Monday, 31 August 2009

The Christian Response

We have been discussing issues relating to the availability of euthanasia for children. It is therefore appropriate to ask what is the Christian approach to this difficult topic. The traditional Christian approach is as follows:

1. Palliative Care with response and resources and higher motivation.
2. Better communication in respect of the child, taking account of the need for counselling and a recognition and respect for the child, equally, as a person formed in the image of God.
3. Valid motivation: the phrase ‘compassion mingled with respect’, attributed to Mother Teresa, perhaps sums up the most constructive attitude and is very much in keeping with the spirit of the Lord’s words – ‘In as much as ye did it unto one of the least of these, my brothers, ye did it unto me’ (Matthew 25:40). The irreducible minimum of care was defined as – fluid and nutrition, analgesia and tender loving care (TLC). If a community is to claim to be civilised, it must care for its disadvantaged.

Here are some references if you wish to read more on the subject.

H Tristram Engelhardt, A Smith Iltis (2005)
End-of-life: the traditional Christian view.The Lancet.

RM Hare(1975)
Euthanasia: a Christian view.Philosophic exchange


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Thursday, 20 August 2009

The factors in change in paediatrics

Five general changes were noted as influencing practice in children:

1 Technical advances, making things possible which could not happen before – often bringing problems as well as advantages

2 The possibility of assigning prognosis to conditions found by screening raises the problem of information being available which it may not be appropriate or helpful to possess (e.g. a bad prognosis given ante-natally, which is not fulfilled post-natally may have a negative effect upon parental attitude towards the child). This is important because a high rate of false positive results is encountered in screening procedures. Unless action is to be taken on the results of the screening – e.g. termination of pregnancy – the screening may be counter-productive.

3 The new consumerism has an effect upon attitudes when things go wrong with the neonate. Society, as well as the individual, are seeking control of life’s events; technology seems to offer this, including control of the arrival of children on time and perfect. A baby may be viewed as a ‘consumer product’ or accession and biological variation may not be acceptable: a view which leads readily to the attitude – ‘if it is not right, dispose of it’.

From the Christian perspective, GOD has control – we do not. Our lives are in God’s hands at the beginning and the end. Human goal setting, ambition and consumerism must give way to our accountability and stewardship of life and relationships, for which we are answerable to God Himself. The question, ‘Am I my brother’s keeper?’, still evokes the answer ‘yes!’ from the highest authority in the matter.

4 Secular philosophy – discussed above – proposes the idea that babies are potential people, not real people. They are capable of life to the full, but if they are seen as not ‘capable’, they are likely to be considered disposable.

5 Health-care economics. Pressure on resources requires allocation of priorities. Babies may not be seen as a priority, especially if deformed or abnormal! Economics asks the question, ‘Is this expense good value for money?’.


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Wednesday, 19 August 2009

Neo-natal care

The specialist field of neonatology came into being to meet the needs of infants delivered in difficult midwifery situations. Low birth weight (premature) children - less than 3.5lbs - account for about 1% of births and survival for such children before specialist intervention occurred was bout 25%. this is now around 75%.

Malformed children account for about 1-2% of all births and, with the important exception of brain malformations, the prognosis for normal life for many of these children is fairly good as neonatal intensive care and surgery have improved. Many previously lethal malformations are treatable with good out6come if diagnosis is made early, and detection techniques are imporving so that early treatment is made possible.

Professional attitudes to this type of work are ambivalent. Some consider these infants as 'nature duds' and would not feel that any treatment was appropriate, especially in view of the high costs involved. 'Foetal medicine' - concerned maily with screening ofr abnormality and termination of pregnancy, if such abnormality is found - has been developing in parallel. In this context it is permissible both in Scots law, and more recently in English Law, to terminate a pregancy for reasions of severe foetal abnormality right up to term.

It has been observed that in deciding how much should be done in such cases of malformation and birth abnormality, a good deal of reliance may be placed on the intuitive responses of parents and others involved, since the general philosophy is still towards the concept of sanctity of life. This may pwe something to the general awareness of a Judaeo-Christian heritage and background.

In some areas of secular philosophy, however, opinions may differ markedly from this approach. Some would express the idea that a child is not yet fully a person, but only a potential person and therefore should have no rights until it has self-awareness. This view is reminiscent of the arguments about personhood in the abortion debate. It is striking that ethicists seem to differ quite markedly from the general public in these matters.

Additional Readings

It is not always possible to provide links to the full texts of related documents to the posting, however whenever possible, I am including links to the abstracts.

Sklansky, M. (2001). Noenatal Euthanasia: Moral Considerations and Criminal Liability. Journal of Medical Ethics.

Kon, AA. (2007). Neonatal Euthanasia is unsupportable: the Groningen protocol should be abandoned. Abstract available here.

Costeloe, K. (2007) Euthanasia in Neonatals. Abstract available here.

This link details to choice made by a mother concerning a screening during her pregnancy.


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Tuesday, 11 August 2009

Petition opposing Legalisation of assisted suicide

Hannnah Caldwell, from CNK Alliance LTD is asking for support towards a petition against the legalisation of Assisted Suicide in the UK. Here is what she has emailed us.

We invite you to sign the following petition opposing the legalisation of assisted suicide. The petition is available in the following link

It declares: "We the undersigned petition the Prime Minister to retain the
law that makes it a criminal offence to assist another person to commit

Thank you for supporting the Care Not Killing Alliance and our efforts to promote palliative care and to oppose euthanasia.

Best wishes,

Hannah Caldwell
Administrator, CNK Alliance Ltd


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The Demand for Euthanasia for Children

There is no demand from parents for intentional killing and the matter is raised more by ethicists and theoreticians than by anyone in the practical field. The majority of paediatricians are against intentional killing and medically assisted suicide, but there is a small group who would support its introduction.

One report indicates that children have been supplied with a lethal injection and have been encouraged to administer this to themselves 'when all eslse has failed'. In such a situation, you wonder whether compassion and care had indeed failed the child!

Unconscious Children
These are usually sufferers from trauma, head injury, and brain lesions of various kinds. The most freqeunt problem encountered is head injury related to traffic accidents. They have often been dealt withi in adult intensive care units until recently, when paediatric units have been opened. The criteria for brainstorm death are the same as in adults. Similar debates occur over brainstem death in children as in adult cases. 'Switch-off' decisions are generally made on the same grounds of negative expectation of recovery, but practice varies.

The parents have the veto and often wish to continue life support initially, but may reach a point of acceptance of the futility of this after an opportunity to come to terms with the realities of the situation. Improved resucitation techniques have really introduced these problems, since many would have died without these being applied.

Where the life support requires to be switched off, this is usually done with the parents present, one of them helding the child in the period after the switch off.

The normal expectation is that death will occur. However the expectation of death may not always be fulfilled, and a brain damaged child requiring a major level of support remains. In one incident following which the child was fosteres in a loving home with excellent care, major guilt still produces problems for the parents. The case for euthanasia in such cases would rest more upon the suffering of the parents rather than that of the child.

Additional readings
Some of these readings might be useful
Shepperdson, B. (1983). Abortion and Euthanasia of Down's Syndrome Children. the Parents view.
Journal of medical Ethics

Engelhardt, T (1989). Ethical Issues in Aiding the Death of Young Children.An excerpt is available here.

Macdonald WL (1998)> Situational factors an attitudes towards voluntary euthanasia. The abstract is available here.


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