Inside The Ethics Committee

Every day, life or death decisions are being made in hospitals all over the country by clinical ethics committees.

In this series, Vivienne Parry is joined by a panel of experts including health professionals, religious leaders, philosophers and lawyers.

Each week, a new case is put in front of the ethics committee and they examine personal testimonies from patients, relatives and medical staff.

As the panel gradually unravels the evidence, they test the moral foundation of how decisions are made in hospitals every day.



Every day, life or death decisions are being made in hospitals all over the country by clinical ethics committees.

In this series, Vivienne Parry is joined by a panel of experts including health professionals, religious leaders, philosophers and lawyers.

Each week, a new case is put in front of the ethics committee and they examine personal testimonies from patients, relatives and medical staff.

As the panel gradually unravels the evidence, they test the moral foundation of how decisions are made in hospitals every day.


In this episode, the panel discusses the case of Baby A, who needs double transplant surgery - a new bowel and liver.

Without either, the baby has weeks to live.

Both organs are rare, but bowels are especially scarce.

Baby A could be kept alive in the short term with an isolated liver transplant to act as a bridge until both organs are available.

However, without a new bowel, this liver would eventually fail and need replacing again.

Should Baby A be given an isolated liver transplant, even though this same liver could be used to save another child's life?


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The panel discusses the case of a man in his late 60s, being kept alive on a life-support machine.

At first, he asked consultants to do everything in their power to keep him alive.

But as the man deteriorated, he scribbled a new statement - I want to die.

The next of kin disagrees, insisting the patient isn't capable of making life or death decisions.

How can doctors determine if a patient is competent enough to decide to die?



Vivienne Parry is joined by a panel of experts to tackle the ethics involved in a real life hospital case.

They consider the harrowing story of Lisa and Gary, a young couple in their early thirties.

Gary's father and grandfather both died at an early age from cancer.

After his health started to deteriorate Gary was diagnosed with HNPCC, a hereditary form of colon cancer.

Should Lisa be granted genetic testing for their two young children, to find out if they have the same condition?


Vivienne Parry is joined by a panel of experts to discuss the tough choices we may face during an outbreak of pandemic flu.

Whether it's the current H5N1 strain, or another less well-known variation, if clinical influenza hits the UK it could affect 25% of the population, and kill 50,000 people.

The programme presents the chilling story of an avian flu outbreak in a small town in Britain.

There is growing panic and fear as a handful of potential bird flu cases are reported in the local hospital.

Relatives, residents and clinicians are all asking for retrovirals to try and protect themselves from the disease.

As the infection spreads, nurses and doctors become ill and others are afraid to come into work.

There aren't enough intensive care beds to take care of all the victims and tough decisions have to be made involving who to treat, and who to turn away.

Tackling these thorny issues is a panel of three experts, taken from clinical ethics committee around the UK.

They'll be debating the life or death decision involved - should medical staff, worried for their families, be forced to come into work? How will the country cope with the intensive care crisis? With limited supplies available, who should be given antiviral medicines?

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Vivienne Parry and the ethics panel discuss a real-life case involving Richard, a man in his early 50s with colon and liver cancer.

He's read about a new wonder drug in the newspapers, which isn't available on the NHS, so he applies to his local primary care trust for funding.

What effect has the recent Herceptin case had on the allocation of new cancer drugs? And with PCTs in financial crisis, should doctors routinely discuss the use of treatments that aren't available on the NHS?


David, who has severe learning difficulties, has been diagnosed with a treatable form of cancer in his stomach.

His treatment would involve regular intravenous chemotherapy and sedation in hospital.

David finds all hospital procedures extremely distressing and doesn't have spoken language.

Can he give informed consent to treatment?


They consider the case of Kate, a woman who has lived with anorexia nervosa since the age of 14.

Now in her late 20s, she has reached the point where she can't face the trauma of more treatment and wants to opt for palliative care.

Is it ethical to allow her to make this decision? Is it ethical to continue force feeding her against her will? What are the ethical issues that are raised by mental illness and how do they differ from other diseases?

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A severely injured man is unconscious in a London hospital.

One of his medical team injures herself with a needle while treating him.

She wants the patient to have an HIV test, but guidelines prohibit this without the patient's consent unless it's in his best interests.

What would be the ethics of testing him without his knowledge?

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Three-year-old Catherine has a life threatening condition.

She desperately needs a bone marrow transplant from a sibling.

Should the parents select a suitable embryo to help?


An 86-year-old man with dementia who has had a bad fall wants to go home but his son is concerned that he cannot look after himself and needs to be in residential care.

The programme looks at how medical staff and families work out what is in his best interests and whether he has the capacity to make decisions about his care, and how his previous preferences should be included in the decision.


An 18-month-old baby is up for adoption.

The local authority want him tested for a genetic condition which he could develop, but the test would not normally be done until the child is five years old.

Should the examination be allowed?

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Sarah has Hepatitis B, which she caught from her mother at birth.

Her mother is adamant that she doesn't want her daughter to know what is wrong.

She has seen families shunned for having Hepatitis B and she doubts Sarah's ability to keep the secret.

But the disease is highly infectious, through blood and sexual contact.

Does Sarah have a right to know about her condition?

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Series in which Joan Bakewell is joined by a panel of experts to tackle the ethics involved in a real hospital case.

The story of a young man called Chris who has been diagnosed with kidney cancer.

He desperately needs an operation to have the cancerous kidney removed; if the cancer begins to spread, it is highly likely to kill him.

But Chris is terrified of going under anaesthetic and has therefore cancelled a string of consultations and surgeries.

What is the surgeon's duty of care to a patient who is refusing to have a life-saving operation? What is a reasonable degree of persuasion for the surgeon to use? And at what point does persuasion tip over into possible accusations of coercion or even assault? What about Chris's rights? Given he has a severe phobia, does he really have the capacity to refuse this life-saving operation? And what about his responsibilities to the NHS? He has wasted hours of fully staffed theatre sessions, so is it fair to keep diverting resources away from other patients in this way?

Should a young man with a phobia of operations be forced to have life-saving surgery?

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Series in which Joan Bakewell is joined by a panel of experts to tackle the ethics involved in a real hospital case.

Charlotte is a young woman in her thirties.

Since her kidneys failed a few years ago, she spends every night attached to a dialysis machine, which cleans the toxins from her blood.

Dialysis is a life line, but is by no means perfect and her long-term outlook is bleak.

Doctors don't expect her to be alive in a decade: her only hope is a kidney transplant from a living donor.

But Charlotte is an extremely high risk patient.

She suffers from a severe form of 'sticky blood syndrome', where life-threatening clots can form in her circulatory system at any time, causing anything from deep vein thrombosis to a stroke.

Charlotte had lost her own kidneys to blood clots, and the risk of a donor kidney failing, both during and after the operation, are considerable.

Family members or a spouse could donate if found to be a tissue match.

But is it ethical to put a healthy person under anaesthetic, and remove one of their kidneys, when it could easily fail once transplanted into Charlotte? Is this the best use of a precious resource?

One person close to Charlotte is found to be a perfect match.

But given Charlotte so desperately needs this operation, how can the medical team be sure that they really wants to donate? How can they ensure that coercive forces are not at play? Can a living donor ever be truly altruistic?

If the operation goes ahead, Charlotte's doctor wants to try out an experimental procedure to help reduce the risk of fatal blood clots during the operation itself, but it has never been used in transplant operations before.

When is it appropriate to use experimental procedures on patients? Does the high risk of the organ failing, or indeed Charlotte losing her life, make it more ethically acceptable?

Joan Bakewell is joined by a panel of experts to discuss the thorny ethical issues in this case.

Should a woman be given a kidney transplant when there is a high risk of failure?


At what point is a woman's disability an obstacle to her having fertility treatment?

Series in which Joan Bakewell is joined by a panel of experts to tackle the ethics involved in a real hospital case.

They examine the case of Ayesha and her bid to receive fertility treatment.

Ayesha has a genetic condition which causes muscle weakness and curvature of the spine.

She is in a wheelchair and heavily reliant on her husband and others for day-to-day tasks such as getting out of bed, having a shower and going to the toilet.

By law, the welfare of any child born through fertilty treatment has to be assessed, and Ayesha's case is no exception.

But how does her disability and future health affect the welfare of a child? Is it ethical to put the needs of someone who doesn't exist yet above those of someone who does? Should a fertility treatment request be treated any differently if one of the parents has a disability rather than a life-threatening illness like cancer? Whose job is it to decide what makes someone adequate parents?

There is a 50 per cent chance that her condition will be passed on to any future child.

It is possible to screen out the condition in affected embryos.

But Ayesha says she would accept any child regardless of its condition and wouldn't want any screening.

The law says you cannot screen in a disability, but says nothing about screening one out.

Is it ethical to consider screening for embryos in effect with the same conditon as Ayesha's if she was offered fertility treatment?

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Should a terminally-ill and suicidal woman be monitored against her will?

Joan Bakewell discusses the real-life case of Mary, a terminally-ill woman in her 80s.

She has considered her condition and has decided that she wants to die.

She is admitted to a hospice for respite care.

On the first night she attempts suicide.

The psychiatric team, who assess Mary, conclude that she is not clinically depressed.

Mary talks quite openly with her relatives and the medical staff about her wish to die, describing her existence as inconvenient.

She also asks members of the team for euthanasia.

While at the hospice she refuses palliative care, and, as her condition is stable, she decides to go home and employ a full-time carer.

But the psychiatric staff are very concerned.

Mary continues to talk of her death wish, and she has asked the psychiatric team to leave her alone when she goes home.

What right does Mary have to determine how her life ends? What is the role of her doctors, and should she attempt suicide again? Is not doing anything the equivalent of a policeman walking past and ignoring a man who is about to jump off a building?

Joan Bakewell is joined by a panel of experts to discuss the complex ethical issues surrounding this case.

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Should a man who believes his life-saving surgery is a conspiracy to kill him be forced?

Joan Bakewell is joined by her panel of experts to discuss the complex ethical issues arising from this case.

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When should a seriously ill child have a say in their treatment?

Joan Bakewell is joined by a panel of experts to discuss the case of Tanya who is nine years old and seriously ill.

Her family don't want her to know her diagnosis and believe the treatment being offered won't help.

What should the medical team do?

Joan Bakewell is joined by her panel of experts to discuss the complex ethical issues arising from this case.

Producer: Beth Eastwood.

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Should the NHS pick up the pieces when private treatment goes wrong?

How should a surgeon respond when obese patients, who have paid privately for weight loss surgery, seek NHS help when that surgery has unexpected consequences?

Join Joan Bakewell and her guests for Inside the Ethics Committee - Producer: Beth Eastwood.

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A woman with a living will attempts suicide.

Should she be admitted to intensive care?

A woman is brought to A&E by her husband.

She is unconscious having attempted suicide.

She's been in pain for more than 30 years with severe arthritis.

Having witnessed elderly relatives' death in distressing circumstances years ago, she and her husband have written living wills or advance directives.

They ask for no medical treatment in certain circumstances.

She has always maintained with everyone she knew that she doesn't ever want to be admitted to intensive care.

She has left five copies of her advance directive with her husband, sister, daughter, lawyer and GP.

The staff in A&E are torn about what to do - should they admit her to intensive care and save her life, or let her die ?

What should hospital staff do? Do they admit her to A&E against the spirit of her advanced directive or give basic treatment knowing it might prolong her life against her wishes but prevent a slow painful death caused by the overdose?

Joan Bakewell is joined by a panel of experts to discuss the complex ethical issues around advanced directives and decision making at the end of life.

Producer: Pam Rutherford.

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How do you make medical decisions about an unconscious woman when she is pregnant?

Anne is brought into Accident and Emergency unconscious, having suffered a cardiac arrest.

She is thirty five years old and pregnant.

Within hours of Anne's admission to intensive care, she has another cardiac arrest and starts to have seizures.

On several occasions over the next few days, the medical team think they might lose her.

But each time she survives.

As Anne's life hangs in the balance, how much should her pregnancy influence the decisions the medical team need to make about Anne?

Producer Beth Eastwood

Presenter Joan Bakewell.

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Can a transplant patient keep a secret that may affect the donor's willingness to donate?

What happens when a proposed medical treatment clashes head on with a patient's cultural values?

Moha has kidney failure.

He's on dialysis to replace his lost kidney function, and on the waiting list for a transplant.

But his chances of receiving a kidney from a deceased donor are slim.

The donor pool is primarily Caucasian, and given that Moha is African and has a rare blood type, it's unlikely a tissue matched kidney will come up.

His nephew back in his country of origin offers to donate one of his kidneys.

But Moha has a secret that only he and his medical team know about.

As his nephew has offered to donate a kidney, the team feel that he has a right to know.

Should Moha be forced to tell?

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Can a conscious patient stop treatment, even though this will directly lead to his death?

Palliative Care teams are used to supporting patients at the end of life.

But recently, some patients with motor neurone disease have been making an unusual request.

They want to stop using the ventilator mask they were prescribed to help them breathe.

Initially prescribed to aide breathing at night, their disease has progressed to such a degree that they are no longer able to take breaths without it.

They are aware that removing the mask will lead to death within hours or minutes, and to remove it themselves would be extremely distressing.

So they ask the palliative care team to keep them comfortable during the process.

Patients have a legal right to refuse treatment, but these requests cause consternation among staff.

Some worry that they could be accused of assisting in their deaths.

Can they conscientiously object to supporting these patients at the end of their lives?

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Should an autistic man be forced to have the life-saving treatment he is fighting against?

Monty has double pneumonia and is in intensive care. A ventilator is breathing for him and he's sedated so that he can tolerate a breathing tube in his throat. Given the risks associated with being intubated in this way, the team are keen to get him off the ventilator as soon as possible, so that he can start breathing for himself.

After several days of antibiotics, Monty improves. So they stop the sedation, wake him up, and remove the breathing tube. The plan is for Monty to wear a mask to support his breathing until he is strong enough to breathe for himself.

But Monty is autistic, and as soon as the mask is placed on his face, he pushes it away. The nurses put it back on, but again he bats it off. The nurses persist, but Monty struggles and lashes out at them. Exhausted, he starts going blue. Fearing for Monty's life, the team re-sedate him and put him back on the ventilator.

As his life hangs in the balance, what lengths should the medical team go to to get Monty to accept the life-saving treatment he is struggling against? Should they physically restrain him?

Joan Bakewell chairs the discussion between medical and ethical experts.

Producer: Beth Eastwood.

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Since losing her husband to a terminal illness, and watching his kidneys fail, Pamela has felt a burning desire to try to help someone else escape a similar fate.

A year after his death, she writes to her local hospital to ask if she can become an 'altruistic' donor, and donate one of her kidneys to a stranger. To her horror, she receives a letter back saying that she is 'too old'. Undeterred, she approaches a transplant surgeon at another hospital, and he agrees to see her.

To the surgeon, Pamela appears fit and extremely determined. But for a potential donor, she's also rather unusual - she's eighty two years old.

Should Pamela be allowed to donate? What are the risks to her - both of the operation itself, and of being left with only one kidney? And, if the team allow her to donate, who should receive such an elderly organ?

Producer: Beth Eastwood.

Should an elderly woman be allowed to donate one of her kidneys to a stranger?

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To what lengths should a medical team go to encourage homeless women to avoid pregnancy?

The number of people sleeping rough on Britain's streets is rising, and the need for supported housing continues. But providing a roof over someone's head is just the start.

A nurse specialist, working in day centres and hostels, provides health services to the homeless. It's an ideal opportunity to try to engage with clients, who usually fall under the radar of a general practitioner.

Physical health problems associated with living outside are common, and many suffer from mental health problems and drug addiction.

Women who find themselves on the streets are particularly vulnerable to assault, and sex work often provides a means of escaping the streets, and also funding a drug addiction.

The chaotic nature of these women's lives means they are often reluctant to accept the nurse's help. Getting these women to use regular contraception is a particular challenge.

Pregnancy is not uncommon among homeless women and their children often end up in care. Despite the terrible trauma this causes, women still find it difficult to use regular contraception.

What lengths should the sexual health team go to to encourage these women to avoid unwanted pregnancies?

Producer: Beth Eastwood.

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Should children with degenerative, life-limiting conditions be kept alive at all costs?

Ayisha and Ben both have life-limiting degenerative conditions which means their muscles are getting weaker over time. Both are taken to intensive care when their conditions get to the point where they can't breathe unaided. Efforts to get vital oxygen to them mean they end up needing ventilation in hospital.

Ayisha is less than a year old, Ben just two and a half. How much treatment should be given to keep them alive? Both could have a procedure where a tube is inserted directly into the neck which would allow them to leave hospital go home.

Ayisha's condition is more severe than Ben's with a worse prognosis, does this make a difference when deciding what should be done? And if treatment is given how do their parents and medical team decide when is the right time to withdraw that life saving treatment if their health declines?

Joan Bakewell discusses the ethical issues raised with a panel of expert guests: Dr Paul Baines is Consultant in Paediatric Intensive Care Medicine at Alder Hey hospital. Deborah Bowman is Professor of Ethics and Law at St George's Hospital, London. John Wyatt is Emeritus Professor of Ethics and Perinatology at University College London. Sally Flatteau Taylor is Founder and Chief Executive of the Maypole Project that supports children with life-threatening illnesses and their families.

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Should a woman with severe disabilities be helped to get pregnant?

Rosemary has battled with severe health problems for many years. She has Ehlers-Danlos Syndrome and, following complications of spinal surgery, she is now a full time wheelchair user and her breathing is impaired. She receives her nutrition via a tube fed directly into her blood stream and she empties her bowels into a bag attached to the small intestine.

She has always wanted a child and now, aged 36 and in the early stages of a relationship, she asks for assisted conception.

The fertility doctor refers Rosemary on to various specialists at the hospital, who enumerate the risks. If Rosemary is to have IVF, she'll need a general anaesthetic which would be extremely risky for her. Furthermore, any pregnancy could be life threatening to Rosemary and a potential fetus, and the team are concerned about the welfare of a future child. Also, if Rosemary becomes pregnant, her child could inherit Ehlers-Danlos Syndrome as the condition is genetic.

While hospitals look after women with complex problems who are already pregnant, enabling a woman like Rosemary to become pregnant is an ethical challenge of a different order. But Rosemary herself is adamant she wants to take the risk, whatever the potential consequences.

Should the fertility team help Rosemary get pregnant?

Joan Bakewell and a panel of guests discuss this ethical issue.

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Mr Khan is brought into A&E with a cardiac arrest and has emergency surgery to clear a blockage in his coronary artery. He's transferred to intensive care with multi-organ failure, his lungs, heart and kidneys supported by machines and medication.

Mr Khan is seventy five and his doctors expect him to need intensive care for about ten days. But he is slow to improve and, over the coming weeks, he has repeated lung infections and needs almost constant support for his organs.

The anticipated brief stay in intensive care turns to weeks, then months. As time goes by, it becomes clear to the team that Mr Khan is unable to survive without intensive care - removing even small amounts of support for his organs leaves him unable to cope.

After six months, the medical team are convinced that Mr Khan has little chance of recovery. He is severely wasted and all the procedures they have to put him through, to keep him alive, are causing him considerable suffering. The team feel they should now limit his treatment and enable him to have a dignified death.

Mr Khan is now so weak and confused that he is not able to communicate, so the team discuss this with the family. They find the idea of limiting treatment very difficult. Like Mr Khan, they are devout Muslim and believe that everything should be done to preserve life. They reason that if there are treatments and machines that might help Mr Khan the team should use them, and then leave it in God's hands to see if they succeed or fail.

As Mr Khan's life hangs in the balance, should the team keep treating him, so prolonging his suffering, or limit his treatment and enable him to have a comfortable and dignified death?

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Alan is in his late thirties when he is diagnosed with lung cancer. A genetic test reveals that he has Li Fraumeni Syndrome, a fault in a gene which predisposes him to cancer.

Alan starts chemotherapy but the treatment takes its toll. He and his wife Rachel try to resume family life - they have three children and Rachel is pregnant. But over the coming months Alan's health deteriorates further and eventually Alan dies.

Soon after his death, Rachel gives birth to their baby. Over the next eighteen months she's increasingly unnerved by the pattern that's now emerging in Alan's extended family. Two of his siblings have died from cancer and there are tumours developing in other siblings, and in some of their children. Rachel is extremely worried that some of her own children, aged 2 to 12 years, may also carry the genetic fault.

Rachel visits a genetics service and asks them to test her four children for Li Fraumeni Syndrome. The genetic counsellor explains that children are not usually tested for this condition as there is little benefit in knowing - while there's a high risk of cancers developing in affected children, there is no reliable way of detecting these cancers early. Rachel remains committed - she wants to know if any of her children carry the faulty gene.

Should the genetic team allow her to have her children tested?

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How much should a seriously ill 17-year-old know about his condition and its prognosis?

John had a lung transplant at 11, but a few years later his illness returned. Should he be given a second transplant? Joan Bakewell and guests discuss this real life case.

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A diabetic teenager who struggles to take the treatment she needs to stay well.

The teenage years are full of change and confusion, creating tensions for parents and children. How much worse can things get when a long-term illness becomes part of the mix?

May is fourteen years old and has type-1 diabetes. After being diagnosed at the age of seven, she initially copes well but, within a few months, she struggles to take her insulin regularly.

The diabetic team try on numerous occasions to help her, and her mum, to manage May's diabetes better, but she doesn't see the point. The risks don't seem real to her and she wants to be normal, like her friends.

At the age of eleven, May is admitted to hospital three times with dangerously high blood sugars. By the age of twelve, the long term complications the team have warned May about, start to appear.

Now on the brink of adolescence, May can't cope. She feels controlled by her diabetes and when those around her try to help, it feels like pressure.

What lengths can the medical team go to to encourage May to take the treatment she needs? Can they force her to take insulin?

Joan Bakewell and her panel discuss the issues.

Producer: Beth Eastwood.

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Under what circumstances can parents donate the organs of their newborn baby after death?

Organ transplants are one of the triumphs of modern medicine. As the field has evolved, views on who can receive organs, and who can donate, have changed.

Elizabeth and Kenny are expecting twins. While one baby looks healthy, the other has anencephaly, a lethal abnormality where the brain fails to develop. Babies with this condition either die in the womb, are stillborn or live for just seconds, minutes or hours after birth. It's possible to terminate the pregnancy of this twin, but the procedure could trigger a miscarriage in the healthy one.

The couple decide to continue with the pregnancy of both twins - a healthy baby girl and a boy with anencephaly. As the pregnancy progresses, it's very emotional for the couple knowing that their little boy won't survive. However, they are keen to meet both babies and spend whatever precious time they might have with their son, before he dies.

Early on in discussions about their son, the obstetrician raises the subject of organ donation. Elizabeth and Kenny are open to the idea. They feel it could enable some good to come out of their son's tragic situation and are keen to explore it further.

Retrieving organs from children for transplant is rare, but it's particularly unusual from newborn babies. It's unheard of in those with anencephaly.

Can Elizabeth and Kenny donate the organs of their newborn baby with anencephaly, after its death? To what lengths can a team go to enable transplantation to take place?

Joan Bakewell and her panel discuss the issues.

Producer: Beth Eastwood.

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When should doctors treat the ailments of people with dementia and when should they not?

Modern medicine has succeeded in treating many of the diseases that kill us and, as a result, people are living longer.

However, as we get older and become more frail decisions have to be made about when to treat the ailments that crop up.

This becomes particularly challenging when a person can't make the decision for themselves, like those with advanced dementia.

Jean is in her eighties and is getting increasingly frail. Each ailment brings another admission to hospital. When should a treatment be given that will prolong her life, and when should it be withheld so that nature can take its course?

Joan Bakewell and her panel discuss the issues.

Producer: Beth Eastwood.

1004 LASTTreating Smokers2014080720140809

Many patients with lung disease receive oxygen therapy to try to improve their quality of life. However, patients with this condition often struggle to give up smoking and continue the habit against medical advice.

Mark has smoked since he was a teenager. Now 67 he has advanced lung disease as a result of his smoking. Despite his worsening ill health and against medical advice, Mark continues to smoke 40 cigarettes a day.

Having oxygen at home also carries a fire risk, so the fire service carry out an inspection at each patient's home. The medical team is concerned as they are noticing an increasing number of patients being treated for burns after smoking whilst using their oxygen in the home.

Our second patient, James, set his plastic tubing alight when he sparked up. The oxygen flowing into his nostrils fuelled the fire and he was hospitalised with facial burns.

Should patients be allowed oxygen therapy if they continue to smoke? Who is responsible for any fire that happens? The doctor? The patient?

And how should the benefit to patients be weighed against the risks for people living nearby who might also be caught up in a fire?

Joan Bakewell and her panel discuss the issues.

Producer: Lorna Stewart.


A dilemma arises for an orthopaedic surgeon when a young woman called Sarah is referred to his clinic.

Six years earlier, Sarah injured her knee in a skiing accident and the intervening years have been dominated by numerous surgical opinions and operations, each followed by months of gruelling rehabilitation.

Despite all this, Sarah's right knee remains unstable. She can't bear weight on it and walks with a limp. Running is impossible and she drags herself up flights of stairs.

With each operation the pain in her knee has increased and she's recently developed back problems thought to be linked to her awkward gait.

Six years of increasing pain and disability are also taking their toll on Sarah's mental health and she suffers from bouts of depression.

Various surgeons have refused to amputate her leg and recommend that she either accept her existing level of disability or agree to further operations.

But Sarah refuses. She doesn't want to live as she is and has lost faith in the medical profession's ability to give her a knee that will enable her to be active. She wants her leg amputated.

The surgeon is caught in a dilemma - he appreciates how she feels but should he amputate her leg?

Joan Bakewell and her panel discuss the issues.

Producer: Beth Eastwood.

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How far should a medical team go to prevent a young woman from ending her life?

Samantha is coping with the recent death of her mother. It's been a turbulent few years - drug binges in her teens, then bulimia. She's now twenty two and is finding it difficult to cope.

She's prescribed antidepressants but stops taking them when she's plagued by terrifying thoughts and images of killing herself. These persist and, over the coming months, she makes two serious suicide attempts and is admitted to hospital several times.

Samantha is detained under the Mental Health Act for her own safety and is diagnosed with borderline personality disorder. The recommended treatment is psychotherapy. She's also offered antidepressants but the team don't think she's overtly depressed.

Samantha refuses all treatment - she's terrified of antidepressants and doesn't want to talk.

Three months on, she's discharged as the team don't think being in hospital is helping her. But her family believe it's the safest place for her.

When Samantha gets home she spends most of her time online on suicide chatrooms. The family monitor her activity and their concerns about her suicidal thoughts trigger further admissions to hospital.

However, the team are reluctant to keep her in hospital for long. They want to encourage her to take control of her life and engage with treatment, which she is still refusing. In contrast to most patients who are suicidal, Samantha seems to have the capacity to refuse treatment.

The senior psychiatrist on the team feels uneasy about the pattern that's emerging. He consults the clinical ethics committee to consider the best course of action. He also wants to know what constitutes capacity in this suicidal young woman.

Joan Bakewell and her panel discuss the issues.

Producer: Beth Eastwood.

Photo credit: Chris McGrath/ Getty Images

1103Withdrawing Feeding In Children2015073020150801 (R4)

Food and water are the very essence of life. But is there ever a time when food and water should be withheld in someone who is not otherwise dying? And what if that someone is a child?

Emma is born with a smooth brain; a life-limiting condition that means she will never develop skills beyond that of a 6 month old baby. Her condition also means she has difficulty swallowing and has to be fed artificially.

As she passes her tenth birthday things start to become more difficult; she increasingly seems to be in pain but the medical team are not sure why and Emma cannot tell them.

Her consultants eventually trace the source of her pain to her intestines and slowly they realise that they can no longer feed her artificially. They are all agreed that feeding must be withheld to ease her pain but they know that would ultimately lead to her death.

Although her prognosis has always been shortened, Emma is not otherwise dying - her heart is strong, her kidneys are functioning, and she breathes without difficulty. Withholding nutrition would bring her life to an end over the coming weeks; should the team be making those decisions in a child who is not already dying?

Joan Bakewell leads a panel of experts to discuss.

Producer: Lorna Stewart

Photo Credit: Joe Raedle /Getty Images.

Is it ever ethical to withhold food and water in a child who is not dying?

1104Teenager Refuses Chemotherapy20150806

Ashley is 14 years old when doctors discover a brain tumour. Tests reveal that it's highly treatable; there's a 95% chance of cure if he has a course of radiotherapy.

Ashley begins the treatment but he has to wear a mask which makes him very anxious and the radiotherapy itself makes him sick. He finds it increasingly difficult to bear and he starts to miss his sessions.

Despite patchy treatment Ashley's cancer goes into remission. He and his mother are thrilled but a routine follow-up scan a few months later shows that the cancer has returned.

Ashley is adamant that he will not have the chemotherapy that is recommended this time. He threatens that he will run away if treatment is forced on him. Although Ashley is only 15 he is 6'2" and restraining him would not be easy.

Should the medical team and his mother persuade him to have the chemotherapy? Or should they accept his decision, even though he is only 15?

Joan Bakewell and her panel discuss the issues.

Producers: Beth Eastwood and Lorna Stewart

Photo Credit: Christopher Furlong / Getty Images.

1203Sharing Genetic Information2016081820160820 (R4)

If you have a life-threatening gene fault, do blood relatives have a right to know?

Andrew is just 33 when he develops bowel cancer. Genetic tests reveal he has a genetic condition called Lynch Syndrome.

Lynch Syndrome has previously been diagnosed in a relative, but Andrew was never told that put him at risk. If he'd known, his cancer might have been spotted sooner and treated.

In a separate case, Lucy discovers that her father has Huntington's disease. She wonders whether to get tested for the gene herself. Unlike Lynch Syndrome the disease can't be treated or prevented so she is unsure whether there is any benefit to knowing.

Lucy's also concerned about what this means for her young son. If she had known about Huntington's sooner she could have chosen not to pass on the gene. But now it's too late - could he carry the Huntington's gene too? How and when should she break that news to him?

Joan Bakewell and her panel of experts discuss the ethics of sharing genetic information. Do doctors have a duty of care only to their patient or also to the wider family? How do they balance their patient's right to privacy with the wider family's right to information that could save their lives?

Producer: Lorna Stewart

Photo Credit: Serge Noel / Getty Images.