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Using a mock trial to make a difficult clinical decision.

¹British Medical Journal, London.

BMJ (Clinical Research Ed.)

|November 21, 1992

Summary

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A mock trial determined that bone marrow transplantation (BMT) should not be offered to all children with symptomatic sickle cell disease due to its risks and the inability to predict patient outcomes.

Area of Science:

Medical Ethics
Hematology
Clinical Decision-Making

Background:

Clinical decisions are often made with limited scientific evidence.
Expert consensus is one approach to address this uncertainty.
Legal processes can also be utilized to analyze complex medical questions.

Purpose of the Study:

To explore the use of a mock trial to decide on a controversial clinical intervention.
To evaluate the ethical considerations of offering bone marrow transplantation (BMT) for symptomatic sickle cell disease in children.

Main Methods:

A mock trial was conducted involving legal professionals and expert witnesses.
A jury was presented with evidence regarding the benefits and risks of BMT for sickle cell disease.
The trial focused on whether BMT should be universally offered to symptomatic children.

Keywords:

Professional Patient Relationship

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Main Results:

Bone marrow transplantation offers a potential 90% cure rate for sickle cell disease.
However, BMT carries a 10% risk of death or severe disability.
Doctors cannot accurately predict which children will experience severe sickle cell disease complications.

Conclusions:

The jury reached a majority decision against offering BMT to all symptomatic children with sickle cell disease at this time.
The decision highlights the challenges in balancing potential cures with significant treatment risks when scientific information is incomplete.