Inside the Ethics Comittee
Apologies if what follows seems like a post-Brexit paean of praise to Blighty – I’ve actually been mulling this blog over since long before the fateful 23 June.
It’s just that one of the things that makes me grateful to live in this country is Radio 4’s Inside the Ethics Committee, the programme in which a panel of experts examines the issues brought up by real-life cases presented to medical ethics committees, and it makes me grateful for the following reasons:
- We have a National Health Service (still, just about, against all the odds) that despite the pressures on it takes the individual needs of patients seriously. (Can I still call them patients as opposed to customers, clients or service users?)
- There are skilled and dedicated people, both specialists and lay members, who are prepared to take the time, often alongside their day jobs and often for no remuneration, to sit on ethics committees and confront some of the most profound, and even distressing, questions of right and wrong in the hope of adhering to the doctor’s guiding principle of doing no harm.
- We have a national broadcaster that that pays us the compliment of assuming that we will find the proceedings of medical ethics committees and the minutiae behind their decisions interesting.
Oh, and the presenter is an octogenarian woman (Joan Bakewell). I rest my case.
The first time I heard the programme it made a deep impression on me. The case under discussion was that of a middle-aged man, David, with learning difficulties, who, from a purely clinical standpoint, needed treatment for cancer. On the face of it, it was a cut-and-dried issue: the usual course of action for a patient with this condition was a course of chemotherapy and David’s disability was neither here nor there: he was as entitled to treatment as anyone else.
But it wasn’t as simple as that. David’s learning difficulty was so severe that he would not be able to understand why he needed treatment, and therefore could not give consent for it. This issue of capacity – the ability to understand and make a decision based on that understanding – was explored in great detail.
The manager of David’s care home described very vividly how traumatic the exploratory CT scan had been for David, and the degree to which it had compromised his trust in his carers: he could not understand why those whom he trusted had taken him to be subjected to a frightening ordeal.
Establishing what would be genuinely in his best interests entailed assessing the relative merits of a number of factors, including the extent to which potentially painful and frightening chemotherapy would further damage his relationship with his carers, and the fact that this treatment only offered a 50 per cent chance of success. In the end, the panel in the studio arrived at the same conclusion as the ethics committee at the hospital: they had decided that to maintain David’s current quality of life, he should receive palliative care only. He died five months later.
The programme recently completed its 12th series, and all 36 episodes are available on iPlayer. It covers an impressive range of topics, including assisted conception, persistent vegetative state, religious objections to treatment . . . Everyone is likely to have personal experience of at least one of the issues discussed, or to know someone facing them.
I now view Inside the Ethics Committee as being like the ravens at the Tower of London: as long as it’s either on or scheduled to return, there is hope. Should it ever disappear we are well and truly done for.