Inside the Ethics Committee 2010 - Treating sick children

Updated Tuesday 27th July 2010

Episode 2: Tanya has a life-threatening illness that slowly revealed itself in childhood. How much could she be expected to understand what was happening?

Joan Bakewell is joined by a panel of experts to discuss the case of Tanya who is nine years old. She contracted HIV from her mother at birth who then died when she was an infant. She has been raised by her aunt ever since.

Despite repeated attempts by the medical team to get Tanya to attend the HIV clinic for treatment, her aunt refuses to take her. Home visits reveal that Tanya is poorly grown, she is wetting the bed, and bouts of illness are keeping her from school.

Inevitable

As the months go by, the medical team become increasingly worried about Tanya’s health. She desperately needs medication to keep the virus at bay, but Tanya’s aunt doesn’t agree. There’s a huge stigma around HIV in the family. Having watched many relatives die from the virus, including Tanya’s mother, her aunt believes that medication is useless and death is inevitable. Without her aunt’s support, it’s difficult to get Tanya to take her medicines regularly.

The team are also concerned that Tanya doesn’t know that she has HIV. Her aunt wants this to be kept from her. But Tanya is approaching adolescence. To avoid the risk of sexual transmission to others, it is imperative that she is told before she becomes sexually active.

Wider community

What should her medical team do? How can they ensure that Tanya receives potentially life-saving treatment when her aunt is not in agreement? Tanya might take her medication more readily if she knows what’s wrong with her. But, given her aunt’s reluctance, should she be told? When Tanya becomes sexually active, what responsibility does the clinical team have to the wider community?

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

 

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