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Divisive dilemmas

How do sixth-formers react to questions of medical ethics? Corinne Julius reports

Who should have the transplant: a 19-year-old with a drug habit or a company director of 45 with a wife, two children and 12 employees? This was one of the questions put to 170 sixth-formers at a conference on medical ethics held recently at the Barbican in London for pupils from the City's girls' and boys' schools.

"We are trying to raise pupils' awareness of the issues of medical ethics which are frequently in the press," said Dr Yvonne Burne, headmistress of the City of London School for Girls.

"Many of the pupils attending the conference are planning careers in medicine, science or law and decisions on priorities within their future fields will be very much part of their everyday life," she said.

The chairman, Professor Heinz Wolff of Brunel University, set students thinking by recounting his own experience of life-saving, but expensive medical treatment. "Four years ago I was declared technically dead, yet three days later I was back at work. I could have been given a riskier and considerably cheaper drug treatment, but Pounds 50,000 was spent on giving me a defibrillator. If the choice had been left to me, I would have preferred the money go to others. What would you have decided and would you have reached the same decision if it had been your mother?" The pupils came from diverse backgrounds and what seemed initially straightforward decisions became influenced by cultural, ethnic and religious values.

Ruth Deech, chairman of the UK Human Fertilisation and Embryology Authority, discussed fertility: "Initially IVF was a novel and frightening technology. Louise Brown (the first test-tube baby) was an oddity 20 years ago, but today, in the UK alone, there are over 20,000 IVF children, so how do we decide on new medical advances and their acceptability?" Commenting on the case of Diane Blood, whom the authority initially refused the right to conceive using her dead husband's sperm, she said: "We were, and remain, very concerned about the human rights of the unconscious or dying patient. Had the requirement of consent been over-ridden we would have faced what I call the M25 scenario. Many thousands of young people die every year in road accidents; what would we do if their relatives or friends arrived at hospitals claiming the right to have them cut open to extract sperm or eggs for storage in order to be able to produce children in the future?" Broadcaster and academic Dr David Cook challenged delegates on the ethics and possible consequences of searching for a gene for homosexuality. Raising the idea of a card that would give an individual's medical history at a swipe, he suggested it would also reveal information that could affect employment or insurance.

He described the critical shortage of organs for transplant, and students were both appalled and delighted by his recommendation that the ideal 18th-birthday gift could be a personally matched genetic pig to provide spare parts as required.

Medical professionals accompanied each group and the discussions in the workshops that followed became heated as moral dilemmas revealed themselves. In most groups the initial reactions were emotional and intensely personal. Age was considered by one group to be the most appropriate criterion for limiting treatment and suggested a cut-off point of 25, which they rapidly re-evaluated when they considered how close they were to it themselves. Fifty was also rapidly reconsidered when it was suggested that this would exclude many of the group's parents.

Decisions that had been obvious and easy became tortured balancing acts between the ideal and the resources available, and discussion centred on how much money the state should spend on individuals' rights.

Aspiring medic Julianne Jesuthasan summarised the pupils' feelings: "The conference exposed me to moral and ethnical issues that I will face daily. It made us understand how we all believe that our views are right, but that the viewpoints of others can be equally valid and that you have to go on asking questions."

And who should be given the transplant? Against their expectations they chose the 45-year-old.


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