There has been comment about RCOG statements on the subject of euthanasia for severely-ill new-born babies...
There has been comment in the press about statements by the Ethics Committee of the Royal College of Obstetricians and Gynaecologists (RCOG) on the subject of euthanasia for severely-ill new-born babies. What did the RCOG actually say? And what is its significance?
In July 2005 the RCOG submitted a memorandum to the Nuffield Council on Bioethics in response to a consultation document entitled The Ethics of Prolonging Life in Foetuses and the Newborn. The memorandum asked the Council 'to think more radically about non-resuscitation, withdrawal-of-treatment decisions, the best-interests test and active euthanasia as they are means of widening the management options available to the sickest of the newborn'.
Describing 'active euthanasia' as 'a deliberate intervention to cause the death of an infant', the memorandum continues:
'Whilst pointing out that this presently would constitute homicide, this might be something the Working Party would wish to leave alone, or contrast with the Dutch system, or suggest a wider debate about changing the law (as per the Assisted Dying Bill). The RCOG Ethics Committee does not have a view that we would like euthanasia to be discussed, but do feel that it has to be covered and debated for completion and consistency's sake…If life-shortening and deliberate interventions to kill infants were available, they might have an impact on obstetric decision-making, even preventing some late abortions, as some parents would be more confident about continuing a pregnancy and taking a risk on outcome...If assisted dying legislation is to be anticipated or enacted at the other end of life, now would be a pertinent time to discuss this'.
The memorandum also touches on what it calls 'economic issues':
'Most babies who leave hospital with severe (or even quite moderate) disabilities get pitifully little help from the state: if a mother really knew the real, life-long costs of caring for such a baby, and also knew that the chances of the central or local government paying anything near enough to cover such costs are very low, perhaps she might feel differently about aggressive resuscitation and treatment of her premature baby…Bringing up a very damaged baby, without nearly enough help, and to such a very uncertain future, would profoundly affect her life and her partner's and her other children's. The estimate of costs…ignores the immense emotional and social cost to mothers and families in many cases, which often they did not anticipate'.
The RCOG has stated, in response to the criticism of its memorandum in the press, that 'the RCOG and its members do not support euthanasia' and that 'we have never advocated active euthanasia for severely pre-term babies or any form of mercy-killing on disabled newborns'. It is reassuring to hear these words.
It is important also to recognise that the RCOG's suggestion - that, if legalised 'assisted dying' for terminally ill adults were in prospect, it might be an appropriate moment to discuss similar action for newborns - was made in July 2005. Since then an 'assisted dying' bill has been roundly defeated in Parliament. The memorandum might be considered therefore to be less topical than at the time it was submitted.
Nonetheless, the shadow of 'assisted dying' has not gone away and it would be salutary to reflect on the implications of the suggestion (in the memorandum) that 'active euthanasia' might be included among the 'management options' for seriously ill new-born babies.
First, we should look carefully at the terminology used. The memorandum refers to 'non-resuscitation, withdrawal-of-treatment decisions, the best-interests test and active euthanasia'. There is an inference here which may escape the notice of the casual reader - namely, that the first three actions listed constitute 'passive euthanasia'. This is a persistent theme of the pro-euthanasia lobby - that any decision which a doctor takes in the expectation that a patient will die a result amounts to euthanasia. This is both legal and ethical nonsense. On the one hand, doctors are criticised for heroic interventions and for striving officiously to keep dying patients alive. Yet, when they decide it is time to call it a day and discontinue treatment which has been shown to be futile and burdensome to the patient, they are said to be practising passive euthanasia.
There is, in fact, no such thing as passive euthanasia. Euthanasia means ending life deliberately for reasons of compassion - that's why it is sometimes called 'mercy killing'. But a doctor's intention, when he withdraws futile treatment or does not resuscitate, is not to end the patient's life. It is simply to recognise that enough is enough and that nothing more can be done to prevent nature taking its course. The doctor may expect the patient's death to follow his action, but that is not the intention. And intention is of crucial importance where ethics are concerned. End-of-life decisions are not the same thing as ending-life decisions. We should beware therefore of attempts to brigade euthanasia innocently alongside other perfectly legal and ethical practices.
The second thing which this memorandum illustrates is the existence of a slippery slope in 'assisted dying'. We are always being assured by the proponents of a change in the law that there is no slippery slope. One might have thought that recent statements by Ludwig Minelli, the founder of the Swiss organisation Dignitas, would have shown how hollow these assurances are. Mr Minelli was in Britain early in the autumn telling us that he wanted to see Swiss law permitting assistance with suicide extended so that it included people suffering from severe depression. Here however we have another example. If assisted dying for terminally ill adults, says the RCOG memorandum, is on the table, perhaps this would be a convenient moment to consider extending it to newborn infants as well. This is all reminiscent of the extension of Dutch euthanasia law to include neonates and of pressure in Holland to extend legalised euthanasia yet further to include people with dementia. The RCOG's memorandum provides a glimpse of what might be just around the corner if we were ever foolish enough to go down the 'assisted dying' road.
Care Not Killing
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