Holby City – Resource allocation UPDATE

March 30, 2009
The most recent episode of Holby City, Feet of Clay, is available to view of download on via the BBC iPlayer until March 17 2009.

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.

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

January 21, 2009
Watch this episode via the BBC iPlayer (available until January 27th 2009)

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)

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Euthanasia, counterfeit drugs – Holby City

January 20, 2007

(Warning, contains plot spoilers!) In this episode, If the heart lies (October 10th 2006,  BBC1, TRILT code 005C80FB), the autumn 2006 season of Holby City continues with its strong representation of bioethic themes.  The issues of both counterfeit medicines entering legitimate supply lines and Gina Hope’s bid for euthanasia in Switzerland continue from the previous episode Taking liberties (Gina’s story is completed in the next episode, Moondance).  There is also a short, but potentially useful, discussion about saving a premature foetus against the wishes of the mother (26:12 to 27:45).

The sections developing the euthanasia storyline are 5:44-6:58, 8:10-9:30, 20:32-22:05, 29:21-31:00, 32:06-33:49, 38:22-40:30, 43:15-44:56, 52:10-53:42 and 55:16-57:06.  Of these, the discussion between Gina and Connie at 8:10 is possibly the most useful in isolation.

The counterfeit medicines plot is shown at 2:51-4:43, 14:19-15:41, 27:45-29:20, 40:32-41:35 and 48:50-50:10.  The best ‘stand alone’ section is probably the first of these, in which Bradley Hume, the assistant hospital manager, discusses the substandard drugs with the pharmaceutical supplier.  She promises to compensate the hospital but, as we discover in the clip 49 minutes in, she flees – leaving her ‘office’ and pill production machinery behind.

Euthanasia – Holby City

January 20, 2007

(Warning, contains plot spoilers!) Moondance (17th October 2006, BBC1, TRILT code 005CBA8B) focuses almost entirely on the culmination of the euthanasia storyline developed in previous episodes (eg. If the heart lies) and sees Gina Hope take her struggle with motor neurone disease to its unnatural end at an assisted suicide clinic in Switzerland.  Much of the dialogue could be used to raise some of the issues.  The majority is clearly delivered from a pro-euthanasia perspective, including 10.04-11.25, 12:55-14:45, and 17:32-22:12 (especially to 19:50).  When Gina’s husband Elliott catches up with her, their conversation at the cafe, starting at 38:11, offers the most balanced introduction to the issues.  The closure of the episode is very moving and caution is required before showing this to school-age students.  At the time of writing there is an ‘episode catch-up’ on the BBC website which conveys some of the emotion, although it omits

On a different theme, a conversation between disgraced manager Bradley Hume and research registrar Reg Lund (27:40 to 30:00) gives different perspectives on the current state, values and future of the NHS  – might be an interesting clip to use with medical students to introduce issues of clinical governance and management (although the recent Open University series Can Gerry Robinson Fix the NHS? offers far more depth on the issue).

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.

Xenotransplantation & Stem cells – Holby City

September 14, 2006

This episode is a bit of a bioethics-fest!  In addition to the xenotransplantation storyline started in the previous episode, there is also a discussion of the clinical use of stem cells, and some ethics of whether or not to honour a “do not resuscitate” order thrown in for good measure.  Several sections could prove useful for introducing xenotransplantation (6:30 to 7:40; 10:06 to 11:00; 29:14 to 30:28).  I think that the clip from 10 minutes into the episode is the most valuable discussion start; in a conversation between Abra and Mickie several of the main safety concerns are clearly expressed.  For more on the science and ethics of this procedure, see a Bioethics Briefing on Xenotransplantation that I wrote a couple of years ago.

Regarding stem cells, the best clip is from 22:13 to 23:30.  In this section, Gina (who is suffering from Motor Neuron Disease) discusses with her doctor whether or not she should fly to Singapore for injections of stem cells.  This is the sort of procedure that was also being discussed in Susan Watt’s excellent Newsnight investigation into experimental stem cell therapies (a streamed video can be reached from this link).

Xenotransplantation – Holby City

September 8, 2006

 A recent episode of the medical drama Holby City has a 90 second clip that could prove a very nice introduction to the concept of xenotransplantation.  In the episode “Better the devil you know“, first broadcast on September 6th 2006 (Sept 7th in Scotland), a terminally ill man has to come to terms with the fact that he can no longer receive the kidney transplant he had been expecting.  Just at the end of the episode (starting 54 and a half minutes in), Dr Percival Durant (known as Abra, and played by Adrian Edmondson) tells the patient that he may be able to offer him a new solution and proceeds to give a very useable explanation of xenografts.  This could lead easily into a discussion of the scientific and ethical problems with a transplant of this type.  For those with access to the services of BUFVC, the TRILT identifier for the episode is 005BDB24.  The actual operation takes place in the next episode “Star maker (September 12th/13th).