‘I wish I knew,’ said the doctor in a rare moment of candour when asked, ‘What do you do with children who don’t want to take the tablets?
‘I wish I knew,’ said the doctor in a rare moment of candour when asked, ‘What do you do with children who don’t want to take the tablets?’
He was talking about Tanya, an HIV-positive teenager who was refusing to take the life-giving anti-viral drugs he had recommended. She’d been born with HIV, her mother had died of Aids when she was still a baby, and she’d been raised by an aunt in ignorance of why she was always falling ill with chest infections. No one in the family wanted her to know.
Can Tanya be treated against her family’s wishes? Should she be told against their wishes? When does a seriously ill child have a say in their care plan? These were the decisions faced by the team of medical and legal experts on Inside the Ethics Committee, Joan Bakewell’s thought-provoking discussion programme which has returned for a short summer run on Tuesday mornings (produced by Beth Eastwood). It’s a classic Radio 4 format — pure talk on a precise topic directed by a highly experienced presenter — although not always accomplished with such perceptivity. Not a slack word, careless expression or idle comment could be detected in 45 minutes of challenging conversation that confronted the difficult ethical realities at the heart of Tanya’s story, the kind of distressing situation that might well be presented to an actual clinical ethics committee on which Bakewell’s programme is modelled.
Bakewell did not just chair the discussion she also guided us gently through the various stages of Tanya’s short life, giving the conversation a narrative arc and turning what could have been a dry and dusty debate into a programme with emotional depth as well as intellectual rigour. Tanya’s health deteriorated, at one time inflicting on her terrifying nose bleeds during which she bled out two-thirds of her blood volume. Still she would not take the drugs that could help her. The experts — a doctor, a lawyer, the director of policy at an Aids trust, and a young person who is HIV-positive himself — were frustrated by their inability to make a difference, but spoke with a refreshing directness about the problems they faced in deciding whether this was a matter for the Child Protection Act.
The contrast with The Moral Maze was stark. That programme has become an instant turn-off, so full of bombast and self-importance. Too much of what is said is based on a wilful lack of factual back-up or thoughtful insight. The questing after a solid answer to questions which are often intractable is at best unhelpful and at worst misplaced. By the end of Inside the Ethics Committee I felt not just for Tanya’s plight but also for the professionals involved in her case. It was as if I had been invited in to share their concern, rather than browbeaten into agreeing with them.
A short series of afternoon plays, also on Radio 4, has been providing another kind of dissection of the issues involved when medicine, ethics and the law come into conflict. I caught a couple of them while driving to and from the hospital to visit a sick parent and was struck by how different they sounded from the usual afternoon fare. Although the dialogue was a bit clunky at times as the writer struggled to blend the fictional situation with the ethics under examination, the drama itself felt true. In Humanly Possible, by Sarah Daniels, we were confronted with two very different neonatal situations as one baby lay brain-dead in an incubator and another born premature at 26 weeks needed the incubator but had to be transferred to a hospital many miles away by emergency ambulance. Which baby should have taken precedence? Who’s to say when the ventilator keeping the first baby alive should be switched off? Who would care to make that decision?
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