More tricky decisions – Inside the ethics committee

August 12, 2008
Visit the Inside the Ethics Committee homepage at BBC Radio 4

Visit the Inside the Ethics Committee homepage at BBC Radio 4

The fourth series of BBC Radio 4’s bioethics programme Inside the Ethics Committee began on August 6 2008, and discussed some of the ethical issues involved in the creation of ‘saviour siblings’ (first broadcast on BBC Radio 4, at 20.00, August 6 2008 and repeated on August 9 2008, at 22.15). Vivienne Parry and a panel of experts discuss the ethical issues around real-life medical cases, on this occasion the dilemma involves a young child, Catherine, and her medical treatment. Previous BioethicsBytes posts have noted the utility of this series (see the post Making tricky decisions – Inside the ethics committee), and this episode is no different.

Shortly after she was born Catherine was diagnosed with Diamond Blackfan Anaemia (DBA). DBA is a rare blood disorder caused by a genetic mutation. In general, its treatment is “gruelling” (00:02:27) and the prognosis is poor. As in several previous cases (notably, the Whitaker, Fletcher and Mariethoz families), Catherine’s parents were offered the option of using preimplantation genetic diagnosis (PGD) for tissue typing alone in order to create a ‘saviour sibling’ whose umbilical cord blood could be used to treat Catherine’s DBA.

Many of the ethical issues involved in this choice have been dealt with in past BioethicsBytes posts (see The Future of Our Families? and the extended commentary that accompanies that post), however this edition of Inside the Ethics Committee brings consideration of these issues up to date. Though the majority of the ethical issues raised are covered in our existing posts, some of the additional details noted here about DBA and the testing procedure introduce new complications into the ethical debate.

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Making tricky decisions – Inside the ethics committee

October 5, 2007

If you were on the ethics committee that had to decide whether or not an anorexic woman can refuse further treatment for her condition and admit herself instead into a palliative care hospital to await death – how would you decide what to allow?  This is just one of the scenarios discussed in the third series of the Radio 4 series Inside the ethics committee. The programme has an interesting format – all the cases considered are real, and the panel of experts are all members of a clinical ethics committee, usually at a different UK hospital. Host Vivienne Parry interrogates them about the advice they would have given on the specific case and the reasons underlying that view.  Finally, the real decision made by the ethics committee is revealed.

The three series to date have covered some interesting ground.

Series 1 (2005) looked at:
treating a Jehovah’s witness with leukaemia who will need blood-products or an expensive alternative
whether a baby should be given a liver transplant which will be damaged by the treatment they are getting and will therefore only be a temporary solution, when several other patients could have the organ instead
deciding what to do for a patient with a chronic lung condition who gave inconsistent views about whether or not he wants life-saving treatment

Series 2 (2006) covered:
whether it is right to test children for an inheritable cancer now that their father has developed the condition
ethical decisions that would need to be made in the face of a pandemic flu outbreak
how to decide whether or not someone gets an expensive medicine on the NHS

Series 3 (2007) was perhaps the most engaging to date. Topics considered this year were:
deciding how to treat a man who has learning difficulties, no speech and no relatives but needs chemotherapy
can a woman with Anorexia Nervosa be offered palliative care?
can an unconscious man be tested for HIV without his consent?

In the most recent of these cases, for example, a man caught in the London bombings of July 2005 had been very badly injured, including exposure to blood and tissue from other victims.  Unconscious in hospital, a doctor treating him accidentally pricks herself with a used needle.  She starts a programme of prophylactic medicine, which would normally continue until it was known whether the original patient was HIV positive and may have infected her.  In this case, the man cannot be asked for permission for him to be tested.  With the healthcare worker now effectively a second patient, how do you resolve the apparent clash of rights and needs for the two individuals?

Inevitably for programmes of this kind, the cases are specifically selected because the decisions are not straightforward – it doesn’t make for good radio if your panelists are always agreeing!  Given the complexity of the cases involved, I suspect that the use in teaching would be limited to University level, and even then it is more suited to philosophy courses or medicine than for bioscientists.  It’s not easy to pick out short soundbites, and I would recommend listening to the full 45 minute episodes in each case.

At the time of writing, all nine episodes are available as streamed files on the BBC website (although the links didn’t always seem to work on all the computers I tried). In addition to the recording, there is also a transcript of each discussion, which can be very helpful in following the arguments being made. Alternatively, audio recordings can be obtained from the BUFVC.