Following on from the recent BioethicsBytes post Holby City – “If you can’t look after yourself, then why should we?” (published on January 21 2009; updated February 4th 2009), which concerned ethical issues in NHS resource allocation as highlighted by two episodes of the BBC1 drama Holby City, this update post covers events in more recent episodes of Holby City – including the denouement to the storyline, as depicted in Feet of Clay.
The storyline concerns the “zero tolerance” policy implemented by Head of Surgery, Dr Ric Griffin (Hugh Quarshie), who is refusing to authorise surgical procedures for patients whose lifestyle choices may have contributed to their illness. Previous posts have covered the instigation of this policy in the episode Just (first broadcast on BBC1 on January 20 2009, at 20.00; TRILT Identifier: 00D15A4E), and the events and debates this creates between the characters in Tough Love (first broadcast on BBC1 on February 3 2009, at 20.00; TRILT Identifier: 00D8E505). This post notes relevant events in the subsequent episodes Trust, Truth and Mercy, and Take Her Breath Away, and the closure of the storyline in Feet of Clay.
Following on from Ric Griffin’s refusal to authorise a hernia operation for an obese man in the episode Just, Trust features a storyline involving the man’s son, Frankie, who is brought in with breathing difficulties (00:10:03 to 00:11:14). Given that Frankie is also overweight, Griffin has to choose whether or not to treat him. He elects to perform the necessary surgery in this case, since the procedure is now an emergency rather than elective one (00:14:25 to 00:16:04). However, following the sucessful surgery, Griffin and colleague Connie Beauchamp (Amanda Mealing) discuss the implications of his weight with Frankie and persuade him to lose weight (00:47:54 to 00:48:31).
Trust was first broadcast on BBC1 on February 10 2009, at 20.00. (TRILT Identifier: 00DB41DD).
Truth and Mercy
Following on from the events in the previous episode, Trust, Griffin involves Frankie in the production of a leaflet to accompany his zero tolerance programme. The leaflet initially causes controversy between Griffin and Connie Beauchamp over whether the leaflet is “advertising” or “public service information” (00:05:48 to 00:06:18). However when Frankie arrives at the hospital he expresses concerns about whether or not Griffin’s programme is really worthwhile (see 00:06:53 to 00:07:43, and 00:12:06 to 00:12:40). This escalates when Frankie’s father arrives on the ward (00:14:31 to 00:15:53, and 00:16:32 to 00:17:16) when he accuses Griffin of “exploiting” Frankie and “taking advantage” of their situation (00:20:10 to 00:20:34, and 00:27:09 to 00:27:52). The events of the episode culminate in Frankie becoming interested in gastric band surgery (00:29:43 to 00:30:13, and 00:32:12 to 00:33:16), and discussion over whether the operation is necessary, desirable and how it should be paid for (primarily 00:44:22 to 00:45:31, 00:49:27 to 00:50:00, 00:51:11 to 00:51:45, and 00:52:58 to 00:53:48).
Truth and Mercy was first broadcast on BBC1 on February 17 2009, at 20.00. (TRILT Identifier: 00DD2ABD).
Take her Breath Away
This episode opens with surgeon Michael Spence, from HolbyCare (the hospital’s private branch), fitting Frankie Moore with a gastric band – a procedure which sparks discussion of the implications of zero tolerance among the staff (00:09:27 to 00:10:13). The financial implications are also debated when Frankie’s father receives a bill for £7000 for his son’s operation – a cost he had believed would be met by the NHS (00:10:13 to 00:11:06, and 00:12:14 to 00:13:31). Mr Moore blames the confusion on Ric Griffin and lodges a formal complaint (00:41:30 to 00:42:03). Meanwhile, despite Frankies’s operation initially appearing to be a success, he begins to experience complications (00:29:29 to 00:30:18) – a situation which leads his father to re-evaluate his position (00:44:09 to 00:44:53, and 00:47:20 to 00:48:56).
Take Her Breath Away was first broadcast on BBC1 on February 24 2009, at 20.00. (TRILT Identifier: 00DF59A1).
Feet of Clay
This episode opens with Ric Griffin preparing a presentation on his zero tolerance policy. Meanwhile, Connie Beauchamp prepares to treat a longstanding Holby City patient despite his being overweight and a known smoker and drinker. Although this patient, Steve Hewitt, should be excluded from treatment under Griffin’s zero tolerance policy he is also an important financial supporter of the hospital. Thus a row ensues about whether or not he should be allowed to remain in the hospital (00:07:26 to 00:08:34, 00:10:24 to 00:11:48, and – in particular – 00:14:03 to 00:15:05, and 00:18:25 to 00:21:56). Eventually – and despite some minor complications – Griffin decides Steve Hewitt should be discharged and return when he has lost weight and seen a dietician (00:33:15 to 00:35:47); a decision which does not appear to affect Hewitt’s donation to the hospital (00:41:25 to 00:42:01 an 00:42:36 to 00:43:23). Unfortunately, just as Griffin is giving his presentation to the trustees, Steve Hewitt collapses outside the hospital (00:49:05 to 00:50:45) and although he survives, this effectively spells the end of Griffin’s zero tolerance initiative (00:53:22 to 00:54:07).
Feet of Clay was first broadcast on BBC1 on March 10 2009, at 20.00. (TRILT Identifier: 00E24D98).
Although Feet of Clay can be considered the closure of this storyline, it is likely that echoes of it will continue throughout this series of Holby City. Overall, the bioethical issues discussed in these additional episodes are very similar to those identified in the previous post on this storyline. These episodes develop the themes and illustrate some of the implications of zero tolerance within healthcare.
Additional issues centre on the experience of obesity and how is it perceived and dealt with within healthcare and family settings (most notably via Frankie and his father). Further, these episodes also provide a number of quotes which can be used to summarise pro- and anti- clinician perspectives, and also that of the patient.