lunedì 6 novembre 2006

Eutanasia pediatrica

Obstetricians call for debate on ethics of euthanasia for very sick babies, Sarah Boseley, The Guardian, november 6, 2006.

Doctors involved in childbirth are calling for an open discussion about the ethics of euthanasia for the sickest of newborn babies. The option to end the suffering of a severely damaged newborn baby – who might have been aborted if the parents had known earlier the extent of its disabilities and potential suffering – should be discussed, says the Royal College of Obstetricians and Gynaecologists in its evidence to an inquiry by the Nuffield Council on Bioethics, which examines ethical issues raised by new developments.
The college says the Nuffield’s working group should “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 newborns”.
The inquiry is looking into “the ethics of prolonging life in foetuses and the newborn”. Euthanasia was not originally on the agenda, because of its illegality. But the RCOG submission has persuaded the inquiry to broaden its investigation, although any recommendation favouring euthanasia for newborns is highly unlikely before a change in the law.

The college ethics committee tells the inquiry it feels euthanasia “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.” It points out that a pregnant woman who discovers at 28 weeks that her baby has a serious abnormality can have an abortion. Parents of a baby born at 24 weeks with the same abnormality have no such option.

There are enormous social, emotional and financial costs involved in caring for a profoundly disabled baby, the submission adds. If a mother really understood the “real, life-long costs” of caring for such a child and understood the slim chance of being fully recompensed by the state, “perhaps she might feel differently about aggressive resuscitation and treatment of her premature baby. Perhaps her doctors might as well,” says the submission.

Euthanasia for very severely disabled newborn babies suffering from specified conditions is permitted in the Netherlands. Some suspect that “mercy killing” probably occurs in the UK. But medical advances which have enabled very premature babies to be kept alive at only 24 weeks gestation – little more than half the expected time in the womb – have led to a presumption that every technological intervention will be used to keep the baby going at all costs. In the case of Charlotte Wyatt, the parents vigorously opposed the doctors’ wish to be allowed not to revive her through the courts. The child, now three, survived, although severely disabled and now in care.

The UK Disabled People’s Council yesterday rejected discussion of euthanasia for newborn babies. “It is not for medical professionals or indeed anyone else like families to determine whether someone else’s quality of life will be good simply on the grounds of impairment or health condition,” said its parliamentary worker, Simone Aspis.

FAQ Disability risks

What is the Nuffield Council on Bioethics investigating?

It is considering the implications of advances which enable babies to be born little more than halfway through pregnancy and kept alive.

Why is this a problem?

Very premature babies run a higher risk of brain damage and disability. Most die – 98% – at 22 weeks, though by 26 weeks 80% survive.

Is euthanasia allowed elsewhere?

Babies born before 25 weeks are not given medical treatment in the Netherlands and euthanasia is permitted in certain conditions.

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