The BBC's 'The Big Questions'

[ippy]

There was a discussion about 'Should Doctors Decide When to Withdraw Life-Saving Treatment for Children'.

During the program they had a poor man that had his child on some of this very distressing kind of treatment, bearing in mind I have every concern and compassionate feelings for this man, I did think his presence on the programme was quite restrictive on the people present in the studio on their ability to fully discuss this particular subject without redress to this poor man's feelings.

I found it to be a very interesting debate but it made me feel very uncomfortable knowing this parent was there, I can see there could be some good arguments for or against this chaps presence there, I would be interested to know from anyone on this forum their views whichever viewpoint is taken, mainly about this man's presence.

At the moment I think that this mans presence restricted the discussion but I'm ready to maybe change my mind if ness.

Regards ippy

[Rhiannon]

I didn’t watch it but my gut feeling is that this is a kind of tabloid approach, exploiting the parent for the sake of ‘good teljy’ (something I’ve seen on this programme before).  Arguably though I can’t see how this debate can be had without the voice of parents being heard.

[ippy]

I didn’t watch it but my gut feeling is that this is a kind of tabloid approach, exploiting the parent for the sake of ‘good teljy’ (something I’ve seen on this programme before).  Arguably though I can’t see how this debate can be had without the voice of parents being heard.

The programme producers, I assume, had prepared a short film of the couple with their child where they were able to expound the details and their take on the situation they were in with this child.

I did think it could be very difficult for the people discussing this problem due to not wanting to say things that would or could upset this man unnecessarily, at the same time I thought sometimes there has to be some cold reasoning brought into a discussion of this sort, a very difficult situation altogether, perhaps discussed in camera without the father present and then with the father present on camera, not easy with a popular T V discussion programme.

I thought it an interesting discussion perhaps not ideally suited to be open and on T V, that old saying it would have to be a judgement of Solomon, I don't have the answer, the cost of supporting this poor child was certainly prohibitive.

Regards ippy

[The Accountant, OBE, KC]

There was a discussion about 'Should Doctors Decide When to Withdraw Life-Saving Treatment for Children'.

During the program they had a poor man that had his child on some of this very distressing kind of treatment, bearing in mind I have every concern and compassionate feelings for this man, I did think his presence on the programme was quite restrictive on the people present in the studio on their ability to fully discuss this particular subject without redress to this poor man's feelings.

I found it to be a very interesting debate but it made me feel very uncomfortable knowing this parent was there, I can see there could be some good arguments for or against this chaps presence there, I would be interested to know from anyone on this forum their views whichever viewpoint is taken, mainly about this man's presence.

At the moment I think that this mans presence restricted the discussion but I'm ready to maybe change my mind if ness.

Regards ippy

I saw that segment. I thought he came across very well. For example he said it was really tough caring for his daughter and even though he would not like his daughter to be described as a burden for emotional reasons, he could understand why other parents might decide his situation would too much for them to cope with.

He also agreed with the idea that the interests of other children in the family need to be taken into account when making decisions to continue treatment for a child that needs constant care.

He also said it seemed arbitrary to focus on the money spent on children who did not ask to be born ill when we could just as arbitrarily focus on the money spent on treating more self-inflicted illnesses such as obesity or alcohol-related ill-health, including people treated by paramedics and A&E after getting drunk on Friday and Saturday nights out.   

I took his statement that you can't put a price on a family member's life, as a cultural value - our society's beliefs  do not seem to disagree with his statement. Isn't that how people feel about money and saving lives? So it made sense to me have that statement on the table, and then figure out how to make decisions about withdrawing treatment, given we can't stop parents feeling that way.

The decision to withdraw life support or treatment is supposed to be made by doctors in collaboration with parents and overseen by the courts, presumably because doctors have the expertise to provide clinical information and statistics about what the child is likely to be going through, and the courts are not family members so can make hard decisions when doctors and parents disagree.

We already know that life-saving cancer drugs and treatments available in other countries, or operations, or manpower to provide quality care are not available to people in the UK because of lack of resources for the NHS so even though we like to believe there isn't a price on people's lives, the evidence shows there is a price.

[ippy]

I saw that segment. I thought he came across very well. For example he said it was really tough caring for his daughter and even though he would not like his daughter to be described as a burden for emotional reasons, he could understand why other parents might decide his situation would too much for them to cope with.

He also agreed with the idea that the interests of other children in the family need to be taken into account when making decisions to continue treatment for a child that needs constant care.

He also said it seemed arbitrary to focus on the money spent on children who did not ask to be born ill when we could just as arbitrarily focus on the money spent on treating more self-inflicted illnesses such as obesity or alcohol-related ill-health, including people treated by paramedics and A&E after getting drunk on Friday and Saturday nights out.   

I took his statement that you can't put a price on a family member's life, as a cultural value - our society's beliefs  do not seem to disagree with his statement. Isn't that how people feel about money and saving lives? So it made sense to me have that statement on the table, and then figure out how to make decisions about withdrawing treatment, given we can't stop parents feeling that way.

The decision to withdraw life support or treatment is supposed to be made by doctors in collaboration with parents and overseen by the courts, presumably because doctors have the expertise to provide clinical information and statistics about what the child is likely to be going through, and the courts are not family members so can make hard decisions when doctors and parents disagree.

We already know that life-saving cancer drugs and treatments available in other countries, or operations, or manpower to provide quality care are not available to people in the UK because of lack of resources for the NHS so even though we like to believe there isn't a price on people's lives, the evidence shows there is a price.

Yes not a bad summing up of the pros and cons, I think we all got that, it underlines the difficulty of making the decision in these cases, whatever decision made it'll always be considered wrong by others.

Being stone cold about this man's plight there's only one answer, I wouldn't like to be thought of as someone taking that stone cold approach, the best idea, I thought, was handing these Solomon like decisions over to the courts, I don't know, but they are better able and more used to judgements than the rest of us.

Regards ippy   

[Nearly Sane]

Yes not a bad summing up of the pros and cons, I think we all got that, it underlines the difficulty of making the decision in these cases, whatever decision made it'll always be considered wrong by others.

Being stone cold about this man's plight there's only one answer, I wouldn't like to be thought of as someone taking that stone cold approach, the best idea, I thought, was handing these Solomon like decisions over to the courts, I don't know, but they are better able and more used to judgements than the rest of us.

Regards ippy

It's handed over to judges, rather than courts which might include a jury. And while they are used to judging, hence the title, they aren't really used to this sort of decision. Now I agree that it's the best method we have but it's a hellish job for anyone to make that final decision.

[ippy]

It's handed over to judges, rather than courts which might include a jury. And while they are used to judging, hence the title, they aren't really used to this sort of decision. Now I agree that it's the best method we have but it's a hellish job for anyone to make that final decision.

If you watch the programme via the Iplayer, the audience didn't have any difficulty understanding the idea of putting this kind of decisions to the courts, in fact a lot of them, those on the programme, had some quite sensible ideas on how to approach this problem.

Regards ippy   

[Nearly Sane]

If you watch the programme via the Iplayer, the audience didn't have any difficulty understanding the idea of putting this kind of decisions to the courts, in fact a lot of them, those on the programme, had some quite sensible ideas on how to approach this problem.

Regards ippy

Not sure how that's relevant to judges having to make what are hugely difficult decisions.

[ippy]

Not sure how that's relevant to judges having to make what are hugely difficult decisions.

How come I'm not surprised at what it is you're saying?

Regards ippy

[Nearly Sane]

How come I'm not surprised at what it is you're saying?

Regards ippy

I don't know. You watched the programme, tell me about what you think would help make this a less dreadful decision for any judge?

[ippy]

I don't know. You watched the programme, tell me about what you think would help make this a less dreadful decision for any judge?

You watch it, then you can make whatever you wish to make of this programme.

Regards ippy.

[Nearly Sane]

You watch it, then you can make whatever you wish to make of this programme.

Regards ippy.

Your case,  up to you to justify it.

[The Accountant, OBE, KC]

The court tends to look at the best interests of the patient rather than the money, which is the conversation doctors suggest wider society starts having, according to the Big Questions segment.

So currently the doctors, the close family and the court looks at whether the patient is suffering or they have a quality of life that justifies not withdrawing life-support.

There was a 2017 ruling in the Court of Protection by Mr. Justice Peter Jackson  that it was lawful to withdraw clinically assisted nutrition and hydration from an adult who was not in a 'persistent vegetative state', but who was said to be 'minimally conscious', and that where doctors and relatives agree, these cases can be decided without going to court. I think the Official Solicitor disagreed with the judge's view that it doesn't necessarily need to go to court in these circumstances.

But the conversation that isn't happening apparently is that there are finite resources so how long should expensive life-saving treatments be carried out or continued, if the reality is that the cost of some life-saving treatments deny life-saving treatments to others also in medical need. How to prioiritise treatments if there isn't money for all life-saving treatments?

[Nearly Sane]

Which is surely a different issue on how you decide when have a single decision? And further is just piling Pelion upon Ossa in making any decision even more unpleasant to make?

[The Accountant, OBE, KC]

Which is surely a different issue on how you decide when have a single decision? And further is just piling Pelion upon Ossa in making any decision even more unpleasant to make?

The money conversation is an unpleasant one, but one the doctors seem to want wider society to consider, as apparently doctors are not allowed to broach it. They may well have private conversations that might not have been outed on social media, but they would like the public to start having the conversation.

Since any one of us could be affected by this scenario of lack of resources, what happens if new medical breakthroughs lead to the discovery of new life-saving techniques or drugs but the cost of keeping people alive with a relatively low quality of life means the NHS cannot afford expensive drugs that would give other ill people a better quality of life or would save their lives? I think Big Questions highlighted that doctors want guidelines developed to withdraw life-support on the grounds of cost.

[Nearly Sane]

The money conversation is an unpleasant one, but one the doctors seem to want wider society to consider, as apparently doctors are not allowed to broach it. They may well have private conversations that might not have been outed on social media, but they would like the public to start having the conversation.

Since any one of us could be affected by this scenario of lack of resources, what happens if new medical breakthroughs lead to the discovery of new life-saving techniques or drugs but the cost of keeping people alive with a relatively low quality of life means the NHS cannot afford expensive drugs that would give other ill people a better quality of life or would save their lives? I think Big Questions highlighted that doctors want guidelines developed to withdraw life-support on the grounds of cost.

Is that what doctors as a generalisation want to be considered here?


And where, if they do, is that any answer to what I posted?

[The Accountant, OBE, KC]

Is that what doctors as a generalisation want to be considered here?

It seemed to be what medical ethicists on the Big Questions say doctors want discussed. I don't think anyone is claiming that members of the audience of this programme speak for all doctors.

And where, if they do, is that any answer to what I posted?

What was your actual question?

Does it relate to the Big Questions discussion referenced in the OP? I'm interested in discussing the Big Questions topic as I caught this part of the programme. 

[Nearly Sane]

It seemed to be what medical ethicists on the Big Questions say doctors want discussed. I don't think anyone is claiming that members of the audience of this programme speak for all doctors.What was your actual question?

Does it relate to the Big Questions discussion referenced in the OP? I'm interested in discussing the Big Questions topic as I caught this part of the programme.

Your post said 'doctors', not the medical ethicists, who don't necessarily need to be doctors, on the programme.

My question is even if the medical ethicists on the programme argue that is that an answer to making the decision any easier. You know the question in post that you first answered, that I had asked.

[The Accountant, OBE, KC]

Your post said 'doctors', not the medical ethicists, who don't necessarily need to be doctors, on the programme.

My question is even if the medical ethicists on the programme argue that is that an answer to making the decision any easier. You know the question in post that you first answered, that I had asked.

I'm pretty sure it was a doctor who was part of a medical ethics committee who said doctors wanted this discussed, but I can't be certain without re-watching the programme, which I don't have time to do. I believe the Big Questions discussion was based on this documentary:

https://www.telegraph.co.uk/tv/2018/03/15/babys-life-decides-episode-one-review-a-heartbreaking-documentary/

The father of Tallulah was a guest on The Big Questions, which is presumably the person Ippy was referring to in his OP.

I agree there is no easy answer or currently any way of making the decision easier  - that was why the medical ethicist on the Big Questions thought society should start having a conversation so it is less of a shock when people are deciding what decision to make. Because apparently the current situation of not talking about beforehand in general conversations is making it more difficult for doctors and parents when the situation arises, and especially if it gets sensationalised if it goes to court and it becoming a social media circus, which apparently is making it harder for everyone, with some doctors apparently having even received death threats during court cases.
 

[Nearly Sane]

So no one on the programme said doctors want money to be considered. A person you are pretty sure was a doctor said this wanted to be discussed, and that allows the generalisation you made that doctors want cost to be part of the discussion here? Forgive me, but those two things are not the same.

No idea why you have the reference to the father who appeared in the programme and the link.

Agree with your last para.

[ippy]

Your case,  up to you to justify it.

Why and what?

If this thread is worrying you so much as it seems to be, don't bother with it?

Regards ippy

[Nearly Sane]

Why and what?

If this thread is worrying you so much as it seems to be, don't bother with it?

Regards ippy

that you think the suggestions made by the audience would make it an easier decision for a judge. Any chance of answer or do you want to continue to avoid making your case?

[The Accountant, OBE, KC]

So no one on the programme said doctors want money to be considered. A person you are pretty sure was a doctor said this wanted to be discussed, and that allows the generalisation you made that doctors want cost to be part of the discussion here? Forgive me, but those two things are not the same.

If you want answers to these questions, watch the programme.

No idea why you have the reference to the father who appeared in the programme and the link.

To help you have some idea of what the discussion was about.

Agree with your last para.

Ok. So what’s your view on the cost angle?

[Nearly Sane]

If you want answers to these questions, watch the programme.
To help you have some idea of what the discussion was about.
Ok. So what’s your view on the cost angle?

I was questioning your generalisation, not sure why watching the programme helps. If someone said it on the programme then you have merely repeated the generalisation

I know what the discussion is about, not everything about it is relevant to specific points.


My take is that cost isn't what determines the decision in courts, nor can it can be for judges because that then makes the decision even worse. If you want to say to a judge it's either this baby being kept alive for x months or two city year olds for x/2 months then that's making a shite decision even more unpleasant.

[ippy]

that you think the suggestions made by the audience would make it an easier decision for a judge. Any chance of answer or do you want to continue to avoid making your case?

I'm not aware I was making a case, looks like you may have misread or misunderstood my previous posts?

Regards ippy