As part of its commitment to fostering public dialogue, WHYY's Health and Science Desk sponsored a community ethics discussion Monday night. Participants were given two medical dilemmas and worked toward a consensus on how to solve them. 

The first scenario focuses on end-of-life care.

"Imagine a fellow named Jim Davis," said WHYY's executive director of news and civic dialogue Chris Satullo, introducing the case.  "[Jim] has colon cancer, goes into the hospital, has some complications and ends up with kidney failure and he's in what the doctors feel is a persistent vegetative state, he needs a ventilator and a feeding tube, the belief is without those he'd die."

The patient's doctors want to remove life support, but his daughter doesn't. What to do?

At one table, Michael Prell, a web developer from Germantown, speaks up.  

"The question is should the family's wishes here supersede the judgment of medical staff?" said Prell. "One question I have is other than life or death, what is the guidance for that question? Are there other points during medical care when the family has that control?"

The consensus at this table is the daughter gets to make the legal choice. But health-care workers had a responsibility to educate her about the quality of her father's life. Marcia Coleman, a retired physician from Bala Cynwyd, argues doctors should help her realize she wouldn't need to feel guilty if she removes life support.

"I mean the ethics committee might make a decision, but they would be working with the family," said Coleman. "They would be intensively, and offering her comfort. She needs comfort, not just being harassed about making a decision."

End-of life care is an intensely personal decision, but after the talk Michael Prell said the public discussion about was a good mental workout.

"There's this thought that the family is always right, and the people closest to the situation know the most, but I don't know if that's necessarily true," said Prell. "I think it's good to develop patterns and models for thinking through all these issues when they're not you're issue."

The next case study looked at face transplantation, asking if transplants are ethical when they are risky, and not strictly life-saving. University of Pennsylvania medical ethics professor Art Caplan introduced the case.  

"So some issues in face transplantation, one is it's still pretty experimental, it's only been done a little bit around the world," said Caplan.  "Second, you have to take immunosuppressive drugs, powerful drugs the rest of your life, its a foreign tissue to you.  A third issue, who do you use as donors?"

At first the story seemed like science fiction to Andrea Leerman, a consultant at Temple from Bala Cnywyd.

"And yet what struck me in part about that conversation, well two things, one was that a few decades from now that might not be science fiction," said Leerman.  "You know, there was a time when heart transplants seemed the same way."

Second, and the big issue for many at the event, was not about whether we should perform face transplants, which many said seemed like an inevitability, but who should pay for them.

"We're really going to be coming to push comes to shove over quality of life issues, insurance coverage," said Leerman. "It's something that we're avoiding, it's the classic white elephant.  At some point we're going to have to make some hard choices about where do we spend our money."

Penn's Art Caplan said though face transplants aren't likely to become all that common anytime soon, now is the time to have a public dialogue about them.

"Sadly for a lot of medical innovations, baboon heart transplants, the artificial heart, the first heart transplant, nobody talked about anything, and the issues unfolded as people began to move the technology along," said Caplan. "I think having the conversation, ethical, legal, before the technologies get too far along is a much more prudent way to handle them."

On sticky ethical issues, Caplan says there's no such thing as talking too much.