This is just one of the dilemmas examined by a medical ethics expert in a fascinating afternoon of BBC Radio 4 programmes, beginning with a drama and concluding with a discussion of the issues raised.


Some landmark legal cases turn on a careful balancing of the rights of the patient being treated and those of either society or sometimes the state.

These cases, which can lead to significant changes in the law or interpretation which have consequences for thousands of other patients, are examined by Deborah Bowman, professor of Ethics & Law at St George's, University in London.

A special ‘Test Case’ is dramatised in a BBC Radio 4 programme before a panel, two members of which were directly involved in the case, discusses the pros and cons of the circumstances around the case.

The programmes examine the case of ‘Mr C’, a patient with schizophrenia at Broadmoor secure hospital, who had developed gangrene in his foot.

Professor Nigel Eastman, an honorary consultant forensic psychiatrist at St George’s, University of London, who gave evidence in the original case also takes part in the first show.

The riveting case has changed the way doctors and patients make decisions about people’s medical treatment.

Professor Bowman said: “Every day, doctors and patients make choices about healthcare. Most of us take the freedom to decide what happens to our bodies for granted.

“Yet, few people will be aware that the right to choose our medical care originates in an extraordinary story: that of a man known only as Mr C”.

He disagreed with doctors who wished to amputate his diseased foot and the subsequent legal battle changed the way the law and medicine understand mental capacity.

Prof Bowman explained: “Mr C listened carefully to the surgeon’s advice before politely explaining that he did not want his foot to be amputated. It was a response that divided the doctors and led to a landmark legal decision.

“Mr C’s psychiatrist, who had known him for many years, was of the view that Mr C was unable to make a valid choice about surgery. But Mr C’s surgeon disagreed with the consultant psychiatrist.

"He pointed out that amputation is a significant operation and that many people express reluctance to undergo the procedure, even when it is medically indicated.

“The question was, said the surgeon, not whether doctors agreed with Mr C’s choice but whether he had the capacity to make a choice at all.

“Mr C had inadvertently caused an ethical standoff. It was a conflict between paternalism and respect for autonomy. The only way to resolve the impasse was for Mr C’s case to be considered by the High Court.”

The programmes will be broadcast on Tuesday February 4 2014 beginning at 2:15pm. For more details see: BBC 'Test Case' website.