Bioethics Think Tank Rejects Infanticide
The Nuffield Council on Bioethics, an independent United Kingdom bioethics think tank, has issued its recommended guidelines for the treatment of prematurely born infants. The very good news is that it rejected infanticide out of hand: "The Council has concluded that the active ending of life of newborn babies should not be allowed, no matter how serious their condition. The professional obligation of doctors is to preserve life where they can. If doctors were to be permitted actively to end the lives of seriously ill newborn babies, there is a risk that the relationship between parents and doctors would be negatively affected. It would also be very difficult to identify an upper age limit beyond which actively ending life would not be allowed." Bioethicists being bioethicists, I guess they couldn't just say it would be morally wrong.
The Council also suggested that infants born at 22 weeks gestation or earlier not be given intensive care unless as part of medical experiments. At age 23 weeks, it urges that no intensive care be given unless insisted upon by the parents and doctors agree. At 24 weeks and above, the provision of intensive care would be the norm.
I am not comfortable with such guidelines in that each patient should be evaluated and treated as an individual, not as part of a group. Of course, knowing the odds of survival at any given stage would be part of that agonizing decision making process. I also worry that futile care theory could seep into this process and that infants would be denied treatment because they would be disabled.
Still, it could have been worse.
posted by Wesley J. Smith @ 7:14 PM
13 Comments
13 Comments:
I am grateful the Nuffield Council on Bioethics has rejected the Royal College of Obstetrics and Gynecology's call for infant euthanasia. However, I was not comforted by the paragraph on fetal medicine.After going to great lengths to specify that infants born after 24 weeks deserve intensive therapy, the Council then absolves doctors of any duty to treat an infant born alive during a late term abortion. Remember the British Courts have sanctioned abortion as late as 28 weeks for defects as minor as a cleft palate.What this council is saying is that the child has no intrinsic dignity but is dependent on the desires of those who would care for him. If he is a "wanted" child, he deserves care. If he is an "unwanted" child he can be left to die.While this in and of itself is distressing, there is no doubt such logic will be applied to any person dependent on the care of others.Both friends and foes of the Netherlands Groningen Protocols concede that these guidelines for the euthanasia of children will be applied to anyone who cannot express his wishes.
Good points, catholic mom.
Wesley,
I just discovered that hospitals here in the U.S. are already trying to implement such protocols with regard to babies born at less than 24 weeks. I just recently learned about this case which happened down the road from me in San Antonio.
I was flabbergasted.
It's a combination of ideology of "quality" and its first cousin, $$$$.
Yes, as Jerri Lynn Ward mentions, big hospitals in the U.S. often give no intensive care before 24 weeks. This has been confirmed to me by a doctor working in such a hospital.
Moreover, this same young doctor told me something interesting: If a woman's water breaks before 24 weeks or close to 24 weeks, the doctors will at some of these hospitals tell her that they have to induce labor to prevent an infection. Then the induction is treated as a "termination of pregnancy," *even if the baby is very much wanted*, and the child is given no ICU care at birth. But if the mother's water broke after 24 weeks, she would not be induced but rather given antibiotics to prevent infection, and she would be kept in the hospital for observation.
In other words, the induction really _isn't_ necessary for the mother's health. It's just that before 24 weeks the child's best interests are regarded as irrelevant, even in a wanted pregnancy, and an induction is more or less pushed on the mother as being necessary for her own health, though they could give her antibiotics and keep her for observation at 20 weeks just as well as they could do so at 24 weeks.
This same young fellow told me a hair-raising story of a very much wanted baby born by such an induction ostesibly at 18 weeks (but my guess is perhaps the gestational age was mistaken) who kept breathing in a back room for several hours, until a (woman) resident said that she really "ought to" smother the child with a pillow. She was chided by a nurse. Eventually the child's breathing became less labored, so it would not be distressing to the mother, and the baby was given back to its mother to die in her arms.
Notice how this complicates things (if they're doing this even with wanted children) for attempts to enforce the Born Alive Infants Protection Act.
Lydia, if this is true, it is criminal. I am appalled.
I should perhaps make sure to be absolutely clear: The resident merely said she ought to smother the child with a pillow. She didn't actually do so. The child just was given no special care and eventually was unable to keep breathing, though it had been breathing room air for a couple of hours.
But the story was posted to a list I belonged to at the time with the warning (from the doctor who claimed to have witnessed it) not to let your preemie out of your sight! I asked him what he thought would have happened if the resident _had_ smothered the baby. Would anyone have reported it? He said he would certainly have spoken up, as would the nurse who chided the doctor, but probably many would not.
I find in my work that the best advocates for patients are the health care workers in the trenches, the nurses, social workers, chaplains, and doctors etc., who retain a deep desire to care for patients.
Yes, and I think one of the many problems with these sorts of "guidelines" is that they make it impossible for such advocates actually to help. So if it's the policy of the NHS or of a particular U.S. hospital not to do NICU care before 24 weeks, then even a strongly pro-life doctor who knows that a given baby might do just fine with NICU care at 23 weeks will find his hands tied.
How much of this, I can't help thinking, is an attempt to protect against lawsuit? Medical organizations really seem to like "guidelines" set by outside and putatively "neutral" groups that lift the doctor's responsibility to deal with each case individually. I suspect in the U.S. that some of this is to indemnify against lawsuit. ("I was following the standard of care.") That motive would probably be less strong in the UK.
Lydia,
Regardless of the fact that the resident wasn't allowed to smother the baby--the actions of laying the baby aside to die are criminal, in my opinion.
I agree totally, Jerri, where 'criminal' is a moral judgement. But could it have been prosecuted? Speaking practically here. I have grave doubts. And if they are going to start non-treatment for wanted children below 24 weeks' gestation, even if they show "fight" and breathe on their own for hours, then all they have to do to get around the Born-Alive Infants' Protection Act is to do the induction abortions for unwanted children before 24 weeks. Then they can point out that they are treating them all the same! Yuck.
To me one of the worst parts of the story is the induction of labor in the first place. It's so unnecessary. If the woman doesn't go into labor after her water breaks that early, that's _great_. It gives the child a chance to grow bigger and stronger, etc. Deliberately to induce labor at that point, with the intent not to give NICU treatment, is to treat the child as dispensible for the small lessening in probability of a uterine infection, when preventative measures could be taken against that without inducing labor anyway. The fact that they wouldn't do this beyond 24 weeks makes it obvious that this isn't about a real necessity for the mother's health but rather about treating babies less than 24 weeks gestation as of negligible value.
Oh my goodness! I just understood what you meant about the significance of induction!
Why wouldn't laying a child aside to die be, at the least, criminally negligent homicide given the duty a health provider has to patients? Wouldn't purposeful induction, as you describe, be homicide under state criminal laws? That said, I'm not a criminal attorney, so I could be wrong.
Jerri, I'm not a criminal lawyer, either, nor a civil lawyer, but I've followed this stuff for a number of years, and I seriously doubt any AG would bring any charges in this case. Take leaving the child without breathing assistance. That's just considered "withholding treatment," which is legal everywhere to some extent and pretty much universally if parents or guardians don't try to insist to the contrary. To require breathing assistance for a preemie is considered to be "micromanaging medical treatment," not leaving the doctors free to "follow their consciences" and not letting them "consider things on a case-by-case basis." All that stuff. To leave this child without breathing assistance is considered to be just another case similar to the agonized decision that some parent might make to allow withdrawal of a ventilator in a far more legitimate case. It's all treated legally as on a par.
Of course, the mother apparently wasn't _asked_ explicitly what she wanted in this case. She was just (I gather) told that the induction was necessary for her health and that the baby would not survive.
So take the labor induction aspect: Well, there are cases where mothers have severe pregnancy toxemia and there's a risk that both the mother and child will die of the mother's extremely high blood pressure. In those cases labor is sometimes legitimately induced to save both the mother and child's life. Of course, they can (and hopefully do) try then to save the born child as well with NICU care, and there are plenty of times when both mother and child survive. But once again, the decision to induce labor early is treated legally as a medical decision made by the doctor who is responsible for the mother--a decision made as part of his "treatment" of the mother and in light of all the factors affecting her health. What distinguishes this type of case is a) the slightness of the excuse regarding the mother's health and b) the distinct intent of the medical people--present at the time the induction decision is made--that the child will not be given NICU care because it is considered "too young." But once again, I doubt very much that criminally those medical facts are going to cause an attorney general to get involved to treat this type of case as homicide when a case of toxemia is not treated as homicide.
What _might_ fly would be a civil suit for malpractice brought by the mother later. She might, for example, argue that she wasn't given the full facts and didn't give fully informed consent to the labor induction, or that she wasn't given sufficient opportunity to make decisions about her child's care and treatment, that she never expressly consented to the withholding of care, etc. That's actually apparently a true description of the situation, and I hope it would be civilly litigable. But I don't know if anyone's ever tried.
What's very important is for women of childbearing age to educate themselves, to know that this kind of stuff happens, and to be prepared to _refuse consent_ to labor induction in a case of this kind where the induction will certainly result in her child's death and where she can be treated with antibiotics and the pregnancy sustained as long as possible rather than induced.
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