Updated
News stories about the Nuffield Council report on Critical care decisions in fetal and neonatal medicine: ethical issues mentioned earlier are beginning to come in. The Nuffield website has not yet published the report itself but has issued this press release: Independent ethics body proposes week-by-week guidelines on treating premature babies.
The Church of England and the Roman Catholic Church in England and Wales, whose bishops are meeting jointly right now, have issued a joint comment by about this report: you can read it in full here.
Joint comment by Rt Rev Tom Butler, Bishop of Southwark, and Most Rev Peter Smith, Archbishop of Cardiff, on behalf of the Church of England House of Bishops and the Catholic Bishops’ Conference of England and Wales on the publication of the Nuffield Council’s report Critical care decisions in fetal and neonatal medicine: Ethical issues:
We warmly welcome the clear recommendation from the Nuffield Council today that “the active ending of life of newborn babies should not be allowed, no matter how serious their condition.” This reaffirms the validity of existing law prohibiting euthanasia, and upholds the vital and fundamental moral principle that the deliberate taking of innocent human life is always gravely wrong.
There is a clear distinction between interventions which are deliberately aimed at killing, and decisions to withhold or withdraw medical treatment when it is judged to be futile or unduly burdensome. In our joint submission in 2004 to the Select Committee of the Assisted Dying for the Terminally Ill Bill the Church of England House of Bishops and the Catholic Bishops’ Conference of England and Wales said:
“Doctors do not have an overriding obligation to prolong life by all available means. Treatment for a dying patient should be ‘proportionate’ to the therapeutic effect to be expected, and should not be disproportionately painful, intrusive, risky, or costly, in the circumstances. Treatment may therefore be withheld or withdrawn, though such decisions should be guided by the principle that a pattern of care should never be adopted with the intention, purpose or aim of terminating the life or bringing about the death of a patient. Death, if it ensues, will have resulted from the underlying condition which required medical intervention, not as a direct consequence of the decision to withhold or withdraw treatment. ” (para 18)
In applying this principle we believe that every case should be judged on its merits and like the British Medical Association, we would have concerns about any blanket recommendation regarding the treatment of babies born before 22 weeks. Decisions regarding treatment should always be made on an individual basis having regard to all the circumstances of the case.
We will wish to study the detail of the Nuffield Council’s report but welcome the extremely important recommendation opposing any action aimed at the active ending of life of newborn babies.
British Medical Association has issued this press release.
Some press reports:
Reuters Pre-22-week babies “should not have intensive care”
Guardian Extremely premature babies should be left to die, says report
BBC ‘Do not revive’ earliest babies
Telegraph Ethics experts set out controversial guidelines for doctors and parents
The Times When to let a baby die: experts set the guidelines
This is such a hard area to comment. In some ways modern medicine has become a curse. It has become possible to keep a body alive long after it would have died without external support. A very close friend of mine died of cancer a few years ago. Like Pope John Paul who followed him, he surprised the hospital and elected not to go into intensive care for his final days. Death had become inevitable and he chose to die with dignity and choice. His moment of passing over was timed to show his brothers that he was making a… Read more »
As one who teaches at the college level on the west side of the Atlantic, I can attest to the difficulty students have in understanding that “can” doesn’t mean “should.” When the ability to do is interpretreted as an imperative to do, any technology becomes the curse Cheryl alludes to above. George Wald, the Harvard Nobel latureate biologist of many years ago, visted my undergraduate campus while I was a student. During his conversation, he commented that if someone discovered how to generate life he hoped it would be a scientist rather than an engineer. (I’m certain he was drawing… Read more »
Well said David. The ethics of understanding that because one can do something does not mean one should do something goes beyond this arena. It also applies to the use of power. For example, is it possible as a church community to shun and shame people in their sphere of influence? Yes. Can this lead to people committing suicide, taking drugs for sedation, breaking up families? Yes. Then the question becomes, if we have this much power, should we be using it? It is again like driving a car. Just because a car is capable of driving at 140 kms… Read more »
“The writers of the Nuffield document should be applauded for their willingness to say that “can” does not automatically lead to “should.””
Anyone who has spent time in the intensive care units of major hospitals – like UVA, where I did CPE, or has visited the highest care nursing units of a retirement community can attest to that. At both beginning and end of life, there are many difficult areas of decision between ‘can’ and ‘should.’
I sometimes think we are more merciful to our aged and suffering pets than to people.
I cannot believe the tenor of these comments.
What is keeping you from employing available technology to save preemies where there is a chance so far as we can tell? Is it merely a cost/benefit analysis? Ought we even make such decisions from within a consequentialist or utilitarian framework?
My previous husband’s other son was the youngest premature baby to survive in Australia at the time. He survived despite having nearly every single complication a premature baby can have. Whole text books were written about him. That is why the loss of his second child, his little girl hurt so much. That is why I find people who throw the guilt of “you should have tried” without checking the facts cruel and heartless. And where is the outrage at children dying of starvation, of preventable illnesses, or being permanently handicapped, for the sake of a few dollars per day… Read more »
The bishops seem to conflate witholding treatment when it would be “futile” (the baby will die soon anyway) and when it would be “unduly burdensome” (the baby might not die if treatment is administered). Surely there is a significant difference. Burdensome for whom? And what and whose measure of burdensomeness is being used? Can any system of mensuration really tell us the tipping point at which life ceases to be worth living, if life is a gift not a possession?
Yes a very good point!! by Sean Doherty
Life is a gift and not a possession. Life should be treated with reverence. Who are we to judge when a life is worth living and acknowledging and when it should be shunted to one side?
A noble sentiment.
Let’s start applying it to the afflicted and eunuchs, including GLBTs. Their life is a gift from God. Who are we to deny spiritual resusitation and technology? Or to judge who will live or die in God at the end of their journey?
Dear Cheryl
I am not sure that life being a creaturely gift translates to “total autonomy to do what I want”. Quite the opposite in fact. I am very happy to discuss gender dysphoria and same-sex attraction although this is probably not the place for it as it would be somewhat off-topic!
S
There’s a danger of confusing life with lifestyle. Life is a gift; lifestyle is a choice: not all choices are eqully beneficial; smoe may be positively beneficial, others positively harmful.
For example, in the abortion ‘debate’ one person’s entire life is weighed against another person’s transient lifestyle. It is obvious which is the weightier of the two – except to those who have the power to apply the law to their own advantage and the advantage of their like.
‘Can any system of mensuration really tell us the tipping point at which life ceases to be worth living, if life is a gift not a possession?’ Yes, I doubt there is such a sytem. So decision-making is hard, and needs to be personal, sensitive,& collaborative,as well as professional, clinical, technical. I believe this means letting these tough situations and decisions be influenced, by ‘soul’. Not soulless. Soul to me, means listening at the centre & to the centre;& from the centre. Even trying to be open to the infant (infans), being with her or him, seeking to intuit their… Read more »
‘…in the abortion ‘debate’ one person’s entire life is weighed against another person’s transient lifestyle. It is obvious which is the weightier of the two – except to those who have the power to apply the law to their own advantage and the advantage of their like.’ This (kind of) comment is what I would ask you to consider, is literally ‘impertinent'(see my lst post above). It would seem to hail from one of the outer circles. Generalisation are all very well, but they have the value, but also the weakness of being general-ised. Ultimately, we find ourselves entering the… Read more »
There’s no need to decide whether to support or care for babies OR to support or care for parents. Obviously we are called to do both. Anything else is a false dichotomy and a non-choice. Christ calls us to care for those who are needy and powerless and in some cases the needy and powerless are BOTH parent AND child. So let’s not play off concern for ‘theoretical’ infants (I struggle to know in what sense they could possibly be only theoretical!) with concern for their parents. But neither let us suppose that concern for adults somehow renders mandatory the… Read more »
Both could be tackled but are not. People advocate stridently for theoretical infants, because they make and keep the infants theoretical. You have to enter the delivery room, the ward and join with real infants, real families — not theorise from a safe distance. Why do ‘pro-life’ organisations loose interest in life after its been safely delivered ? This is surely just when help may be needed. Why are so many children born into poverty and poor health ? What has the Bush administaration done for them ? Or adults in poverty and without health care (they were born you… Read more »
Laurence Your posting was beautiful. And yes, the pain of the infant is often overlooked. My previous husband’s first son has an incredibly high pain threshold from all the needles and other things whilst he spent months in a humicrib. One of the battles that I had to take on when I took this family under my wing is that he had not learn the normal “aversion” responses to things that cause pain or displeasure. He found the idea of respecting boundaries extremely hard to understand. In fact, when I first came into his life he had been shunted into… Read more »
CS Your comment about pregnancy being a transitary lifestyle is shocking. No decent woman ever forgets any child she ever conceives, she counts even her miscarried children for the rest of her life. It does not take into account how conception occurs. Was the woman raped? How old is she? What is her capacity to care for the child? It does not take into account the physical intrusion that a pregnancy has on a woman. The hormonal swings, the changes in your body’s metabolism, the physical size and then movements of the baby. There is an unbelievable emotional difference between… Read more »
Sean
I do not see that the two are unrelated.
In both cases there are souls where choices are being made on whether or not to service their needs.
A robust model applies and demonstrates universal principles.
A flawed model is often best highlighted by demonstrating the inconsistency in application.
Laurence I can’t pretend to understand all that you wrote. I’m not sure telepathy is going to help us much in ethics though. I think your idea of impertinence is helpful as it makes the point that it’s not necessarily up to the person making a particular comment. There is a difference for example between the way I think aloud about these matters and the way I would care for a woman who has been raped and found out she is pregnant (for example). However, I think the thinking aloud is important, for three reasons. First, because I am someone… Read more »
Sean
There are theological circles that obsess about concerns for the unborn whilst at the same time actively sabotaging activities to provide help for others.
If you are not of that camp, fantastic.
For the people who are of that camp, hypocrites.
Thanks so much Cheryl. Thanks for sharing this with me. I think that probably the adult world finds the pain of the unborn and of infatns unbearable.
No, no Sean –of course it can’t be you personally — we don’t know each other well enough for starters. VERY best wishes for the pregnancy to you both. WoW ! what an amazing moment in life to reach. Just take care of her and the pregnancy–and yer slen !
Yes, abstraction is as you say limited.
Pax amoque
LAURENCE X
Thank you both. Laurence, I do find the comment about finding pain unbearable a bit confusing (probably I have misunderstood you). As I understand the arguments in favour of euthanasia for some fetuses and neonates, the issue is precisely the unbearableness of such pain which leads many to feel that death is preferable to life for them (e.g. the quality of life argument and the intrusive treatment argument). The pastoral and spiritual traditions of Christianity yield profound help here – and a profound challenge to such arguments. They seem to suggest that the role for Christians (following the pattern of… Read more »