The ethics of Surgery Live

'The Operation: Surgery Live is an extremely exciting project designed to educate and inspire people that watch it.

'However the idea of doing surgery live and allowing the audience to interact with the surgeons could be controversial.

'Below are two contrasting expert opinions.'

David Glover, Commissioning Editor, Science
Channel 4

Operating in public

Francis Wells is a consultant cardiothoracic surgeon at Papworth Hospital in Cambridge. On Monday 25th May, Francis performed the first Surgery Live operation - open heart surgery. Here, Francis tells us why he's happy to operate in front of a public audience.

'Whoever the audience is, one thing is key. It is a matter of making sure in everybody's minds that the most important person in the room is the patient. Nothing else matters.

'It is a patient's right to say no right up to the moment that they go to sleep. And when you put it like that, they are usually very happy to help. People are very generous providing they know why you do it. They trust you and they know you will look after them.'

Why perform to the public?

'I do not think that the human body should be the province of only specialists. Every living person has a body, and I believe they have the right to know about how it works. The more people know about their anatomy and physiology, and see what a beautiful, delicate, incredibly wonderful structure it is, the more likely they are to look after it. Most people have no idea about what goes on inside them at all. The subplot is that I think it's good for people to know the sheer care and dedication and level of skill that's brought to bear in surgery. So that if ever it happens to them, they can go in with confidence knowing that they will be looked after.'

The effect of having an audience

'In fact, performing open heart surgery with a video link is commonplace in hospitals. I do a lot of teaching and because in an operating theatre you cannot have 20-30 surgeons gathering around, I run video-based courses. So I commonly have surgeons in a lecture theatre in another part of the hospital and then I do what I normally do and I have myself 'miked up' so they can ask me questions.'

Bread and circuses

Professor Tony Hope is Professor of Medical Ethics at the University of Oxford. Here, Tony describes the key ethical issues he feels should be addressed when broadcasting these live operations.

'Much reality TV is about as natural as a Disney cartoon. But the OJ Simpson trial was real enough and provided theatrical entertainment for millions of willing viewers. The judge in that case is said to have been affected by the TV presence.

'Now the TV camera is being brought live into the operating theatre. What motivates a surgeon to appear real time in front of millions of viewers, the life of a patient in his hands? And why do people watch - for education, or for entertainment, and what do they hope they might see?

'These questions of motivation may be pertinent in assessing character but they are not, in my opinion, relevant to the question of whether this form of reality TV should be allowed, or under what conditions. Such mind reading is a stage too far even for Big Brother. The major ethical issues concern the interests of the patients, and in particular their privacy and safety interests.'

Privacy interests

'No patient should be exposed in this way unless she has given valid consent. This requires first that the patient is fully informed of what is going to happen and what the risks and benefits of this TV exposure are. Second the patient must have the capacity to understand the issues and decide for herself. And third the consent must be given free from coercion.

'The patients being shown in this programme are over 18 years old. I predict that soon there will be interest in showing operations on children. At what age can a person consent? In England, a 16 year old is presumed to have the capacity to consent to the operation, and younger children may have capacity. Should the age for consent to have the operation televised be any older, or younger?

'My main concern, however, is the third criterion. Might the patient feel under pressure to consent? She is hardly likely to feel at her most assertive when needing an operation, and would do well not to cross her surgeon. And her family might be attracted by the frisson of publicity. 'What about payment? Some argue that payment acts as coercion. I disagree. An adult with capacity who has privacy concerns can decide for herself whether any money on offer makes the breach in privacy worthwhile. Indeed, since the patient is a key, if rather passive, actor in the whole entertainment, and much money is being made, should she not be paid a decent sum?'

Safety interests

'Even more crucial are the safety interests. The patient should not be harmed as a result of televising her operation. Will the surgeon operate as safely under the glare of the TV lights and in the knowledge that everything he does is being watched by millions? Will the questions posed by the live audience be a distraction?

'The surgeon might think that he will not be affected. Many people believe their driving is unaffected when they chat on their mobile phones: but they are wrong. In these days of evidence-based medicine, do we not need evidence based reality TV?

'Perhaps most important of all: what if something goes wrong? As an airplane passenger I don't think I would like my pilot to be live on TV when two engines fail just before landing.'

Response from David Glover

'I feel Tony Hope makes excellent points. I wish to re-assure readers of this that many of the specific issues that he raises are exactly the issues that have been focused on during the pre-production of this series. We have designed the production so that the patient's welfare is paramount and have safety procedures and protocols in place such that the surgeons and Hospital Trusts involved are satisfied.

'As for whether this is "Bread and circuses" - it isn't meant to be... but I suggest you all watch and interact with the programmes and judge for yourselves.'