Introduction

The case of Barts Health NHS Trust v Dance & Ors (Re Archie Battersbee) is a poignant legal battle revolving around the fate of 12-year-old Archie Battersbee. On April 7, 2022, Archie was found suspended by his mother with a dressing gown cord around his neck, leading to his hospitalization. Due to severe brain stem injury, Archie was placed on mechanical ventilation. The Trust sought a declaration that Archie was brain stem dead or, alternatively, an order deeming it not in his best interests to continue life-sustaining treatment. This case navigated complex issues surrounding medical ethics, legal standards for declaring death, and the paramount consideration of a minor’s best interests.

Summary of the Judgment

The initial hearing led Mrs. Justice Arbuthnot to declare Archie dead based on the irreversible cessation of brain stem function, thereby permitting the withdrawal of life support. The parents appealed this decision on multiple grounds, primarily arguing that the judge should have adhered to the criminal standard of proof and focused on Archie's best interests rather than declaring death without definitive brain stem testing. The Court of Appeal acknowledged procedural missteps and the absence of conclusive brain stem testing, leading to the remittance of the case for a proper best interests evaluation rather than upholding the initial declaration of death.

Analysis

Precedents Cited

The judgment references several key precedents that have shaped the Court's reasoning:

• In re M (Declaration of Death of Child) [2020] EWCA Civ 164: This case established that declaring death removes the focus from best interests to the finality of death, making best interests' evaluation irrelevant.
• Parfitt v Guys and St Thomas' Childrens' NHSFT [2021] EWCA Civ 362: Highlighted that even without conscious awareness or pain perception, physical harm can still influence best interests determinations.
• Tafida Raqeeb v. Barts NHS Foundation Trust [2019] EWHC 2531 (Admin): Emphasized the importance of future welfare in best interests assessments.

Legal Reasoning

The Court of Appeal scrutinized the initial judgment's adherence to the Code of Practice for the Diagnosis and Confirmation of Death 2008. The Code mandates a strict six-stage brain stem test to confirm death, involving the assessment by two medical practitioners. In Archie's case, the inability to perform this test due to no response during the peripheral nerve stimulation test rendered the declaration of death non-compliant with the Code. Consequently, the court determined that the judge should have proceeded directly to a best interests assessment instead of attempting to declare death without proper medical confirmation.

Moreover, the court recognized the parents' contention that the focus on death declaration overshadowed the necessary evaluation of what would genuinely serve Archie's best interests, considering his medical, emotional, social, and psychological welfare.

Impact

This judgment underscores the judiciary's obligation to adhere strictly to established medical protocols when declaring death. It emphasizes that without conclusive medical evidence, particularly as outlined by the Code, courts should prioritize a comprehensive best interests evaluation. The decision sets a precedent ensuring that legal declarations of death are not executed without meeting rigorous medical standards, thereby safeguarding the rights and welfare of patients, especially minors.

Future cases involving incapacitated individuals or those unable to undergo standard death confirmation tests will likely reference this judgment, reinforcing the necessity of best interests determinations in the absence of absolute certainty regarding death.

Complex Concepts Simplified

Brain Stem Death

Brain stem death refers to the complete and irreversible loss of all brain stem functions, including the ability to breathe independently. It is a legal and medical standard for declaring an individual dead, especially when the body is maintained on mechanical ventilation.

Best Interests Evaluation

A best interests evaluation assesses what would most benefit the patient, considering various factors such as medical condition, emotional well-being, family views, and long-term prospects. For minors, this evaluation is paramount in guiding decisions about medical treatment.

The Code of Practice for the Diagnosis and Confirmation of Death 2008

Commonly referred to as "the Code," this document outlines the protocols for accurately diagnosing death, particularly focusing on brain stem function testing. It ensures consistency and reliability in medical and legal determinations of death.

Conclusion

The Barts Health NHS Trust v Dance & Ors (Re Archie Battersbee) judgment serves as a critical reminder of the intricate balance between medical protocols and legal responsibilities. By remitting the case for a thorough best interests evaluation, the Court of Appeal reinforced the necessity of aligning legal declarations with stringent medical standards. This ensures that decisions profoundly affecting individuals’ lives, especially minors, are made with utmost care, consideration, and adherence to established protocols. The judgment not only rectifies the procedural oversight in Archie's case but also sets a significant precedent for future cases involving complex medical and ethical considerations.