I was invited last week to be part of a panel discussing whether doctors should be permitted to actively end the lives of certain severely-impaired newborns with parental consent.
The host of the debate was a prestigious thoracic surgery society. The problem, simply put, is this: Every year a small number of fetuses are carried to term who have no reasonable chance of living a life worth living. They are so severely impaired that they will live a miserable, short life until they eventually expire. The good news is that, courtesy of prenatal screening, only few such births take place and the numbers are decreasing. We have some data from the Netherlands, where a few hundred out of about 200,000 newborns annually tend to fall into this category.
Well, the topic of our debate was a dicey one. We were given a scenario whereby the child’s prospect were sufficiently miserable that the attending doctors suggested to parents – among other options – the withdrawal of nutrition and hydration while providing palliative care to ensure the newborn does not suffer unnecessarily, as well as active euthanasia. The outcome of both scenarios: the death of the child. The jurisdiction where our case played out permitted the active ending of the newborn’s life.
One of the reasons for why we feel uneasy, to put it mildly, when we discuss what to do about severely impaired newborns, is, of course, that unlike adults in comparable circumstances the newborns do not have the capacity to make their own choices. In fact, the newborns’ developmental state is such that they don’t even have the capacity to desire continuing life. Would it make much sense to undertake significant surgery with the – unlikely but possible – result that the newborn might live a miserable life for another year or two before his impairment eventually catches up with him and kills him? Should we withdraw nutrition and hydration while providing palliative care so that he doesn’t suffer? Should we actively terminate his life to end his nightmare quickly and painlessly, as well as that of his parents? In our scenario the parents asked that their son’s life be ended quickly and painlessly. Should the doctors oblige them, was the question we were asked to address.
On the one hand we have – typically – religiously motivated opponents of euthanasia for severely impaired newborns. The distinguished theologian panel member who I debated argued that we should let nature takes its course, that we should provide clinical care not aimed at shortening the newborn’s life and that we should eventually let nature takes its course. The problem with the nature-takings-its-course argument is that we invented medicine to stop or delay nature from taking its brutal course. So, the letting nature take its course argument was a non-starter.
My opponent also argued that we should ask ourselves whether we would want to live in a society that terminated the lives of such vulnerable newborns. That’s a good question to ask as it forces us to think more carefully about the values that are at stake in such situations. If we merely go by the newborn’s quality of life and life prospects it seems indeed best to end the unfolding tragedy sooner rather than later, but probably a decision should be arrived at with parental consent as opposed to against the unfortunate parents. It turns out that one can reasonably answer the rhetorical question of whether one would want to live in a society that terminated the lives of certain severely impaired newborns if one held the view – as I do - that the newborn’s current and future quality of life is all that matters here. I could live in such a society where empathy for human suffering trumps religious conviction.
This view, in turn, requires us to rethink how we go about doing medicine, at least to some extent. It would require us to give up on what is called the sanctity-of-life doctrine in medicine and replace it with a quality-of-life ethic. There is no point in maintaining human life for the sake of it if that human life cannot enjoy a moment of its existence and is trapped in a never-ending cycle of immense pain and suffering. A quality-of-life ethics would not merely ask ‘do you exist’, but ‘do you have a life worth living?’, or ‘will you have a life worth living?’ We are not there yet, but significant changes in this direction are occurring in many countries.
My esteemed colleague also suggested that the infanticide proposition violated human dignity. It’s a strange thing this ‘human dignity’ rhetoric. If you were to ask yourself whether human dignity is important, you’d almost certainly say that it is. We all want to be treated with dignity. In my field, in medical ethics, you can find boatloads of declarations and guidelines having the dignity moniker included for good measure. Surprisingly though, when you look closer at it you will discover that this is about as question-begging a term as there ever was. It has actually no meaning in its own right. For Catholics human dignity means living by Catholic values, to Muslims it means living by Islamic values, to secular folks it could mean living by secular ethical values, and so on and so forth. Typically, when it comes to controversial ethical questions, human dignity is deployed to hide those actual values, mostly because they are likely to be more controversial than to just say ‘human dignity’. So, the long and short of it is, in the discussion about the severely impaired newborn, human dignity gives us neither action guidance nor action justification. A couple of years back, the judges on our Supreme Court, when looking at the euthanasia issue, also availed themselves, among other reasons, of the human dignity trope. It tells you something that both sides used it and neither side could show that their opponents just happened to use it wrongly. To the theologian I debated it was clear that euthanasia would violate human dignity because of his religious views on end-of-life matters. A secular ethics person could well conclude that human dignity was violated by not permitting euthanasia. So, we were non the wiser. Well, more to the point, we agreed to disagree.
What would your preferred policy on severely impaired newborns look like?
Udo Schuklenk teaches bioethics at Queen’s University. He tweets @schuklenk.
