Inside the ethics committee. 4/4.

Radio documentary presented by Joan Bakewell about ethical dilemmas, discussed with the help of a panel. In this episode she asks about how far medical intervention should go into critical illness. The story involves John who, as a teenager, was diagnosed with a serious version of pulmonary hypertension. He has to have a lung transplant, take anti-implant rejection medication, monitor his health, and use a mini-lung function machine at home every day. He didn't do all of this perfectly, but he was well for the first few years. Five years later he has Bronchiolitis Obliterans syndrome diagnosed, and a decision has to be made over whether he can, or should, have a second lung transplant. The studio panel is introduced: Dr. Joe Brierley, consultant of paediatric intensive care at Great Ormond Street Hospital, Deborah Bowman, professor of ethics and law at St. George's, University of London, Professor John Dark, consultant in cardio-thorassic surgery at the Freeman Hospital in Newcastle, and Dr. Antonia Cronin, consultant nephrologist at Guy's and St. Thomas' Hospital. Facts and figures on lung transplants, including those in children, are discussed along with lifespan probability, pulmonary hypertension and drug treatments. John's growing independence is considered, with Antonia Cronin, remarking that previously many decisions have been made for him. Ethical issues are discussed in relation to the ownership of decision making and age. His waywardness with his medication (although this is quite normal in all ages) and the ethics of redo transplants are discussed. John Dark talks about unacceptable risk when looking at transplant medical criteria, and the duty to all patients on the waiting list, with one of the biggest causes of organ failure being failure to take medication properly. In the story, John has a second transplant, but becomes increasingly ill over the next few months, and needs dialysis. He remains in paedicatric intensive care. His medical team begin to feel that they are no longer working in his best interests as he is in great pain. It is also unusual to have someone who seems like an adult, making their own decisions, in the paediatric IC unit. They take their concerns to the Clinical Ethics Committee. The studio panel discuss the second transplant and how the situation has developed. Antonia Cronin considers that John's best interests have to be considered. She says it is difficult to reconcile that sometimes death is in the best interest of the patient. They discuss the ethics and actuality of when you tell someone, particularly a young person, that they are dying and how treatment is withdrawn. The panel discuss whether he needs to be told he's dying if it's inevitable. The panel say that children and young adults need to trust in the process of what is happening and be part of it. This is important for future patients of the same medical team too. Withdrawal of treatment is then discussed. The panel think they would support the family and involve John completely allowing him to have a dignified death. In the story, John decides he wants to die and has the chance to makes his wishes, such as funeral arrangements, apparent. A few weeks later, his dialysis is switched off and he dies.