Blood & Guts – A History of Surgery: Fixing Faces

Michael Mosley performing facial surgery on a mannequin/dummy

In the fourth part of the BBC 4 Blood and Guts series, Fixing Faces looks at the evolution of plastic surgery. True to form, Michael Mosley presents a graphic account of how brutal attempts to reconstruct patients’ diseased or damaged faces have led to a modern medical speciality which is now believe to be on the eve of the first full face transplant. This episode describes and illustrates the history of this area of surgery: showing the work of the 16th century Italian doctor Gasparis Taliacotii (00:05:06 – 00:18:02); the beginning of the Botox era (00:18:02 – 00:30:00); and the work of Sir Harold Gillies and Sir Archibald Mclndoe, who developed both surgical techniques and the need for psychological support for patients undergoing reconstructive facial surgery (00:30:00 – 00:50:00) (Please see this Student BMJ article – ‘A brief histoy of plastic surgery’).

This episode highlights two main ethical topics for discussion: functional Magnetic Resonance Imageing (fMRI) and Neuroethics (00: 01:54 – 00:05:06); and face transplants or facial allograft transplantation (00:50:00 – End).

Blood & Guts – A History of Surgery: Spare Parts

Blood & Guts - A History of Surgery: Spare Parts is the third part of the BBC Four documentary series about the “brutal, bloody and dangerous history of surgery” focusing on the development of transplant surgery. The documentary primarily gives a graphic account of the history of transplant surgery, in particular focusing on the work of Alexis Carrel (00:04:24 – 00:22:47),  Joseph E. Murray (00:22:47 – 00:45:32) and Sir Roy Calne (00:36:40 – 00:45:32). However both at the beginning (Start – 00:04:24) and the end of the programme (00:45:32 – End) Michael Mosley (Also seen in BBC’s documentary series Medical Mavericks) discusses some of the ethical concerns that may arise from transplant surgery. Mosley meets with two patients who have both had a hand transplant, however only one of the patients is able to keep his new hand as it illustrates the success and failure of the radical surgery.

Michael Mosley (00:02:00 - 00:04:24): "I'm really intrigued by David (patient because to me this is something more than just incredible surgery. The whole idea of living with a dead man's hand is one I find fascinating but also disturbing. A lot of people I've talked to are really freaked by the idea of having something like an arm transplant, its also true frankly of all the buts of the body that show like; noses, eyes, and faces probably the freakiest of them all. No other form of surgery impacts on our sense of self in quite the way transplants do. There is something profoundly strange about swoping body parts, melding your flesh with others. And these days there seems to be no limits."

DNA – The Promise & The Price

Narrator Bill Paterson: "A child born in 1953, the structure of DNA has just been discovered. 1989 and this baby's genetic fingerprint can be identified. The first single gene for Huntington's disease has been discovered. 2003 this child's entire genetic code can now be read and faulty genes in his DNA can be adjusted. Another birth, but this time no ordinary miracle. The baby's sex and eye colour were decided before she was conceived; also her hair, the shape of her nose and her intelligence. The date of her birth? Perhaps only a few years from now. She's born from a revolution in genetics. A revolution where each new step brings new questions of ethics and responsibility. And as the promises of the science gets greater, so do the questions for all of us get bigger."

DNA – The Promise & The Price provides an excellent resource for discussing the ethical implications of advancing genetic research, focusing on; gene therapy, stem cells and cloning. The documentary examines the frontiers of genetic science, revealing how researchers attempt to fulfil DNA’s potential to help cure and prevent disease. It also questions how some aspects of these novel technologies may have significant consequences for individuals and society. Bill Paterson: “Much is promised by genetic science, the manipulation of our genes. But can it deliver? And if it does are we ready to take responsibility for meddling with the very fabric of life itself: our DNA”.

Professor Steve Jones: "When it comes to medical research, any medical technology that works, it is very quickly accepted by the public. Ethicists may not like it, scientists may not like it, but the public, if they believe it works they will accept it, and the legislation will always follow. Ethics has always followed science, it's never led it and I don't see any reason why genetics is going to be any different. Ethicists would love to tell geneticists what to do, but I'm afraid the geneticists are not going to listen."

The topics found in DNA – The Promise & The Price include: genetics; genetic diseases; gene therapy; transplantation; stem cells; and cloning can all be found in the UK National Curriculum. Please note all timings mentioned  include advertisement breaks - (00:04:51 – 00:08:00, 00:25:31 – 00:28:40 and 00:46:50 - 00:50:00) 

Blood and Guts – Bleeding Hearts

This short post focuses on Bleeding Hearts, the second part of the BBC 4 series Blood and Guts: A History of Surgery, presented by Michael Mosley (Also seen in BBC 4 documentary Medical Mavericks). This episode traces the historic journey of cardiac surgery. Initially, progress was very slow with surgeons fearful of operating; the main difficulties being the need to maintain blood supply to the vital organs of the body (especially the brain), and preventing the patient bleeding to death. The documentary illustrates how heart surgeons managed to maximise the time they could work on the patient without major post-operative health consequences. For the purpose of teaching bioethics, this short post will focus on a section (00:42:45 – 00:52:00) which examines how surgeons have to seek out hearts for transplantation when their patient’s own heart is damaged beyond repair.     

Michael Mosley: “The heart possesses a mystique, a romance that sets it a part from any other organs. This difference helped make heart surgery an extremely dangerous procedure. Not just for the patient but also for any surgeon prepared to operate on it.”

Fighting Talk (Doctors) – a duty to disclose?

(Warning: contains plot spoilers!) This is an old episode of the BBC’s daytime drama Doctors, centred on the Mill Health Centre, a fictional midlands clinic. The relevance is probably limited to clinical ethics training for medical students, but it’s great for that purpose so worthy of a quick note here.

In Fighting Talk (TRILT ID: 0059FD65, first broadcast on BBC1, 15th June 2006), Dr Greg Robinson is faced with a dilemma when local bully Darren Waters has beaten up geeky pupil Kevin Dobson on his way to school. What Darren doesn’t realise is that Kevin is HIV positive. When Darren presents at the clinic with a bleeding hand and then Kevin later comes in with cuts to his face, Dr Robinson realises there is a risk that the virus has been transferred from victim to bully. Does he have a duty to disclose the details to Darren and his family?

In truth, the episode is entirely focussed on this story, punctuated with snippets of longer term issues for those who work at the Mill Health Centre. One short section, however, conveys all that needs to be told as a case study for tutorial group discussion. In the section starting at 16:23 Dr Robinson visits Kevin and his mother trying to persuade them to let him tell Darren. Kevin’s HIV status is mentioned openly, it had only been hinted at in early clips. The scene runs onto 19:17, but is best stopped at 17:50 when Kevin’s mum puts her hand on his shoulder – the rest of the clip is window dressing.

For completeness, the clips in which the story unfolds are: 02:00-02:58 (the fight), 03:40-05:03 (mum patches Kevin up), 07:52-10:00 (bully goes to GP), 10:26-12:40 (Kevin goes to GP), 12:40-13:37 (Dr Robinson discusses what to do with colleague), 14:10-15:55 (Doctor visits Dobson family), 16:23-19:17 (HIV status discussed), 20:11-20:50 (Doctors discuss ethical duty), 20:50-21:10 (Kevin visits clinic to give consent), 21:37-23:38 (Dr Robinson tries to get Kevin’s mum to agree), 24:22-26:12 (Kevin persuades his mum).

The Family Man – playing God at the fertility clinic?

The Family Man – Dr Patrick Stowe

(Warning: contains plot spoilers!) The Family Man is a three part BBC 1 drama centred on the successful (fictional) ‘Wishart Fertility Clinic’. The patriarch of the clinic is Dr Patrick Stowe (Trevor Eve) whom is driven by pursuit of better ways to help distressed couples have a child. The drama follows four couples facing a spectrum of fertility problems. In an attempt to fulfil their dreams, they turn to Dr Stowe to help find the answers. At times this tests the legal parameters of fertility treatment in the United Kingdom, and as such raises a whole raft of bioethical issues.

Welcome to BioethicsBytes

Bioethics is a discipline of increasing importance.  As such, it is now a component of many Biology courses at Higher Education, but also features in the specifications for both A levels and now GCSE Science courses at Secondary School (these are examinations taken in the UK at 18 and 16, respectively). This site will host a collection of resources to assist in the teaching of bioethics.  We hope you will find it a helpful repository.  If you have additional materials that you’ve found useful and are willing to share via this medium, then please feel free to send a comment.