BARTS Qs
What have we learned from Archie's situation?
What would you do, if you were the doctor in charge?
Can you summarize what happened?
Were archie's parents robbed of autonomy?
Patients have lots to deal with a lot emotionally
Media may be biased when reporting things (sky news article focusing on mum's views only)
Child found unconscious by mother
40 mins of CPR to the hospital
hypoxia in brain --> swelling
brain stem death
court vs parents
Took from April to August for Archie to die
CLC involved
How has medicine changed in the past century?
Medicine isn't always in black and white
Make sure the parents feel enough support from the hospital and the medical staff, and have all the education and information needed, so that court and CLC don't get involved so fast.
Try to act more empathetic towards the patient
people live longer
many different innovations
most diseases are treatable, research says a lot
patients have more rights
define autonomy + other ethicall pillars
Archie's best interest and court
Archie being unconscious himself
low chance of recovery, or "living" a good life even if the so-called-miracle happened
Give media some more insight into what was actually happening
Provide professional support to the parents - refer to a psychiatrist as they were in lots of distress
The actions were justified, but it could feel like that
What were the implications of this on the NHS?
Public mistrust
loss of resources
Every patient is different from another
Doctors doubting themselves and feeling unappreciated
Why do you think these cases are common in medicine?
Barts trust being criticized
Patients not feeling supported by the NHS
patients hiding things from professionals
No clear definition of death in English law
The media increases tension between family and doctors
Stigmatising death means family doesnt talk about their wishes in case of trauma/brain damage so poor communication when such an instance does happen. (Rachel Clarke teaches us that we need to speak to our family about death i.e. we need to destigmatise this convo)
Why BARTS
clubs and societies
Med soc
City
London is capital + lively
lots of diversity
lots of cases in London --> great placement opportunities
Very accessible by public transport
variety of food
CREATE lab
bio fabrication
3D printing
Great chance to improve research along clinical stuff
Course
Lots of tests and exams which can ensure learning
Spotters
ICAs
OSCEs
Anatomy and physiology covered in both lectures and practicals
GP placements + reflections
swimming/badminton
Interactive 2hr PBL sessions twice a week
team work
helps us prepare
What are the 4 medical pillars considered for this case
Beneficence - Doctors decided that it would be in best interest to take out life support. Mother thought it was in best interest to keep him alive.
Non-maleficence - by providing support and explanations to the family, and backing up their points by justification in court, and also confirming results with other doctors they did no harm. The trust took care of Archie until the legal issues were solved. The patient was dead at last, however, and the parents could do with a bit more emotional support. DEATH COULD BE SEEN AS HARM TOO
AUTONOMY - Charlie couldn't decide his own choice of treatment because unconcious. Parents and Doctors together then decide whats in the best interest of Charlie.
Justice - Distributive justice - Archie needed 24/7 life support, ventilation, nurses, doctors, medication/drugs. Expensive for the NHS since underfunded.
Early clinical experience
developping communication skills
learning professionalism
Gaining more confidence
Lots of sightseeing places
Prosection
Use of VR is new and innovative
Can help you watch and learn and gain experience
Cadavers are more respected
Cutting is done right
What are the wider impact of this on society.
November means there is no evidence that Archie took part in this challenge so he could have attempted suicide (JUST A THEORY) but highlights the importance of mental health in children
Talk to their family about this and maybe find a compromise before such an event happens
Online challenge so maybe educate children about this topic
NHS mistrusts
Possible personal Qs
Tell me about x in your personal statement
Tell me about a time you showed
integrity
honesty
leadership skills
teamwork skills
good communication
compassion
empathy
What do you do to wind down
long term stress
short term stress
clubs and societies in barts
resilience
Christian Legal Centre antagonised the hospital and since it has a religious background it could reduce the trust the evangelical christians have on the NHS
How does it relate to medicine
What have you learned from it
What could you have done better?
What will you take to your studies from it?
cardiology
Psychiatry
Surgical
Amnesty international
LGBT+
book club
Food
What are your thoughts on the article
The article explains technological advantages and disadvantages
The way Rachel clarke explained what happened was different to the other news sources, she included her emotions in as well, explaining how the team in Barts trust were devastated, too.
The article is explaining how online media coverage can have its own advantages and disadvantages.
Rachel Clarke is providing a different perspective than what the media has already offered to share
What opinions would doctors have on this issue
They might feel like the doctors didnt communicate with the family effectively which lead to this escalation.
Doctors would agree that taking out life support was the right thing to do. MRI scan showed his brain stem was necrotic (no blood flow) and was coning (pushed into spinal cord)
Rachel Clarke doesnt take a side but she empathises with the healthcare team and archie's parents. She is a palliative care doctor so she knows what its like to lose a very close person/patient because the grief lives on w the loved ones even though patient dies.
what do you think about the reaction of the public
Many people were violent and aggressive online
Many people financially helped
many people who were misinformed were scared that this might happen to them
Biased
religious people disagreed with the court
do you think cases like this being publicised is worth it?
No, because the family was being cyber bullied by people online saying that archie should just die. Made the whole situation more distressing than it already was.
CLC views so going public may cause other christians to distrust the NHS as well
Increase NHS mistrust
Destigmatises death which is something that must be done because 500k die every year in UK but no one talks about it. Makes decision making easier for families if death was understood as more natural and less institutional.
Yes, it allows the public to learn about the legalities around such a sensitive topic and talk about them with their family
who do you think was right in this case?
Doctors had their reason: brain stem dead etc
Archie used resources from May 31st (presumed to have died) to August 6th so he used up many resources over many months. (distrubitive justice)
shared decision making. parents right in humanitarian but doctors right in biological expectation. Court to manage it therefore.
I dont think anyone was right or wrong in this case. Both parents and doctors had their own reasons. Usually they both make the decision together.
If i had to pick a side then go for Doctors because, best interest + no prospect of archie recovering (no blood in brain stem + coning)
Involve the hospitals ETHICS commitee and not a rapid case review group which therefore could have avoided all this in the first place.
BMJ Ethicist said they didnt involve the hospitals ethics team and if they had then this could have been prevented. Therefore involve an ethics team and maybe an independant mediator since clearly the doctor-family bond was broken and a mediator acts to help them recover this bond and think about what really matters (Archie's best interest and the way that there is no prospect of recovery)
Mother had her own reasons. Archie was said to be a fighter and she thought that archie himself would want to live. But maybe the seriousness of what happened was clouded by the emotional distress of having to lose the child
Conflicts were essentially related to differences in participants’ views on what constitutes ‘good care’ based on different care approaches. Healthcare professionals’ views on good care were based predominantly on a biomedical care model, whereas families’ views on good care were mainly inspired by a holistic lifeworld-oriented approach. Since their views are fundamentally different, it creates tensions.
Aspiring doctors learnt the reality of medicine and hard decision making
IMPACT ON ARCHIE'S HEALTHCARE TEAM
They are humans
Doctor wants what's best for patients and sometimes it's really difficult to do in these kind of cases (frustrating)
Experience abuse by media and public
Sometimes patients may not agree with you over best interest situations
IMPACT OF MEDIA AND INTERNET ON THIS CASE (BESIDES BULLYING)
Made more aware of the cases
Impact of a similar case in the future will be greater
Made it public therefore people donated for the cost of the court fees, external solicitors, cousel + medical experts
People can confuse death with sleeping
This technology allows organ transplants