Using a mock trial to make a difficult clinical decision

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.

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.