The Nuffield Report
Despite the spin and hysteria conjured by the Daily Mail and various pro-life groups, the Nuffield Council on Bio-ethics report entitled ‘Critical Care decisions in fetal and neonatal medicine’ is not a primer for the euthanasia of newborns; nor can it be described as ‘nothing short of eugenics’. It is instead a well-researched and sensible set of recommendations designed to aid parents, as well as Doctors, in making an informed decision about this most emotional of issues.
Due to considerable advances in neonatal technology in the past twenty years, the survival rate of babies considered ‘extremely premature’ (i.e birth at 25 weeks) has steadily increased. However, most babies born this early still die and those that survive are very likely to have severe disabilities. This report was commissioned in an attempt to update medical ethics and practice with our rapidly advancing knowledge of medical science.
The report advises that babies born before 23 weeks should not be resuscitated, as only 1% of them survive and a high proportion are born with disabilities. Between 23 and 24 weeks the outlook is poor – two thirds of those very few that survive end up disabled – but the final decision to give treatment should be with parents, provided they have been properly briefed by an experienced doctor on the chances and future their child has. After the baby reaches 25 weeks, invasive intensive care should be given but ‘the healthcare team should make it clear that statistics indicate that most babies born below 25 weeks of gestation will die.’
It is important to note that in practice doctors, in the vast majority of cases, do not resuscitate babies born before 23 weeks anyway. The report also forcefully rejects the approach of the Netherlands, whereby doctors are allowed to allow any baby born before 25 weeks to die in cases of ‘hopeless and unbearable suffering’. Equally, however, the report is not absolutely pro-life in all cases; it acknowledges ‘that it is not in a baby’s best interests to insist on the imposition or continuance of treatment to prolong life when doing so imposes an intolerable burden upon him or her.’Here we reach the crux of the matter. The report recognizes that there is a multiplicity of opinion regarding what constitutes ‘intolerable’. This topic has been the subject of much earnest and bitter public debate over the past few decades; do we opt for ‘quality’ or ‘sanctity’ of life when making decisions such as these?
Doctors cannot be asked to end life, because that would be a contravention of what the medical professions exists for; but it is quite another thing to know when to give up on treatment. Pro-life organizations, many of them religious in nature, often oppose any attempt to limit suffering through humane decisions to withdraw treatment. Their position is ironic, because it is only in recent years that we have been able to keep babies (and terminally ill people of other age groups) alive when all hope of recovery has been lost. In a sense, man is already playing God – to say that removing treatment is a form of Godhood is a false inference; the treatment itself has defied Nature and taken away Her powers of life and death.
At this point, before we get too bogged down in the enormous minefield of bioethics, it would be illustrative to remember the case of Charlotte Wyatt. She was born in October 2003 at 26 weeks with serious heart and lung problems, and has confounded doctors by living as long as she has. She has never left hospital and needs a constant supply of oxygen. She has no prospect of living beyond infancy.
Her doctors and parents have been involved in a High Court battle over whether she should be revived if she stops breathing. The doctors say no, as her quality of life would be so poor and she would be in constant pain. Her parents, both committed Christians, believe she is developing and want her to be revived at all costs. Considering her condition and prospects, however, surely the more humane position and the one more responsive to the child’s distress would be to withdraw treatment if she stopped breathing? Would this be a life well saved?
Importantly, the report also considers the costs (both to parents and the NHS) of caring for a disabled child. Intensive care treatment is very expensive, and whilst obviously this fact alone is no reason to deny treatment to anybody, it must be considered within the context of a cash-strapped health service with finite resources. It also takes into consideration what would happen after the baby and family walked out of the doors of the hospital – very few families can afford the kind of care that is provided within the infirmary at home.
This report represents one of the best of British civic traditions. It is even-handed, measured and reasoned. Whilst it does not exclude emotion from its calculations, it balances them with a good dose of rationality – thus ensuring that the parents and the doctors both have space to offer their opinions and neither party is drowned out by the sheer emotiveness of the issue. It is unlikely that it will become public policy, but it represents a welcome new addition to a debate in dire need of the cool balm of reason.
-posted by Adam
