Ann Westmore: So how was that resolved within the University, the Hospital and paediatrics more broadly?

Henry Ekert: John's support from the Anti-Cancer Council of Victoria and importantly the establishment of COSA [the Clinical Oncological Society of Australia] enabled his work to flourish and attract support. From that beginning, the results improved and the support of colleagues followed to the point where ethics was no longer an issue.

Ann Westmore: Presumably that same sort of dilemma arises now where a treatment causes suffering and provides minimal assistance to patients in the first instance, but shows promise for the longer term. Can someone clarify the mechanisms now within the hospital to deal with this situation?

Durham Smith: That situation would be dealt with by the Hospital Ethics Committee.

Frank Oberklaid: Ideally, we would have Ethics Rounds at the Hospital where clinicians would present particular cases to a panel including their peers, ethicists and ministers of religion. The rounds would be open to the entire Hospital and University community. Clinicians would be exposed to a debate that they would incorporate into their thinking, without any obligation to do one thing or another. I've seen this sort of thing work successfully in hospitals elsewhere.

Bernard Neal: Two more quick examples. One is child abuse, where there are many ethical problems. Do you send the child, you suspect of being abused, home and when do you involve the police? The other one is in the neonatal ward; when do you turn off the treatment for a very small premature baby? The extent of treatment for sick newborn is a very important matter.

David McCredie: We started a very similar thing - a sort of brainstorming - on the issue of when to use dialysis and transplantation in renal failure. We had a lot of things to contend with regarding treatment of newborn. It was a very difficult problem.

Glenn Bowes: The clinical ethics thing is still unresolved today, the journey hasn't been completed. But there’s a theme that seems to come through the Colebatch example and David’s example. And Peter Phelan might like to speak about cystic fibrosis. There’s a sense that there were a whole range of illnesses in childhood, in which it was felt we should let children die peacefully rather than intervene. Is it only the leadership for change that came from the Children’s Hospital and/or the University members involved, or both, that actually gave rise to the persistence, the doggedness, to actually continue?

Peter Phelan: I think that's true. Certainly when I started my paediatric training in another part of the country in about 1963, there was a much more pessimistic view of a lot of other illnesses. The attitude to leukaemia was that it was unfortunate when a child died within 24 hours of diagnosis, and with cystic fibrosis you didn’t try.

Coming to Melbourne, it was quite clear that there was already a different attitude, already starting to treat children humanely but to do all that's possible, remembering, first to do no harm. There was a dramatic change in attitude that rapidly spread during the late 1960s and early 1970s. There were many people who were criticized, including Doug Stephens for some of his surgical research. But that was the only way we made progress. And at the Children’s there was a supportive environment and, I suspect, Vernon was the key person in providing that supportive environment for people to try something new.

A number of things that turned out to be very successful would, I fear, in today's environment, not get ethics committee approval. And I think that’s very worrying.

Witness to the History of Australian Medicine