Euthanasia in Childhood and Infancy

In the practice of paediatric medicine there are two main areas in which eithanasia may be relevant-paediatric terminal illness and neonatal intensive care.

Paediatric terminal illness: the concious child.
Most conscious children requiring terminal care are cancer patients, but some have meningitis or other progressive conditions. Palliative care for these has recently received new emphasis, as expansion in the filed with specialised hospice provision for children has occurred. By contrast in Holland, where the euthanasia concept is widely accepted, there is no such specialist provision. Euthanasia is overtly perceived as the solution to these problems.

The emotional aspects of caring for a dying child are difficult for parents and for staff to handle, irrespective of the symptoms of the condition. Carers must consider the autonomy of children, as well as considering them as people who do have a right and a need to know what is happening to them in terms which they can understand. A child, like an adult has the right to have wishes, feelings and preferences and to express them.

It is responsible and necessary to give factual information to a child as much as to an adult, and experience has shown that children may handle the terminal care situation better than many adults. Family involvement, which includes siblings in decisions results in easier relationships and management of difficult situations. counselling of a whole family is often necessary and involvement of other children in family grief has a healing effect. Long family silence about a dead child is found to be common, but it may have a destructive effect.

Adequate symptom relief, sometimes self-administered and controlled by the child (who can become very skilled at it) and support for the family through the time of trauma, result in the elimination of the need for intentional killing.

The following websites have relevant information about this topic.
Terminal illness
Child Trust Fund
Facing Bereavement

Credits
The picture of the sick child was taken by Shainlee

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Alternatives to the Progression of Euthanasia

There is increasing evidence that requests for euthanasia come from patients whose sympotm control has been less than adequate, and these requests are very rarely sustained after good symptom control has been established. Often the demand arises out of fear of unbearable suffering. When it becomes apparent that this fear is unfounded and that relief will be available, the fear itself is allayed and the apparent need for euthanasia is diminished.

Hospice care and palliative medicine

Over the past three decades the Hospice Movement has led the way in improving the care of dying patients. This improvement has been achieved not only by in-patient units, but also, and more extensively, by the community of palliative care services provided by Macmillan Nurses and Marie Curie Nursing staff. The underlying philosophy of the movement has been the recognition of the importance of quality of life involving physical, emotional, psychosocial, intellectual and spiritual aspects of that quality.

Much of the development has been towards patients with advanced cancer, but the principles are just as appliclable to other conditions and the benefits should be available to all. Palliative care has tended to be sought by hospital as well as general practitioners, as a last resort, towards the end of the course of an illness but there is much to be said for earlier referral. The skills of palliative care require to be applied as an integral part of the management of the condition and should be considered much more often and applied at an earlier time if the greatest benefit in terms of quality of life is to be obtained.

Multi-disciplinary Caring

An integrated approach to the patient's problems is achieved best by a multi-disciplinary team which will involve medical, nursing, paramedical and other professional personnel, and the input of religions institutions is by no means irrelevant in this context. The hospital chaplain or minister may be an extremely important member of the team.

The principle challenge is to duplicate the hight standards of patient care and symptom relief as established in the field of cancer care, to influence the approach to the terminal stages of many other diseases.

Pain relief is a major issue in the quality of life.Pain relief has improved significantly even in the area of non-malignant pain which can be very debilitating and has proved more difficult to control. Pain control clinics while patchy in availability are making advances in methods and approaches to persistent pain.

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Trends relating to suicide

An increase in suicide amongst young men was reported in an article by C. Pritchard in the British Journal of Psychiatry. Several reasons for this increase have been proposed notably, lower rates of marriage, higher divorce rates, high rates of unemployment, misuse of alcohol and drugs, the threat posed by AIDS and increase risk of imprisonment. This trend has been noted in several countries of the European Community however, the increase in the rates amongst men in the 15 to 24 age group was worse in the UK when compared to the rates in most other EU countries. Unemployment has long been recognised as a major risk factor for suicide (see for example the work by Bartley and Plewis) and although the impetus for job creation schemes is often purely economic, the reality is that unemployment also has severe health implications.

The position of the Church of Scotland on suicide remains clear. It offers compassion and understanding rather than condemnation.

Credits
the photograph of the young man was taken by Dr. John
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