Us Reality Show Crosses Ethical Line

In discussions over what broadcasting’s ultimate depravity would be, the consensus has usually settled around two scenarios: the televising of an execution, and a gameshow in which cardiac patients compete for a transplanted heart. The first has been pre-empted by the internet (where pseudo-judicial murders from the Middle East have been screened), and the second will soon be brought closer by American network television. ABC is preparing a series in which "an elite team of physicians" will submit volunteers to "breakthrough procedures". The apposite titles This is Your Life and Survivor having already been used for other formats, the show will be called The Miracle Workers.

The series is still at a stage where, as they say in TV, the treatment is being written, so casting (or perhaps plaster-casting) is not complete. But the International Essential Tremor Foundation reports on its website that ABC is seeking patients with this neurological condition to undergo the experimental technique of "deep brain stimulation". So presumably feelers are also being put out to bodies representing other chronic and hard-to-treat conditions. The rules seem to be that participants will not be charged but must agree to every stage of their treatment being followed by cameras. There is therefore the possibility of deterioration (or, in an extreme case, death) taking place before an audience of millions.

My instant symptoms at the prospect of The Miracle Workers are nausea and sweating. I can see that an easy case in favor can be made. Medical procedures have been a commonplace on television for years: birth, death, circumcisions, vasectomies and every form of transplant have been screened in peak time. Professor Robert Winston cleverly used television documentaries about his patients to increase the profile and funding of fertility medicine.

A second defense would be intention. Most of television’s innovations increase the medium’s level of malevolence, Big Brother being a perfect example. But even Hippocrates might agree that it is better for trained physicians to treat consenting patients on screen than for the mentally unstable and recovering addicts to be locked in a house without their shrinks or support groups, as routinely happens on Celebrity Big Brother.

So The Miracle Workers, it can be argued, is benevolent television: merely a clinical version of makeover programs such as Home Front, Changing Rooms and Ground Force, where telly pays for people to address their external furniture. ABC’s series will now work on the internal. Perhaps there will even be a similar climactic "reveal" sequence in which the volunteer is asked what they think of their new digestion, erection or shakeless hand.

All these justifications, though, raise troubling ethical questions. Crucially, when Winston put childless couples on Horizon, or filmed the last stages of life in The Human Body, medical consent and television consent were separate issues. You could receive IVF without agreeing to be on TV; the terminally ill patient would not have been denied morphine if he had suddenly become camera-shy at the end.

The line The Miracle Workers seems to cross is that, for the first time, you only get the treatment if you agree to be on TV. It’s true that this seems more shocking in a British context than an American one, where there is notoriously no general right to medicine. If the BBC or ITV proposed a similar show it would seem to be an affront to the NHS. But ABC can argue that its program is merely an extension of private medicine, with the remarkable twist that these patients don’t have to pay.

However, all these excuses are merely placebos, because the strongest objection to The Miracle Workers, as with most reality television, is that it swaps pain (loss of dignity and privacy) for gain. And for a sick person to have to be filmed is a rather different transaction from an Essex girl risking humiliation in the hope of a recording contract, because privacy is a fundamental principle of medicine. Although the ideal is sometimes breached (most grievously in the case of mixed-sex wards in hospitals), the right to keep illness and treatment secret is morally and legally required of doctors with a force otherwise matched only by the Catholic seal of the confessional and the 30-year rule for political secrets.

The argument that the patients have agreed to treatment doesn’t work because it is coerced consent, encouraged by their desperation to be better. The comparison with home-makeover shows also breaks down here because, if the wrong shade of Dulux or an ill-advised water feature are used, reversal is easy enough. But what if you’ve had your guts replumbed or been given a face transplant?

In recent years, two infections have spread through television like MRSA in a surgical ward: the invasion of privacy, and an attitude of almost governmental arrogance towards intervention in people’s lives. In The Miracle Workers, these viruses seem to have come to their crisis.