Hawaii legalised assisted suicide this week. It becomes the seventh American jurisdiction to do so. Since 1997, the legislatures of Hawaii, Oregon, Washington state, California, Colorado, Vermont and the District of Columbia have passed laws permitting assisted suicide. In Montana, a court decision found that it was legal, but there has been no legislation.
The new law follows the controversial Oregon model. One of the drawbacks of this legislation is its definition of "terminal illness". It is usually understood to be a condition which will lead to death withinn six months or a year. But if a patient decides to spurn all treatment, treatment which could keep them alive for years, his or her illness will automatically become "terminal". This is a flimsy basis for such an important law.
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A new article in Bioethics criticises policies in neonatal care units that mandate the withholding of treatment from babies born before 25 weeks gestation.
Neonatologist Manya J Hendriks (University Hospital Zurich) and paediatrician John D Lantos (Children’s Mercy Hospital) argue that many extremely premature babies -- babies born between 22 weeks and 25 weeks gestation -- can survive and, indeed, develop healthily if given adequate treatment. Yet many neonatal intensive care units in Europe and North America have policies based on estimated-gestation age (EGA), and these units routinely withhold treatment from extremely premature infants based solely or primarily on the fact that they were born before 25 weeks gestation. Units in France and the Netherlands will typically not intervene in cases where children were born prior to 24 weeks gestation, and in North America there is wild variation among the treatment policies of different units.
According to the authors, EGA-based policies are “contrary to both medical norms and to most theories of justice”. Instead, the authors argue for an “individualised approach” to treatment decisions based upon the likelihood of an intervention’s success.
The criteria for limiting treatment in preemies, as in any patient group, should include a combination of (a) poor prognosis for survival, (b) likelihood of unacceptable disabilities, (c) burdens of treatment, (d) costs and cost-effectiveness, and (e) informed consent and shared decision-making with parents. A just system would apply those criteria to all patient groups. Our current approach of denying treatment to some premature babies when it is provided in situations where it is less cost-effective to patients with a worse prognosis is unjust.In evaluating current neonatal care policies, the authors speculate that neonates are sometimes seen as “conditional persons” with less of a claim on our health care resources than fully-developed adult human beings. The authors argue that this view is contrary to basic egalitarian principles:
We assert that newborns, even those born prematurely, are full-fledged members of the human community and have the same right to treatment as other humans. This entails giving extreme preterm babies the best possible chance to life. Policies and practices that limit treatment based on gestational age alone violate this basic principle of justice.