Doctors would be justified to end the lives of some terminally impaired newborn babies, says a prominent Canadian bioethicist in a report that pushes the country’s euthanasia debate into provocative new territory.
Much of the discussion of physician assisted-death in Canada has centred around adult patients capable of making known how they want to end their lives.
But Udo Schuklenk, a Queen’s University philosophy professor, argues that in rare cases of severely impaired, deeply suffering newborns, actively causing death is morally acceptable, if still illegal in this country.
“The parents should be able to freely decide on what would amount to postnatal abortion,” he argues in a paper just published in the Journal of Thoracic and Cardiovascular Surgery.
Euthanasia would even be preferable to “terminal sedation,” where food and liquids are removed from a dying patient, because it would save parents and medical staff the distress of seeing a baby waste away over days or weeks, said Prof. Schuklenk.
The child does not suffer in that scenario — which can and does occur now in Canada — but “it’s a terrible thing to witness,” he said in an interview.
The Ontario research chair in bioethics also headed the Royal Society of Canada’s 2011 panel on end-of-life decision making. He wrote the opinion piece after being invited to debate the newborn issue at a conference of the American Association of Thoracic and Cardiovascular Surgery in Toronto earlier this year.
Even as the concept of euthanasia picks up momentum in Canada, applying it to children has not been on the table. The new Quebec assisted-death law — like those in five U.S. states — applies only to mentally competent adult patients. An assisted-suicide case now before the Supreme Court of Canada also revolves around adults who can choose their own fate.
The Netherlands does permit euthanasia of some newborns. Still, it makes sense for Canadians to first address the situation of consenting adults, whether or not they decide later to allow assisted-death for others, too, said Prof. Schuklenk.
The parents should be able to freely decide on what would amount to postnatal abortion
Opponents of euthanasia, though, are voicing dismay that the academic would even suggest that doctors and parents be allowed to terminate the life of a severely disabled newborn.
“What you’re doing is declaring that certain types of human beings have a life which we in society have determined is not worth living,” said Alex Schadenberg, head of the Euthanasia Prevention Coalition. “Which would be considered by another group of people as a eugenic philosophy.”
The genesis of Prof. Schuklenk’s opinion piece was a debate at the surgery conference, focused on the case of a baby with a severe form of “heterotaxy” syndrome, where the heart or other organs are misarranged in the body.
The treatment options included: at least three complex surgeries before age five, and possibly more, which at the very best would allow life until teenage years; non-surgical treatment for heart failure permitting survival at most into early childhood; comfort care that would most likely lead to death within a year; and euthanasia.
In cases where babies’ current and future life involves “overwhelming pain and suffering,” proactively ending life is ethically acceptable, Prof. Schuklenk argued in his later article.
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He rejected the notion that allowing euthanasia in such cases would lead to a slippery slope where the idea is applied increasingly broadly. In the Netherlands, health-care staff ended the lives of just four babies between 1995 and 2005, and none from 2005 to 2010, he said, although terminal sedation occurs as much as 299 times a year.
In a counterpoint to Prof. Schuklenk’s article, theology professor Gilbert Meilanender of Indiana’s Valparaiso University said patients should not be subjected to aggressive treatment if it is futile, but they should also not be intentionally killed, either.
“That would be to think of ourselves … as people who are fit to exercise a kind of ultimate authority over the life of another,” wrote the former ethics advisor to U.S. President George W. Bush. “If we simply sweep such children off our doorstep every morning with euthanasia, medicine will never learn better ways to help them and others like them.”
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