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Neonatal euthanasia
1Department of Pediatrics and Program in Bioethics, University of California, Davis, Sacramento, CA 95817, USA. aakon@ucdavis.edu
Insights
This review examines end-of-life care for newborns, including pediatric palliative care and the Dutch protocol for neonatal euthanasia in cases of unbearable suffering. It discusses ethical considerations and US regulations on life-prolonging interventions.
Area of Science:
- Medical Ethics
- Neonatal Care
- Palliative Medicine
Background:
- Advances in infant care have not eliminated newborns with conditions incompatible with sustained life.
- Pediatric palliative care aims to alleviate suffering but may be insufficient for some infants.
- Unrelenting suffering in neonates raises ethical questions about the benefits versus burdens of life.
Purpose of the Study:
- To examine ethical aspects of end-of-life care for neonates.
- To review the Dutch protocol for neonatal euthanasia and its ethical underpinnings.
- To discuss US regulations on limiting or withdrawing life-prolonging interventions in infants.
Main Methods:
- Review of ethical arguments supporting euthanasia.
- Examination of the history and verbiage of US regulations on neonatal interventions.
- Description of neonate categories eligible for euthanasia under the Dutch protocol.
- Analysis of published reviews of the Dutch euthanasia protocol.
Main Results:
- The Dutch protocol provides euthanasia for specific categories of neonates experiencing unbearable suffering.
- Ethical arguments exist supporting euthanasia when suffering outweighs the benefits of life.
- US regulations govern the limitation and withdrawal of life-prolonging interventions in infants.
Conclusions:
- The review explores ethical considerations for neonatal end-of-life care, including palliative options and neonatal euthanasia.
- It provides context on the Dutch protocol and relevant US regulations.
- Practical considerations for potential implementation of neonatal euthanasia are presented.
Abstract:
Despite advances in the care of infants, there remain many newborns whose medical conditions are incompatible with sustained life. At times, healthcare providers and parents may agree that prolonging life is not an appropriate goal of care, and they may redirect treatment to alleviate suffering. While pediatric palliative treatment protocols are gaining greater acceptance, there remain some children whose suffering is unrelenting despite maximal efforts. Due to the realization that some infants suffer unbearably (ie, the burdens of suffering outweigh the benefits of life), the Dutch have developed a protocol for euthanizing these newborns. In this review, I examine the ethical aspects of 6 forms of end of life care, explain the ethical arguments in support of euthanasia, review the history and verbiage of the United States regulations governing limiting and withdrawing life-prolonging interventions in infants, describe the 3 categories of neonates for whom the Dutch provide euthanasia, review the published analyses of the Dutch protocol, and finally present some practical considerations should some form of euthanasia ever be deemed appropriate.
