Vivienne Parry returns with a third series of Inside the Ethics Committee. She is joined by a panel of experts, who sit on clinical ethics committees, to discuss real-life medical cases.
Programme 1 – Treatment decisions for people who can’t give informed consent. Who decides and how?
This week the panel discusses the case of David, a middle aged man with severe learning difficulties with no family who lives in a residential care home. He has no spoken language and doesn’t respond to pictures used as communication tools.
David has been diagnosed with a lymphoma, a form of blood cell cancer, inÌýhis stomach. Treatment for the condition would involve regular invasive chemotherapy in hospital for hours at a time. It has a 50:50 chance of a cure.
David can’t understand the full nature or consequences of his illness or what treatment would involve. He finds all hospital visits and medical procedures extremely distressing and he needed sedation for a CT scan to establish the extent of his lymphoma.
His clinicians and carers have tried to explain his illness and what treatment might involve.
Ethical issues
- Can David be helped to understand the treatment and so give informed consent to the procedure?
- If David can’t make that decision – who does and how do they decide what is in David’s best interests?
- Is it ethical to treat David when he won’t understand the procedure he’s made to undergo?
- Is it ethical not to treat him when chemotherapy could save his life?
The panel
- Dr John Robertson, Clinical Psychologist and Chair of Clinical Ethics Committee for a Learning Disabilities service, for Nottinghamshire Healthcare Trust
- Professor Tony Holland, Chair in Learning Disabilities, Department of Psychiatry, University of Cambridge
- Dr Deborah Bowman, Senior Lecturer in Medical Ethics and Law St George’s University of London
