term ‘best interests’, which is where the courts come into play.
When a child is conscious, they also sometimes can make decisions about their healthcare, per Gillick's competence and the Fraser guidelines. Gillick competence & the Fraser guidelines are key terms in discussion around medical consent and capacity.
They originate from a 1980s court case that sought to determine whether a doctor could give contraceptive advice or treatment to a patient under 16 without parental consent. The terms are often used interchangeably but have different definitions.
The Fraser guidelines are specific to contraception and sexual health. However, the test of Gillick's competence serves as a general framework for all medical decision-making in teenagers.
They guide whether or not a teenager demonstrates the capacity required to consent to medical processes. As such, there is no specific age of Gillick competence - different people will reach the threshold at different points.
It is always important to encourage children to discuss medical treatment with their parents, but when they don’t, these guidelines impact the follow-up process.
You can read more about consent and capacity in our medical ethics guides.
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👉🏻 Read more: Gillick Competence & Fraser Guidelines
When is it appropriate to withdraw life-sustaining treatment?
In the UK, withdrawal of life support is legal for brain stem-dead patients and is considered to be different from euthanasia or assisted dying, which are illegal.
A recent court case ruled that families do not need to seek a judge’s consent to remove a patient’s life support. However, courts will still be involved when there is a dispute between doctors and the family.
Another critical issue is the concept of ‘brainstem death’ and how doctors determine this. Brainstem death is defined as the “irreversible cessation of brainstem function, including the ability to breathe independently”.
Brainstem death must be tested for and certified by at least two doctors who have carried out their tests. This is complex and usually involves many medical professionals such as neurologists, intensive care doctors and organ retrieval teams (SNODs). Patients are examined for pupillary reflexes, corneal reflexes, pain response, caloric reflex, gag reflex, and any attempt at breathing with a short period of ventilator disconnection.
All tests must be failed for the patient to be declared brain stem-dead. Occasional limb or torso movements may occur, however, these are spinal reflexes and do not alter the diagnosis of brain stem death.
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Example Medicine Interview Question and Answer on Archie Battersbee
Q: Do you think that Archie Battersbee’s doctors acted appropriately in their decision-making?
The Archie Battersbee case was an extremely challenging one for all parties involved, and I can’t imagine how upsetting it must have been and how challenging it must have been to make decisions.
Archie’s doctors argued in favour of removing his life support. Overall, I believe this was the right choice given the results of tests such as an MRI scan that revealed that Archie was highly likely to be brain stem-dead. However, I also understand and respect why his parents would have disagreed with this decision.
More importantly, however, Archie’s doctors did not make their choice unilaterally but brought the case to the courts to seek their approval. This showed a good ability to work within medico-legal frameworks in the UK, and to recognise the limits of their practice. It ensured that whatever decision was made would be fair and legal, which is extremely important.
Given this, I think that Archie’s doctors were correct and - much more importantly - acted appropriately even if they were not.
Worth reading: there was a similar debate during the case of Charlie Gard.
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Example Medical Ethics Interview Archie Battersbee Practice Questions
What do you know about the recent Archie Battersbee court case?
What are the implications of the Archie Battersbee case for the medical profession?
Consider the cases of Archie Battersbee, Charlie Gard, and Alfie Evans. Can you spot any patterns in terms of how the NHS approaches cases like these?
Who was right in the Archie Battersbee case - his parents or his doctors?
How did the public respond to the Archie Battersbee case, and what did this reveal about the emotional impact of end-of-life decision-making?
What were the main arguments used by Archie Battersbee’s parents in the recent court case?
How did the recent Archie Battersbee court case highlight the importance of positive communication between medical professionals, parents, and their families?
Do you think that doctors or parents should be able to make medical decisions for children, and how does this play into the Archie Battersbee case?
How did the UK courts rule in the Archie Battersbee case and why?
Which international bodies were consulted in the Archie Battersbee case and how were they involved?
The Archie Battersbee case highlights complex ethical considerations that arise when making decisions about end-of-life care and the fundamental importance of considering the four pillars of medicine when making these decisions.
👉🏻 Read more: Answering Medicine Ethics Questions
Overall, questions about Archie Battersbee can provide a valuable opportunity to reflect on the ethical challenges that can arise in medicine and to demonstrate your ability to think critically about these issues. Read other medical interview hot-topic articles that we have written on Charlie Gard, Abortion, Harold Shipman and more!
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Check out our other articles on NHS Hot Topics:
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