Many factors over the course of time have influenced the way parents react to the death of their baby, including a less private attitude towards bereavement, unrealistic expectations of survival, perhaps an erosion of spirituality, and more recently mistrust of the medical profession.

In this issue of the journal, the results of a survey carried out in three neonatal referral centres in Scotland are presented that shed light on parents' perceptions of the withdrawal of intensive care1 and subsequent autopsy.2 The strength of these two papers rests not so much with their scientific precision, but with their role in prompting discussion of a sensitive subject.

When neonatal intensive care (presumably assisted ventilation) was withdrawn with parental consent, almost one quarter of the parents were concerned and distressed at the length of time it took for their babies to die, which ranged from three to 36 hours. Parents were not prepared for this, and had anticipated a swifter death. Furthermore, the dying process was particularly stressful for the parents of some babies. There is irony in the idea of withdrawing intensive care in order to avoid prolonging pain and suffering, when it is followed by a variable and unpredictable period of what is perceived as further pain and suffering. Furthermore, the use of drugs primarily to hasten death in this situation probably amounts to euthanasia, which of course is illegal in the United Kingdom and other countries.

Neither of these papers clarifies the precise reasons for withdrawing intensive care. A distinction should be made between withdrawal because a baby has already entered the process of dying, and further intensive care is simply prolonging death rather than saving life, from a decision based on a perception of “quality of life” if the baby survives.3 The likelihood of a lingering …