Intended for healthcare professionals

Education And Debate

Tragic choices in health care: lessons from the Child B case

BMJ 1999; 319 doi: (Published 06 November 1999) Cite this as: BMJ 1999;319:1258
  1. Chris Ham, director (
  1. Health Services Management Centre, University of Birmingham, Birmingham B15 2RT
  • Accepted 5 July 1999

Four years ago the case of Jaymee Bowen, more commonly known as Child B, captured the newspaper headlines. The coming together of a father who was determined to seek the treatment he believed was best for his daughter, doctors who disagreed about what treatment was appropriate, health service managers who were prepared to take a stand on the use of resources on services of questionable effectiveness, lawyers willing to test the decision of the health authority in the courts, and journalists who saw the case as exemplifying the dilemmas of health service decision making meant that Jaymee's story caught the public imagination and highlighted the challenge of rationing.1 The way in which the case was handled contains important lessons for decision makers in health authorities and primary care groups charged with making difficult choices in health care.

Summary points

The Child B case showed that decisions on funding experimental and costly treatments raise ethical and practical dilemmas

Concern to use resources for the benefit of the whole population has to be weighed against the urge to respond to the needs of individuals

The decision making process must be rigorous and fair

Decision makers should explain the reasons behind decisions, show that these are relevant, give the opportunity for appeal, and ensure the process is regulated

Not all these conditions were fulfilled in the Child B case—health authorities and primary care groups should learn from this experience

Jaymee's story

To understand the significance of the case it is important to recount some of the detail of what happened at the time. Jaymee Bowen was an articulate and lively 6 year old when, in 1990, she was diagnosed as having non-Hodgkin's lymphoma. She was treated at Addenbrooke's Hospital in Cambridge, but in 1993 was diagnosed as having a second cancer, acute myeloid leukaemia. Jaymee underwent …

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