Review

Should we do all that is possible?

TRAGIC CHOICES IN HEALTH CARE: the case of Child B
Chris Ham and Susan Pickard
King’s Fund, 1998, £15.00

‘Jaymee’s story illustrates... the conflict that may occur when a concern for cost-effectiveness at the population level coincides with a request for heroic and expensive intervention on behalf of an individual who is likely to die.’

Jaymee Bowen — Child B — was diagnosed as having acute myeloid leukaemia in 1993, having previously been treated for non-Hodgkin’s lymphoma. Despite a bone marrow transplant her disease recurred in 1995 and at this point her care by paediatricians at Addenbrooke’s became palliative rather than curative. This book examines the subsequent battle by Jaymee’s father, David, to get treatment for his daughter, culminating in the decision by the Court of Appeal to uphold Cambridge and Huntingdon Health Authority’s decision not to treat, and Jaymee’s appearance on Panorama.

Although at first sight this appears to be an discussion about justice and allocation of resources, the authors explore the other important issues arising from such a case. Clearly one of the key questions is, who speaks for the child? Although Jaymee was regarded by many as an exceptionally mature nine-year-old, her father had chosen not to inform her of the arguments about treatment, seeing himself as the best judge of her interests. The paediatricians treating Jaymee also saw themselves as acting in her best interests by refusing to implement distressing treatments which had little chance of success. Further conflict arose between clinicians who saw themselves as specialists in treating children and those who were specialists in treating leukaemia. On a broader level, there is clearly a question about who should be responsible for priority setting in the NHS, a debate which was brought into focus by the involvement of the courts and the media in the case.

This book will be of interest to anyone concerned with health policy and decision making in the NHS, presenting as it does a clear and fascinating discussion of the Child B case and its ethical and organisational dilemmas.