Saad s Essay

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Saad Riaz

SS-100

Aqeela Zaman

16th

Dec, 2013

Is neonatal Euthanasia Defensible?

Euthanasia refers to the act of putting any person to death in order to relieve him/her from

the pain they suffer. This practice is considered to be controversial due to moral implications it

has. Euthanasia is legal in few countries like Belgium, Netherlands and India under definite

circumstances. Medical experts have made a distinction between active and passive euthanasia.

Active euthanasia refers to a practice in which the patient is put to death deliberately. Passive

euthanasia refers to the cases of euthanasia where no intervention to prolong the patients life is

made. Even though we have made huge technological advances in the field of medical care,

medical experts face the problem of prolonging the lives of neonates or newborn babies (infants

who are less than four weeks) whose prognosis (course of medical recovery) appears to be too

bleak. Occasionally the parents and the medical experts the question of whether they are doing

the right thing in prolonging thepatientslives. Medical experts and the parents must take into

account the question of moral principles and possible criminal legal responsibility associated

with the practice of euthanasia (Sklansky). Proponent of neonate euthanasia justify it by

contending that neonates are not strictly persons in the biological sense; they also show their


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support for neonate euthanasia based on the principle of beneficence and the fact that doctors

may predict a bleak prognosis for the neonate. This can be refuted by arguing for the

impossibility of absolute prediction of medical cases and by raising the question of the final

burden of decision and the problematic, slippery slope argument that makes it difficult to decide

how many neonates can be let go and how many can be provided with medical care. From these

arguments, this paper will show that neonate euthanasia is not justified.

Parentssubstituted judgment (substituted judgment refers to the fact that the actual

victim of euthanasia- the neonate- has no part in the decision) to take the lives of their defected

neonates is ambiguous because their decision is based on predictions (after consultation with the

doctor) about the quality of life the infant may live afterwards. This prediction about the

quality of life is a common justification for carrying out neonatal euthanasia. This is very

problematic as this prediction about the prognosis of the neonates life bears the risk of being

faulty. Doctors can never be certain about no recovery or chances of survival. According to

Carlo Belleini, a research fellow from Clinica Neonatologica, Ospedale Le Scotte, Siena, Italy,

the power to predict neurological developments of neonates isonly sixty two percent.

Therefore, one can argue that there is no certainty about the prognosis of the neonate.

Subsequently, one may argue that if the prediction is not right in almost forty percent cases then

how can such an argument give anyone the right to initiate euthanasia on neonates?

The second problem with the quality of life argument is that the quality itself is a very

subjective term. The proponents of practice of euthanasia on neonates are judging the quality of

life on what the individual may be able to do in life and there is no consideration of the intrinsic

value of life itself. How can one infer from such an argument that it is morally justifiable to kill

someone if they dont have a certain quality of life? It is impossible to know the intrinsic value


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life itself may have for neonate if it is able to survive. One must not treat the quality of life as

something objective because we can never measure the quality of life. Consequently, one can say

that quality of life differs for every individual. So, it is clear that the justification of euthanasia

by quality of life argumentis nothing more than a subjective appeal to human sensibilities and

does not account for objective potential realities. Furthermore, predictions are never absolute and

quality of life is a subjective term, thereby weakening the case for neonate euthanasia.

When a child is born with defects, the decision has to be made whether euthanasia will be

carried out or not. However, who is going to decide whether the child is to be treated or put to

death? Parents are given the right to decide with the required consultation of the pediatricians. If

the disagreement arises between the parents and the pediatricians then the ethics committee

(Hospitals in the advanced countries have ethic committees) resolves the issue. Parents are

always the main decision makers in this process, but we must consider the emotional pressure

they face while deciding about the life of their child who is born with defects. We cannot ignore

factors like financial constraints on the parents to keep the child alive by paying huge amounts of

money. When parents are deciding about the course of action regarding the life and death of the

neonate, they have to consider the limitations they face due to financial constraints by keeping

the child alive. Sometimes, keeping the defective child alive may cost too much and it may result

in harm to their financial situation in the long run. We can therefore argue that the decision made

by the parents who face emotional pressure and financial pressure while deciding about the life

of neonate carries far too much pressure for parents to behave rationally.

After parents, doctors are considered to be authorities to give their opinion regarding the

defected neonatescourse of medical treatment. Some critics argue that even though the doctors

decision is considered to be sounder because they are not connected emotionally or financially to


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the neonate, insurance agencies may reward doctors for recommending non-treatment as this

may be costly for the agencies, thereby biasing the decagons of doctors in favor of euthanasia.

Thus, doctors also have their own limitations which influence their decision regarding the life of

defected neonate. Last authority to decide on the course of action relating to neonate euthanasia

is the ethics committee. In the cases of neonates with defects decisions have to be made as soon

as possible so when the case is referred to such committees they sometimes fail to deliver in the

required time as every case varies. Moreover, sometimes these committees can be dominated by

single mindset or framework (committees own principles) which may be harmful for the life of

neonates. Considering the problems of all these decision making authorities one can come to the

conclusion that there are many chances of mistakes and biases of all parties involved in this

process who have to decide for the life of a neonate.

Proponents of euthanasia for neonates sometimes refer to complex philosophical

arguments regarding the definition of being a person and its right to live whichdrives from

being a person. They argue that infants right of life must not be derived from its biological

existence rather it has to be driven from moral sense, as the neonates does not constitute to be

person morally speaking so they dont have a right to lifeper se. Moreover, they define being a

person as someone who can dream or think about his future. So, whatever is considered to be

right for the children by performing euthanasia parents are not going against the right of life. But,

one can say that the social aspect in this decision is missing. If social aspect is taken in account

then it will enforce the social principles which are directed towards the weak. This is the

category of human beings who do have certain rights but no duty. So, we can include infants in

this category. Moreover, one can also say that these infants are born in a society and all societies

believe in the principle of kindness towards weak. If we consider this argument in mind then we


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may realize that there is another aspect to this philosophical debate which tries to be careful

while deciding about the life of the infants and treats them as someone who have some rights but

no duties at all.

In this debate the concept of autonomy is important. Traditionally individuals who are suffering

are given the right to choose medical course of action or refuse it altogether. But, when we take

cases of neonates we see that they dont have any ability to make such choices. Hence the

traditional meaning of autonomy has almost no effect on treatment of neonates. Caregivers and

parents of neonates have come up with the concept of beneficence; a moral virtue to act which

tries to benefit another person. Beneficence aims to maximize someone elses best interests,so

the parents can make the decisions to maximize their neonates short term and long term

interests. However, as Sklansky argues that we cant look at this principle of beneficence in

isolation because we have to take into consideration some other principles as well. Principle of

justice is very important here as it maintains that everyone has equal rights. So, how can one not

take into account some moral principles while deciding about their life? Moreover, best

interests are not objective at all. Wedont have any metric to measure whetherputting neonate

to death is best for the neonate.

Sklansky talks about the problematic slippery slope argument and says that letsassume

that euthanasia is acceptable in some rare cases and people are given the right to decide and it

has been made legal. One problem may arise from accepting this morally complex debate, which

is that the individuals may start to choose euthanasia for their infants based on their reflexive

decisions. There is the possibility that if euthanasia is legalized it may help those who are

suffering but at the same time it can also be misused by those who think they are suffering

because of someone. This legalization may lead to this issue becoming desensitized and a


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common practice. One can say that this legalization may lead to the abuse of this law which is

very problematic. To support Sklanskys argument lets take an example from the research

conducted in Netherlands. Recently a research paper was published by English legal academic

John Keown, which states:

The Dutch reports contain abundant evidence that doctors kill more

without their explicit request than with their explicit request, and that

euthanasia is not restricted by the so-called strict medical guidelines

provided by the Dutch courts.

According to a report in Telegraph some hospitals in United Kingdom have tried to kill

under the pretext of euthanasia. Elderly patients were 'helped to die to free up beds'. Such

incidents are validated if euthanasia is allowed even for rare cases. This may lead to

criminalization of this right to use euthanasia even when faced with severe cases where voluntary

euthanasia is conducted. (Bowater)

As far as the euthanasia for adults is considered one can argue that they have the ability

to decide and they may be given the right to choose their considering the medical reports

forefront. But as far as the euthanasia for neonatal infants is considered its justifications are

faulty-consider the arguments of predicting the prognosis and quality of life, beneficence

principle. Moral justifications for these arguments are not sufficient and they are faulty as well.

Moreover, one can also argue that the legalizing such issues may be detrimental and create abuse

of law as it is evident from the case of Netherlands. Every year, many cases of neonate

euthanasia and other forms of euthanasia go unreported, which highlights the importance of legal

actions relating to incidents which encourage the culprits to engage in such activity.


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Works Cited

Bellieni, Carlo. Quality of Life is a Misnomer: The Case for Neonatal Euthanasia.Journal

of Medicine and The Person 4.3 (2006): 103-105. Web. 15 Dec. 2013.

Bowater, Donna. "Elderly Patients 'helped to Die to Free up Beds', Warns Doctor." The

Telegraph. The Telegraph, 20 June 2012. Web. 15 Dec. 2013.

Sklansky, Mark. Neonatal Euthanasia: Moral Considerations and Criminal Liability.Journal

of Medical Ethics 27.1 (2001): 5-11. Jstor. Web. 15 Dec. 2013.


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