Healthcare Rationing

It is a sad reality of any publically-funded heath service that there is always more that could be done if only there were sufficient finances. This short video by Medical students at the University of Leicester, raises some of the different tensions facing those who need to make decisions about the allocation of resources.

Whose cells are they anyway?

Rebecca Skloot's book has received critical and popular acclaim in 2010

In hundreds of research labs around the world, including within my own Department, scientists carry out experiments using a human cell line known as “HeLa”. Most cells die after a defined period of time, but mutations within the HeLa cells have allowed them to continue dividing outside of these normal contraints, and as such they are said to be “immortal”. The original tissue sample from which HeLa cells are derived was taken from the cancerous cervix of an African-American woman Henrietta Lacks (the name of the cell line being an abbreviation of her name).

The Immortal Life of Henrietta Lacks, a captivating account of the human story behind these amazing cells, has recently won many plaudits, including the prestigious Wellcome Trust Book Prize.

Private Practice: Acting ethically at the Wellness Center?

(Warning – contains plot spoilers!) Private Practice is a spin-off from Seattle hospital drama Grey’s Anatomy in which Dr Addison Montgomery (Kate Walsh) moves from Seattle Grace to join the staff of the Ocean Wellness Center in Los Angeles.

I have to admit that I tired of Grey’s Anatomy during Season 1 and although I was aware it has spawned another series I had no desire to watch. All this changed, however, following an excellent talk on the programme, given by Dublin Doctor Audrey Dillon at the 4th Postgraduate Bioethics Conference (Belfast, June 2009).

The writers of Private Practice, headed by Shonda Rhimes, have made a conscious decision to incorporate ethical issues into the storylines (see ‘Private Practice’ explores bioethics questions). This means, therefore, that the series may well throw up some interesting case studies as discussion starters.

At the time of writing, Living TV (UK) has just started transmission of Season 2 (see here for Episode guide). A Family Thing, the first programme of the series, was aired on 25th June 2009 (TRILT code 00FC042B). True to promise, it contained two subplots featuring ethical dilemmas.

Saviour siblings – a donor by design?

In the first (starting 7 minutes in), Molly and Eric Madison present at the clinic demanding that the staff deliver their baby daughter that day, despite the fact that she is only 27 weeks gestation. The girl, it transpires, has been conceived following Pre-implantation Genetic Diagnosis, to be a ‘saviour sibling’ for her older brother, Jason.  The boy has leukaemia and has had his own bone marrow wiped out in preparation for a transplant from a donor who has now fallen unwell with pneumonia. He is therefore immunocompromised and urgently needs umbilical stem cells courtesy of the new child.

Holby City – Resource allocation UPDATE

The most recent episode of Holby City is available to view of download on via the BBC iPlayer.

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.

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."

BBC Radio 4 – Cancer Tales

Listen again to Cancer Tales via the BBC iPlayer (available until Monday 2nd February 2009)

On Monday 26th January 2009 BBC Radio 4 broadcast Cancer Tales as the Afternoon Play (aired at 2.15pm). This interesting and emotional radio adaptation was based on the play of the same name written by Nell Dunn (first published in the UK in 2002 by Amber Lane Press) which provides fictional accounts of experiences of cancer diagnosis and treatment. The accounts are very emotional and moving, and include the perspectives of the patients themselves, their family members and, occasionally, members of their clinical care teams. Dunn’s narratives are based upon the real-life experiences of cancer patients and offer a true-to-life snapshot of their experience of cancer diagnosis and treatment. Thus, Cancer Tales provides an opportunity to see many aspects of medical care and services from the patients perspective. This is particularly the case with the recent Radio 4 adaptation, which, within it 45minute running time, focusses on three of the narratives contained in the original script. These are all female experiences and explicitly dealt with experiences of clinical services (as opposed to wider social and psychological themes connected to cancer diagnosis).

A Short Stay in Switzerland

A Short Stay in Switzerland is a BBC dramatisation telling the true story of Dr Anne Turner. Diagnosed with the degenerative neurological condition Progressive Supranuclear Palsy (PSP) and facing progressive deterioration in her condition, Dr Turner decided that she would end her own life by travelling to the Swiss clinic ‘Dignitas’. Unlike the UK, assisted euthanasia is legal in Switzerland. A Short Stay in Switzerland tells a highly emotive account of a woman who wishes to “die with dignity”, a decision eventually supported by her children.

A Short Stay In Switzerland - BBC 1 Sunday 25th January 2009, 21:00. The moment Dr Anne Turner tells her children that she has PSP.

The programme follows the events during the final stages of Anne Turner’s life. Although the dramatisation attempts to illustrate events as accurately as possible, it does so with a clear agenda in favour of her autonomous decision and it does not discuss the other possible alternatives when faced with such a situation in any detail.

There is, however, a section of the programme which shows Dr Turner’s children attempting to convince her that her life is worth living and that they can provide palliative care for her (00:25 :10 – 00:33:33). In this specific case, Dr Turner succeeds in her wish after an unsuccessful suicide attempt in her home persuades her children how determined she is. (Warning:  if using the section indicated by the timings above, please be aware that the scenes that follow, graphically depict Turner’s earlier suicide attempt and therefore may not be suitable for all audiences).

There is also a BBC news article about the programme and you may be interested in this post on Panorama – I’ll die when I choose.

BBC News article 22nd January 2009. 'A Short Stay in Switzerland'.

 A Short Stay in Switzerland was first broadcast on BBC 1 21:00 – 22:30  (90 minutes) Sunday 25th January 2009, and is available on BBC iPlayer until 10:29pm Sunday 1st February 2009.

(DJW)

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) 

Holby City – “If you can’t…look after yourself, then why should we?”

Watch this episode via the BBC iPlayer (available until January 27th 2009)

The issue of resource allocation in the NHS has cropped up several times in recent programmes (see, for example, Dom’s on the Case regarding the “postcode lottery”. The present post examines the ethical issues implicit in a different aspect of resource allocation in healthcare: the potential for conflict between traditional medical ethics and core NHS values and increasingly prominent views of the individual as both responsible and accountable for their own health status. This tension came to the fore in Just, a recent episode of the BBC drama Holby City (first broadcast on BBC1 at 8.00pm on 20th January 2009), and is captured nicely in one particular quote from the programme in which surgeon Ric Griffin challenges his patient, an obese smoker, “if you can’t be bothered to look after yourself, then why should we?” (00:38:07)

Panorama – I’ll Die When I Choose

In recent weeks a spate of stories concerning euthanasia have received prominent coverage in the British media. This post focuses on one of these, the BBC 1 Panorama documentary I’ll die when I choose. Please note that this post reports the content of the programme without, as yet, significant discussion of the ethical arguments for and against euthanasia. It is hoped that a fuller Extended Commentary giving a more rounded perspective will follow in due course.

I’ll die when I choose investigates the issues that surround assisted suicide and euthanasia. As both a MSP for the Scottish Parliament and a sufferer of Parkinson’s disease Margo Macdonald believes she can actively contribute to the debate:

Margo Macdonald MSP: “The job that I am taking on now as a lawmaker and a journalist, is to investigate the impact of our current criminalisation of people who want assistance with dying. And although I feel that I want the right to choose, I don’t know as a society we should change the law and where we should set the limits.”

This programme provides a personal insight into the lives of some patients who suffer from deliberating diseases, while providing arguments from those that oppose any changes in the law. The current post will attempt to discuss the issues raised in this programme while making reference to other recent events associated with the subject, including Daniel James‘ assisted suicide in Zurich following a rugby accident that left him paralysed and the failed attempt in the High Court by Debbie Purdy to clarify the law on assisted suicide.  

Panorama – I’ll Die When I Choose (30 minutes) was first broadcast on BBC 1 Monday 8th December 2008 20:30pm and will be repeated on BBC 1 Friday 12th December 00:25am and BBC News Channel Sunday 14th December 2008 20:30pm.  Please see other BioethicsBytes materials on Euthanasia.

Note: The programme is both very emotional and thought provoking as it contains sensitive material. It therefore may not be appropriate for all audiences and educators are strongly advised to watch the material through themselves prior to use in any teaching setting.

Panorama - I'll Die When I Choose