The Purvis Society was delighted to welcome Dr Sara Paterson-Brown, Consultant Obstetrician and Gynaecologist at Queen Charlotte’s Hospital, London, to the third of this term’s Dr Sara Westcott (1 of 6)meetings.  Her theme was “A Doctor’s Day in the Life of Ethical Challenges” and, with the aid of some excellent slides and prompted by a PowerPoint presentation, she held her large audience in the palm of her hand for well over an hour.

She began by introducing herself, and then reminded us that “ethics” effectively represented a code of moral principles derived from a system of values and beliefs; it is the study of ideal conduct that, over the last 30 years (since she did a post-graduate year on “Medical Ethics and the Law”), has changed in the medical world more than one could possibly have imagined.  It has become a “code of moral principles derived from a system of values and beliefs and evidence; ideal conduct that changes with time as science advances”.  The IVF programme, viewed as morally reprehensible in 1985, is now an accepted and celebrated, treatment for infertility, for instance.  Medical decision-making, she informed us, meant that reasoning and judgement are applied to general ethical principles to help to direct one in specific cases, and it is the specific cases that act as a test for the adequacy of our principles.  She suggested that one has to expose oneself wholly.  For example, “If you don’t agree with euthanasia, don’t avoid the geriatric ward” and “If you agree with it, don’t avoid meeting the doctor asked to do the deed”.  Ethical principles were briefly touched upon: the sanctity of life – ‘life is sacred’ but at what cost?  Utilitarianism, good versus bad for the greatest number; autonomy – promoting the individual; religious beliefs; rights; the double effect – the end justifies the means; acts and omissions – killing versus not saving.

With her audience now fully briefed (and hooked), she embarked upon a series of moral dilemmas, all taken from her long time as a clinician.  After these difficult situations (and several others – the pace of the evening was hot!) the audience was faced with one final dilemma: a junior doctor is allowed to ‘go solo’ for his first surgical procedure. Should he tell the patient?  Pretty obviously the answer to this is no but Dr P-B then explained some – massively reassuring – detail concerning the training and safeguarding of junior doctors…

Finishing with a splendid picture of foetal feet, she came out with the following wonderful statement: “I love feet, baby feet (adult feet are disgusting); if I can see the feet then I have something to get hold of and the baby will be born.”

The audience had been enthralled and the applause was loud, sincere and long-lasting.

JCEM