The first programme in the BBC Radio 4 series Inside The Ethics Committee tells the distressing, real-life 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. He has a pregnant wife and two small children.
Chris was referred by his GP some four months after diagnosis and the surgeon expects to meet him for his pre-op consultation. He was previously offered keyhole surgery to remove the kidney on three occasions at another hospital. Each time he would cancel, a day or two before, using different excuses. Given the four month delay, the surgeon is extremely worried that Chris’s cancer could have already spread. He needs to operate on him as soon as possible.
It becomes apparent, when the surgeon meets Chris, that he is terrified of going under anaesthetic. The surgeon discusses his fears and reassures him. Chris agrees that he needs the operation and promises to come in on the following Tuesday for surgery. But again, a day or so before, Chris calls up and cancels, saying his mother has had a stroke. The staff are not sure whether this is true or just an attempt to get out of the operation. Each time he misses an operation, half a day of operating time, involving a fully-staffed operating theatre session, is wasted.
The medical staff are deeply frustrated and worried for this man. But they are also slightly afraid of him. Chris can get defensive when cornered on the issue of the operation.
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’ rights, given that 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; is it fair to keep diverting resources away from other patients in this way?
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First broadcast: Thursday 16 Jul 2009 on BBC Radio 4
Inside The Ethics Committee in more depth:
OU on the BBC: Inside The Ethics Committee - Transplant
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By Mike Lacon via Flickr under Creative Commons licence
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