24.03.15
Doctors told not to save premature babies just because they can
Newly published guidance advises doctors that they shouldn’t automatically intervene to save the lives of premature babies just because they might be able to.
The Royal College of Paediatrics and Child Health (RCPH) said increased survival rates for infants born between 22 and 25 weeks over the last decade should not be used as a reason to continue treatment in cases where babies were left with a “non-existent” quality of life.
A framework on life-limiting and life-threatening conditions in children asks doctors to compare the likely suffering of the young patient to the potential benefits of continued treatment.
The framework also says that doctors should consider the wishes of the patient when an older child with extensive experience of illness repeatedly and competently consents to the withdrawal or withholding of life-sustaining treatment (LST).
The document says: “In these circumstances, and where the child is supported by his or her parents and by the clinical team, there is no ethical obligation to provide LST.”
The framework provides three sets of circumstances when limiting treatment can be considered because it is no longer in the child’s best interests to continue:
- When life is limited in quantity - If treatment is unable or unlikely to prolong life significantly it may not be in the child’s best interests to provide it
- When life is limited in quality: This includes situations where treatment may be able to prolong life significantly but will not alleviate the burdens associated with illness or treatment itself
- Informed competent refusal of treatment An older child with extensive experience of illness may repeatedly and competently consent to the withdrawal or withholding of LST. In these circumstances, and where the child is supported by his or her parents and by the clinical team, there is no ethical obligation to provide LST.
Dr Simon Newell, a Consultant Neonatologist in Leeds and a former vice president at the RCPCH, said: “During the last 30 years working on neonatal units, I’ve seen some very ill newborns. Such is the advancement of medicine that thankfully we can successfully treat the majority of these babies and they go on to become healthy children and then adults.
“However, for some, continuing life-sustaining treatment is simply prolonging suffering in the face of the inevitable. For these babies, no treatment is going to cure them and their quality of life is non-existent. In these cases, an active decision is reached amongst the clinicians, parents and other parties involved to discontinue treatment rather than cause greater suffering for the child by keeping them alive.”
Current guidelines dictate that doctors should not resuscitate or provide intensive care to babies born at 22 weeks or below and should only attempt treatment in babies born between 22 and 23 weeks when both parents and doctors agree.
The last major study, published in 2012, found that, while overall survival has improved for those between 22 and 25 weeks, the vast majority of gains occurred after 24 weeks, with little improvement for infants at 22 and 23 weeks.
Dr Joe Brierley, chair of the Ethics and Law Advisory Committee at the RCPCH, said: “This is a sensitive and challenging area of medicine. The guiding principle remains to act in the best interest of the child, actively involving them in the decision making where possible, and of course considering the interests of the families and their rights.
“Decisions to limit treatments should be made by clinical teams in partnership with, and with the agreement of, the parents and child.
“It’s also important to remember that decisions to limit life-sustaining treatment do not constitute withdrawal of care. Treatments, including palliative care, to relieve suffering of the child should be offered early in the course of life-limiting or life-threatening illness.”
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