http://observer.guardian.co.uk/uk_news/story/0,,1945866,00.html
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
Amelia Hill and Jo Revill
Sunday November 12, 2006
The Observer
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.
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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 it 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.'
