IVF – A Child Against All Odds (1)

December 30, 2006

A Child Against All Odds is a six-part BBC series on different aspects of IVF presented by fertility expert and well-known TV personality Robert Winston.  The first episode, Choosing Children (BBC1, 14th November 2006, TRILT code: 005D7759), focuses on three British couples undergoing Preimplantation Genetic Diagnosis (PGD) in order to check the genetic make-up of their embryo(s) prior to transfer into the uterus.

Gill and Ian are both carriers for a severe form of Gaucher’s disease, a neurological condition which led to the death of a previous child Ellie during infancy.  Glenn and Andrea have four sons, but would love to have a daughter.  Sex selection of this kind, for non-medical reasons, is currently prohibited in the UK and so Glenn and Andrea join the growing number of people who engage in “fertility tourism” and travel to Cyprus for the procedure.  Pete and Sarah have a severely handicapped daughter Maizie as a consequence of a chromosome translocation.  They are now embarking on screening to try and avoid having an embryo with the same problems.

As their stories unfold, all three couples reach a point at which they are able to have a screened embryo transferred to the uterus but, at the end of the day, only Gill and Ian achieve a successful pregnancy resulting in the birth of a new son.  Interestingly, they know from the PGD that although he will not suffer from Gaucher’s disease himself, he does retain one copy of the faulty gene and as such is a carrier for the condition (none of the embryos had two good copies, which would have been the perfect outcome).

This fascinating programme (58 minutes) is an excellent insight into the world of modern fertility medicine.  The episode involves frequent cutting between the three stories, which makes it difficult to recommend particular clips, and in some ways the programme needs to be seen in its entirety in order to get a feel not only for the science but also the emotional turmoil felt by all of the couples.  Having said that, the technicalities of PGD are nicely demonstrated in a section from 21:45 to 24:13 and the difficulty of tracing one “spelling mistake” in one gene is shown in 26:36 to 27:12.  The series is supported by an excellent website which offers background information and links to other relevant sites. For BioethicsBytes notes on the next episode, Ice babies, follow this link.

Euthanasia – Holby City

December 28, 2006

With her motor neurone disease getting worse, Gina decides to take matters into her own hands and plans to seek assisted suicide in Switzerland (see also the episode Moondance). The main focus of the episode Taking liberties (BBC1, October 3rd 2006; TRILT identifier 005C67BF) is her completion of necessary arrangements at Holby.  These include collecting together her favourite mementoes from her marriage to Elliott and persuading Connie to help her with the plans.  There are many sections of this episode where this theme is developed, including 11:38-12:31, 14:18-16:51, 23:14-24:24, 31:55-32:25, 33:20-34:33, 42:43-44:38 and 53:52-56:03.  The most helpful clips for raising the issues are the first two listed, which deal with the motivations for going to Switzerland, and the final clip where Gina and Connie fill in the online application form accompanied by a recording of Gina’s farewell message to Elliott.  The section from 42:43 where Elliott confides in Connie that he also seeks a swift end to Gina’s suffering may also be helpful.

As is so often the case with this series, there are two further subplots with a bioethical theme.  One involves Dr Joseph Byrne prescribing himself medication, but no isolated clips from this episode would really help in explaining the situation.  Of greater potential, however, are the revelations that some of the medicines being provided from the hospital pharmacy are counterfeit.  This storyline reflects a genuine concern that there are fake medicines finding their way into the legitimate supply lines in the UK and elsewhere (see, for example, BBC news report Fake medicines ‘a growing menace’).  Clips discussing this theme are at 24:55-25:35, 41:03-41:36 and 51:17-51:50.

AIDS Medicines, Selling Organs – Holby City

December 9, 2006

(Warning: contains plot spoilers!) The principal bioethics storyline in the episode Fly me to the moon (BBC1, 2nd November 2006)  focus on Nesta, a Zambian who has travelled to the UK to sell her kidney in order to buy medicines for her brother, who has AIDS.  The issues are therefore the availability of drugs in the third world, interwoven with issues of whether it is right to sell one of your own organs.

The best section concerning the supply of medicines to the third world comes when Abra (Adrian Edmondson) tries to retrieve some drugs, which are about to be incinerated, in order to try and get them taken to Africa.  Ric (Hugh Quarsie) intercepts him in the basement and they have a frank discussion about the ethics of current policy, and Adra’s DIY supply idea.  This clip is from 40:00 to 43:12.  There is also a section where Abra discusses pharmaceutical availability in the third world with a sympathetic pharmacist (30:00 to 32:26).

The best sections on selling organs come earlier.  Try 17:22 to 19:20, which includes the line “there used to be a time you could only sell your dignity, but now you can sell your body parts”, or 24:18 to 27:19 where Nesta explains what she has done and why.  03:06 to 04:18 “[whoever did the botched kidney removal]… fell asleep during the ethics class” and 05:12 to 05:52 “how would you sell an organ?” may also be worth a look.

Finally, the episode also has a subplot about an elderly couple in which the wife has Alzheimers disease and the husband has a weak heart.  The TRILT Identifier for this episode is 005D20B9.

IVF – A Child Against All Odds (3)

December 7, 2006

The third episode of Robert Winston’s series on IVF, Make me a dad (BBC1, 28th November 2006, TRILT code: 005D9CF2)  looks specifically at the use of ICSI (intracytoplasmic sperm injection) to help men with fertility problems.  This fascinating programme focusses on two couples where infertility/ low fertility is known to stem from the male partner. 

Tom has cystic fibrosis and although he makes sperm he is missing the vas deferens tubes which would deliver the sperm from his testes to his penis.  Wayne has been undergoing chemotherapy to treat his cancer, but this has also has a bad effect on the quality of his sperm.  In both cases the couples are put through a programme of IVF using ICSI, in which the sperm are artificially delivered directly into the egg using a micropipette.

Several ethical issues are raised during the episode.  These include (a) the fact that ICSI bypasses the natural process by which substandard sperm are filtered out and therefore there is increased risk that damaged sperm are transferred; (b) the health costs to the female partner whilst taking chemicals to cause her to overproduce eggs; and (c)  whether Tom, as a sufferer with CF, has equal rights to such treatments.  Some interesting comments about the motivation and need felt by individuals to become parents were also made.

A discussion of the next episode Cheating time is also available here on the BioethicsBytes site.

Face transplant – Horizon

December 7, 2006

The World’s First Face Transplant is an episode of the BBC science documentary series Horizon.  It focuses on the circumstances surrounding the transplant of the lower part of a face for Isabelle Dinoire after she was mauled by her dog.

In terms of discussion starters, the best material available at the moment is actually on the BBC website for the episode.  A series of short interviews with surgeons (Nick Parkhouse – anti, Peter Butler – pro) and facially-disfigured individuals (James Partridge – anti, Simon Weston – pro, Sundeep Hunjan – pro) nicely set out some of the principle arguments for and against face transplantation. 

Perhaps unsurprisingly, the programme itself contains several sequences of surgery being performed and also has images of Isabelle in the period between the attack and before the operation.  In consequence, it may be inappropriate to show the whole episode to some groups of students. 

A section starting at 35:02 and running to 35:43 has a montage of newspaper headlines and TV news reports about the operation.  This helpfully finishes with the BBC anchorman George Alagiah stating that this “… raised ethical questions”.  This could be used as an intro to start discussion about what those issues might be.  Other clips offer potential answers.  In particular, some or all of a section running from 23:40 to 29:00 includes Nick Parkhouse talking about the lifelong commitment to immunosuppressive drugs and the side effects such as raised cancer risk and life shortening.  This is followed by Simon Weston saying it might not be his choice, but people ought to be given the right to have a transplant if they want.  Mention is also made of the psychological issues – of coping with a life of disfigurement v coping with looking in the mirror and seeing someone ‘not you’ looking back. 

The need for a donor to match the recipient in terms of age, gender, skin colour, blood group and the requirement to obtain permission from the donor’s family are all brought up at different points in the programme, but not in one user-friendly clip.  Comparison is made to the experience of Clint Hallam, who in 1998 was the first recipient of a hand transplant but struggled to follow the necessary regime of immunosuppressant drugs and eventually had the hand removed.

This episode was first transmitted 17th October 2006 (TRILT code: 005CBF55)