Euthanasia for newborn babies with lethal and disabling conditions is illegal worldwide, but in reality, its acceptance and practice vary between different countries.
In the Netherlands, about 200,000 live births occur annually; of these, 10-20 babies – mostly with severe congenital malformations – are thought to be actively killed. Yet between 1997 and 2004 only 22 such deaths were reported to the authorities, writes Kate Costeloe, Professor of Paediatrics at the University of London.
To regulate neonatal euthanasia, clinicians in the Netherlands have argued that all cases should be reported and they have developed guidance which defines criteria that must be fulfilled before euthanasia can be considered. Doctors who follow this guidance are not guaranteed freedom from prosecution, but to date no paediatrician in the Netherlands has been prosecuted.
In UK law, the fetus becomes a legal entity only at the moment of birth. Because of this, the Royal College of Obstetricians and Gynaecologists can recommend that late termination of pregnancy for fetal anomaly should be preceded by feticide, but any clinician who injected a similar severely malformed newborn baby with potassium chloride moments after birth would be guilty of murder.
The report of the Nuffield Council of Bioethics, published after widespread consultation in November 2006, "unreservedly" rejected the possibility of neonatal euthanasia in the context of UK practice even when life is intolerable.
One of the reasons the UK is resistant to adopting the Dutch recommendations is that active killing as a therapeutic option is seen as a "slippery slope" towards its wider use, she says, although some reject this argument.
Another reason is the fear that active killing may have a negative impact on the psychology of professional staff, and that parents may feel pressured to accept the option of euthanasia so that they do not become a burden on medical and social services.
Acts by neonatologists in the UK undertaken with the purpose of ending life seem to be rare, and guidance provided by the Royal College of Paediatrics and Child Health around end of life decisions has provided a framework within which UK neonatologists feel comfortable.
The availability of active euthanasia as a therapeutic option would undermine this progress and be a step backwards, she says.
However, we must look at how to provide for babies who might be candidates for euthanasia elsewhere in the world. Sadly, too often, parents have to battle for essential services that ensure the best outcome for their disabled child, and that also make their own lives more tolerable, she concludes.
Source: BMJ-British Medical Journal.