In its report published today the Nuffield Council on Bioethics concludes that active steps to end the life of newborn babies should not be allowed...
In its report published today (Critical Care Decisions in Fetal and Neonatal Medicine: Ethical Issues) the Nuffield Council on Bioethics concludes that active steps to end the life of newborn babies should not be allowed, no matter how serious their condition. The professional obligation of doctors, says the report, is to preserve life where they can. The Council states that among the problems of allowing euthanasia for seriously ill newborns is that it would be very difficult to identify an upper age limit beyond which the practice would be permitted.
The report also endorses current medical practice and law which allow decisions to be made either to withhold or to withdraw treatment in cases where treatment would be futile or cause intolerable suffering for no benefit. And, equally important to endorsing current law and medical ethics in this area, the Council calls for palliative care to be given to newborns who are not to be treated, so that they can die peacefully and in comfort instead of simply being left to die suffering the symptoms of their illness.
The Council's report makes other recommendations, but we focus on these as being those which affect the current 'assisted dying' debate. It will be recalled that the Royal College of Obstetricians and Gynaecologists (RCOG), in its evidence to the Council in July 2005, asked for the issue of neonatal euthanasia to be considered. At the time when this request was made the RCOG believed that 'assisted dying' legislation might be in the offing that that it would therefore be “pertinent” to consider whether euthanasia should be applied to newborns as well as terminally ill adults. Happily, Lord Joffe's Assisted Dying for the Terminally Ill Bill was roundly defeated in Parliament last May, and all the leading UK medical professional organisations have now declared their opposition to a change in the law. The Nuffield Council is therefore to be congratulated on recognising that there is little support for 'assisted dying' in either the medical profession or the population as a whole, whatever the age of the patient, and for firmly closing the door on neonatal euthanasia.
The Council's endorsement of current legal and ethical guidelines for the withholding and withdrawal of treatment is also to be welcomed. It is a persistent theme of the pro-euthanasia lobby that there is no ethical difference between withholding or withdrawing futile treatment from dying patients and taking steps – such as administering a lethal injection or giving a prescription for poison – with the deliberate intent to end a patient's life. The distinction between the two has now been firmly endorsed by an independent body which focuses specifically on the ethical issues raised by developments in medicine and biology, so let us hope that we shall hear no more of this deliberate blurring of the issue.
While commending the Council's general conclusions, we would raise a note of concern. The report suggests that premature babies born before 22 weeks should not receive intensive care, that for those born between 22 and 23 weeks it should not normally be given, that those born between 23 and 24 weeks should be given intensive care if the parents insist, and that babies born between 24 and 25 weeks should normally receive intensive care. While the object of these guidelines is understood, it is to be hoped that they will be treated as just that – guidelines – and not as inflexible rules. The condition of every premature baby needs to be considered on its merits and we would hope that the guidelines do not become hard-and-fast rules to be applied irrespective of the circumstances of each case.
It is also to be hoped that decisions not to give intensive care are based on an appraisal of a newborn baby's chances of survival rather than on a prognosis of whether the child, if he or she were to survive, would be disabled. Great care must be taken not to equate disability with illness and not to withdraw treatment because of a subjective assessment of the child's likely quality of life.