Child Euthanasia

[Osob]

Hey everyone.
Just thought Id seek some opinions on a current issue which might be a potential interview topic.
It’s on child euthanasia. The case is;

A baby is suffering from spinal muscular dystrophy and is almost completely paralysed (cant communicate, eat, breath and soon not open its own eyes by its self). The baby has already lived twice as long as expected. But the doctors say its life is intolerable and they want to turn of the ventilator.
However the parents disagree and say the baby’s quality of life is reasonable.

I think they have taken this case to court now and they have to make the decisions. But is it really up to the court to make this kind of personal decision?
Shouldn’t the parents be the ones who decide, as surely they must want the best for their child? Or should the experts (the doctors) decide….:S (in this case, if the doctors decide the baby would die!)

This is where I’m a wee bit stuck. Obviously each individual case will be different and often the doctors and parents come to some sort of agreement but what if they don’t? (like in this case)
ANY views would be appreciated

[Cymro]

There's no right or wrong answer.

If I was in the position of the consultant, I'd explain as best as I could to the parents that I did not think that it was in the best interest of the child to use artificial interventions to preserve its life.

If this was unacceptable to the parents I would have to refer them to another consultant, explaining that I respect their decision but feel unable to provide the care that they desire.

Cymro.

[belis]

I am not sure if that would be a case of euthanasia, I guess euthanasia by omission. You may wish to read about The Texas Futile Care Law, it is obviously not relevant to UK but a could example of where things may be going in the future. If parents and doctors disagree the case goes to court, which need to decide in the best interests of the child taking expert advice in account.

It is best for parents if they can make the decision but it can be argued whether they realy want the best for the child or just prolong suffering from selfish fear of separation (I am trying to be objective, I know it is a tragedy for the family and matter that need to be dealt with great delicacy). Finaly there is an economic aspect, it costs loads to keep this child alive. Maybe the money would be better spend on other things such as research into the cure or treating children that actualy can be helped. Is it justified way of spending NHS money?

[Je'bacon]

A couple of weeks ago I read a suprisingly wise quote by Jeremy Clarkson, which read something like 'If you've got all the facts then you'll see two sides who are both right, and if you have an opinion then you don't know all the facts.' I'm now trying to work out if this works with ethics questions.

I personally think that this case highlights the current and growing obscession with maintaining life that is prevellant in our culture today, especially in expectations of medecine. A century ago, even only half a century ago, people generally had a better appreciation of death, as they didnt tend to live as long, and much fewer diseases were curable. But today, because medecine has advanced significantly, people expect doctors to be able to cure anything and everything. With regards to this case, I would be inclined to say that if the baby is unable to do anything for itself, and does not look like recovering, then it would be best to stop treatment/life support.

[little_miss_phonics]

At my BSMS interview I was asked what my opinion on general euthanasia was and I said that I thought it should be legalised because I have seen so many people who really do have no quality of life and I think its kinder if they die peacefully rather than in pain...especially if they specifically request it.

I think that with children who obviously can't make that decision the doctors should make the decision because the parents are just displaying a natural reaction to the news that their child is going to die however ill they are. A parents judgement is clouded whereas the doctors have a much better idea about the child's quality of life and their prospects. Saying that, I know that if I was in the situation that the parents are in I wouldn't want my child to die but I still think it would be unethical to keep them alive xx

[racheljane]

I'm a mother. If a doctor had suggested to me that my daughter had no quality of life and should be allowed to die I would have fought tooth and nail against that suggestion. All the medical evidence in the world would not have made me choose otherwise. My argument would be that modern medicine has made such huge advances during my own lifetime that I could never ever be sure that there wouldn't be a cure for whatever her illnesses during her lifetime. What if I allowed her to die and a medical breakthrough occured in a few months time that could have helped her? Today's drugs could keep her free of pain and support her life until such a time as medicine advanced that little bit more in the right direction for her. That pain relief, life support and treatment would be available to us for free on the NHS so I would have no financial reasons to affect my decision.

A doctor's take on things is likely to be more informed and less biased emotionally, and this puts them in a better position to make such a decision. However the doctors may be accused of being biased towards saving costs and bed spaces. If doctors were allowed to take a decision like this one away from a parent without legal backing it's likely that the parents would be the ones who subsequently took court action.

I don't see that the doctors have any choice but to take this decision further i.e. to the courts, where both sides can be heard impartially. I certainly wouldn't want to be that judge though.

[karnesh]

Saving costs and bed spaces? Personally, I've never treated patients with that view in mind. I leave that for bed managers and the like (who only seem to think about that).

Like many have already said, there's no right or wrong answer. Both sides can be argued. Unfortunately, as doctors, there are times when we are faced with such decisions, and we have to make a choice based on our experiences and training. As with any decision tha someone makes, there is always going to be someone who disagrees/second guesses you. Part of being a doctor is learning to make the hard decisions (that others run away from) to the best of your ability.

[racheljane]

Hi Karnesh, my point that the doctors may be accused of being biased towards saving costs etc. was to back up the fact that in this sort of case legal backup might be essential, I did not mean to infer that doctors actually have that view. A hurt, angry and grieving parent often has no other way of hitting out than to make accusations and I'm sure that being on the wrong end of this is another difficult part of the job. It is challenges like this that attract me to the job.

[karnesh]

Hi Racheljane. You're right. At times like this, accusations can fly in every direction. Legal backup is imperative for both the hospital (who always have a legal department anyway), and the patients family. While the doctors will probably not argue the costs issue, management most likely would.

The way it stands now, for adult patients, noone else can dictate what medical treatment should/should not occur apart from the doctor. We will talk to the family and get their opinion and explain the situation to them, but at the end of the day the decision is ours, though others might disagree on emotional/other grounds.

For children, things are very tricky. If I remember correctly, I think legally things are technically the same. However, being young patients, hospitals tend to tread a little more softly (for fear of media scandalising the situation...etc...).

As for the rights and wrongs that Osob was talking about, as with all ethical questions one can be asked at interviews and other times, there is no right answer. Having interviewed for a total of 5 years myself, I can say that when I ask such questions, I'm looking to see how a person analyses the situation, and whether they can see and argues both sides of the arguement, or whether they can only see their opinion.

But yeah racheljane, you're right. There are few things harder in the job than having to make these decisions, except possibly having to break bad news. I hate doing it, but it's gotta' be done....

[racheljane]

Thanks for that Karnesh, it's really helpful to hear things from an experienced point of view, especially an interviewer's! I was thinking that maybe I was being too biased seeing things more from a mother's point of view, so it's good to hear that seeing it from both sides is useful.