Lest We Forgetů.
Part Two of Three
By Dave Andrusko
Of all the many thousands
of articles I've written about attacks on innocent human life,
none have drained me more than what were (then) the famous "Baby
Doe" cases. There were many differences, but one soul-wrenching
commonality in these cases from the 1980s: a baby was born with
serious medical issues and his or her parents had decided to
"forgo treatment." That can mean "discontinuing" or never
beginning medical treatment and/or food and fluids.
The "problem" in these
cases was not that the baby would die. The "problem" was, if
provided with medical treatment (or even just food and fluids)
the baby would live!
Only occasionally does
this barbarism show its ugly face.
Over at National Right to
Life News Today, I've reprinted a blog entry from bioethicist
Wesley Smith about a study discussed at Medscape.com. The
article he comments on is titled "Prolonged Survival Frequent
After Withdrawal of Neonatal Nutrition and Hydration" and is
written by Kate Johnson. It is based, we are told, on "a case
series presented here at the 18th International Congress on
In addition to Wesley's
typically astute comments, I'd like to add a couple of thoughts.
The first four sentences of the article are among the most
chilling I have read in a long, long time.
October, 7, 2010
(Montreal, Canada) -- Neonatal survival after withdrawal of
artificial hydration and nutrition can last up to 26 days,
according to a case series presented here at the 18th
International Congress on Palliative Care.
distress is not apparent in the infants, the psychological
distress of parents and clinicians builds with the length of
survival, said Hal Siden, MD, from Canuck Place Children's
Hospice in Vancouver, British Columbia.
"These babies live
much, much longer than anybody expects. I think that
neonatologists and nurses and palliative care clinicians need to
be alerted to this," he said.
"The time between
withdrawal of feeding and end of life is something that is not
predictable, and you need to be cautioned very strongly about
that if you are going to do this work."
details are given clinically. Johnson writes that once food and
fluids are "discontinued the mean duration of survival was 13.2
days (range, 3 to 26 days), she said." (The "she" is Kerry
Keats, MSW.) "Infants' ages at death ranged from 18 to 67 days."
They were apparently
pretty successful at "dampen[ing]" the babies' crying. But what
they couldn't hide was how emaciated the babies became. Are they
worried about the babies' suffering? They have morphine and the
like, which they persuade themselves handles that little
But it is kind of hard for everyone to witness, Johnson writes.
"A critical factor for
counseling is to anticipate the kind of suffering that comes
with witnessing the emaciation," she writes. "It isn't
something people can prepare themselves for" (emphasis added).
The autopsies appear
problematic, even though recommended. What's the hang-up?
"Parents should be warned
that the report will document the technical cause of death as
'starvation' -- a loaded word for all concerned," Johnson
writes. "It is important that parents separate this word from
any notion of suffering, he said."
Speaking of suffering,
"All of the children we've cared for have been in a very quiet,
low metabolic state -- not an agitated state -- with no overt
signs of hunger behavior," Dr. Hal Siden, MD, from Canuck Place
Children's Hospice in Vancouver, British Columbia, tells
Johnson. Sounds reassuring. Then he adds, "Whether they are
neurologically capable of hunger behavior is another question,
and I don't know the answer."
However, "Not everybody is
comfortable or aware that it's morally and ethically permissible
to make decisions to discontinue these types of interventions,"
said Joanne Wolfe, MD, director of pediatric palliative care at
Children's Hospital Boston, in Massachusetts. "This study
highlighted those key things more systematically -- that it's
acceptable and it doesn't invoke suffering -- while
acknowledging that there is a physical change that we need to be
prepared for, and that we need to help the family prepare for
and proceed through."
The scariest comment? "An
informal poll of the room by Dr. Siden revealed that most of the
attendees had direct experience with this type of case."
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