Should Shattered be allowed?

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Should Shattered be allowed?
Trisha McNair, a doctor on the ethics panel that advised the programme-makers, on the quandaries they faced.

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The Guardian, Tuesday 6 January 2004

The producers of Shattered are hailing the week-long programme as a great experiment, where some risks such as hallucinations and paranoia are predictable but where there is also the possibility that anything may happen. It promises exciting viewing - but is it right to let people risk their health on a primetime TV show for the chance of winning a fat cheque?

Actors are protected by their unions, while those enrolled in medical research are protected by strict protocols agreed by ethics committees before a study is given the go-ahead. But until now little thought has been given to the health of reality TV guinea pigs. For this series, Endemol (the producers of Shattered) took the unprecedented step of putting together an independent ethics panel to advise them on protecting the wellbeing of those taking part. The panel consists of the director of a leading sleep research centre, a professor of psychology, a health and safety expert and myself, a doctor with experience in medical ethics and law. Together, we had to examine how far the producers could be allowed to torture their participants in the name of entertainment.

One of the fundamental principles of medical ethics is that of informed consent - that people should be competent to make a voluntary and informed decision about taking part, understanding the risks and benefits at any stage of the programme. Guaranteeing that consent is truly informed can be difficult especially when the effects of sleep deprivation are unpredictable. Participants had to be fully briefed about the risks that were likely to arise.

After detailed discussions, we on the panel recommended a range of health and safety measures, including banning alcohol from the set, maintaining humidity within the studio (to prevent excessive dryness of eyes held open for long hours under hot studio lights), and making sure that everyone involved was aware of the small but significant risk that sleep deprivation may trigger epilepsy in predisposed individuals. Endemol had already arranged for 24-hour cover by a medical team; we insisted that they should be fully briefed on the particular problems of sleep deprivation.

Our main concern was with the potential for psychological problems, and also the implications these had for consent. People lose the ability to act and think coherently after being substantially deprived of sleep. Because of this, they may not be competent after about four days to make sensible decisions about their participation. For this reason, we insisted that arrangements be made for an independent advocate to act for the individual when necessary after this point.

The production company's initial plan to use a viewer's voting system to allocate small "punishments" to participants was vetoed by the panel, because we felt this could induce an unacceptable state of helplessness. Endemol had also thought of using mild electrical shocks attached to door handles during challenges, or even to toilet seats to waken participants seeking a quick snooze in the loo. But we felt this could cause fear and unnecessary suffering, and would convey inappropriate messages about the safety of electricity to the audience. So the production team were left to dream up alternatives.

The possibility that medical problems might come to light during the programme raised the issue of confidentiality, and it was important that participants were aware from the start about these issues. Plans to film participants in the toilet also worried the panel, although the production team reassured us that this footage would not be broadcast unless the participant fell asleep there.

Throughout the programme, the dignity and well-being of every individual participant must be a priority, and every effort should be made to avoid psychological humiliation. Each participant had to be clear about the rules, how elimination was decided and what would happen if the medical experts felt it was not appropriate for them to continue.

Finally, the panel insisted that some sort of post-show care was needed. Sleep deprivation is intensely stressful, with unpredictable short- and long-term effects. It's important to ensure that each eliminated participant is fully rested before returning to the dangers of the outside world, while a follow-up a few weeks later should reduce the risk that the stress of taking part leaves an indelible mark. We wait to see if those marks will appear.

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