UNITED KINGDOM
November 12, 2006
Some Sick Babies Must
be Allowed to Die, Says Church
Bishop Admits Right to Life
for Newborns is Not Absolute
Nuffield Inquiry to Publish
Guidelines on Premature Births
The Observer reports:
Church of England leaders want doctors to be given the right to
withhold treatment from seriously disabled newborn babies in exceptional
circumstances. The move is expected to spark massive controversy.
The church leaders' call for some children to be allowed to die
- overriding the presumption that life should be preserved at
any cost - comes in response to an independent inquiry, which
is to be published this week, into the ethics of resuscitating
and treating extremely premature babies.
The decision by religious leaders to accept that in some rare
cases it may be better to end life than to artificially prolong
it is a landmark for the church. The Rt Rev Tom Butler, Bishop
of Southwark and vice chair of public affairs of the Mission and
Public Affairs Council, states in the church's submission to the
inquiry, that 'it may in some circumstances be right to choose
to withhold or withdraw treatment, knowing it will possibly, probably,
or even certainly result in death'.
The church's report does not spell out which medical conditions
might justify a decision to allow babies to die but they are likely
to be those agonising dilemmas such as the one faced by the parents
of Charlotte Wyatt, who was born three months prematurely, weighing
only 1lb and with severe brain and lung damage. The report also
suggests the enormous cost implications to the NHS of keeping
very premature and sick babies alive with invasive medical care
and the burden on the parents should also be taken into consideration.
Doctors wanted to switch off Charlotte's life support machine
because they said her severe mental and physical handicaps left
her in constant pain with an 'intolerable' quality of life. They
pointed out that every time she had an infection, staff would
have to give injections or set up drips that caused yet more pain.
After the case went through the courts, the child, now three,
survived but with severe disabilities. She is now in care as her
estranged parents found it too hard to meet her 24-hour healthcare
needs.
The church's call comes in their submission to the Nuffield Council
on Bioethics, an independent body that publishes guidelines on
how doctors should deal with ethical issues. The council set up
the inquiry nearly two years ago in order to consider the implications
of advances which enable babies to be born halfway through pregnancy
and kept alive.
Their statement comes the week after one of Britain's royal medical
colleges called for a public discussion over whether to permit
the euthanasia of the sickest babies. The proposal from Royal
College of Obstetricians and Gynaecologists was welcomed by geneticists
and medical ethicists, but described as social engineering by
others.
In its submission, the Church of England said that although it
could not accept the argument that the life of any baby was not
worth living, there are 'strong proportionate reasons' for 'overriding
the presupposition that life should be maintained'. 'There may
be occasions where, for a Christian, compassion will override
the "rule" that life should inevitably be preserved,'
wrote Butler. 'Disproportionate treatment for the sake of prolonging
life is an example of this.'
The church states that it would support the withdrawal of treatment
only if all reasonable alternatives had been fully considered
'so that the possibly lethal act would only be performed with
manifest reluctance'.
But it accepted there were a range of reasons why the final decision
to withdraw or refuse treatment should be made, including the
question of cost. 'Great caution should be exercised in bringing
questions of cost into the equation when considering what treatment
might be provided,' wrote Butler. 'The principle of justice inevitably
means that the potential cost of treatment itself, the longer
term costs of healthcare and education and opportunity cost to
the NHS in terms of saving other lives have to be considered.'
Very premature babies run a higher risk of brain damage and disability.
If they are born at 22 weeks, 98 per cent of them die, though
by 26 weeks the chances of survival has risen to 80 per cent.
Different counties have different policies for very tiny infants.
Babies born before 25 weeks are not given medical treatment in
the Netherlands and in certain conditions, euthanasia is permitted.
When the Nuffield Council produces its long-awaited report on
Thursday, it is expected to reject a Dutch-style limit, with hospitals
required to let a baby below a certain age die, arguing that even
two infants born at exactly the same age can vary widely. Instead,
they are likely to call for much clearer guidelines to doctors
about the issues of viability. Parents of very premature infants
will also be asked to start talking to doctors at a much earlier
stage about the likely health outcome of their babies, so that
they can be prepared for the worst.
The church's submission counsels parents against expecting too
much from medics, and asks doctors to refrain from giving parents
false hope. 'The principle of humility asks that members of the
medical profession restrain themselves from claiming greater powers
to heal than they can deliver,' it said. 'It asks that parents
restrain themselves from demanding the impossible from the medical
profession and indeed from themselves and their own capacity to
cope.'
by Amelia Hill and Jo Revill
Read Gaby Hinsliff's original article on the premature
baby debate here.
