Parents and end of life decisions in neonatal practice

MALCOLM CHISWICK

doi:10.1136/fn.85.1.F1

Responses

Leading article

Parents and end of life decisions in neonatal practice

Compose a Response to This Article

Compose Response

Title *

Author Information

Contributors
First Name and Middle Initial * First or given name, e.g. 'Peter'. Last Name * Your last, or family, name, e.g. 'MacMoody'. Email Address * Your email address, e.g. higgs-boson@gmail.com Occupation * Your role and/or occupation, e.g. 'Orthopedic Surgeon'. Affiliation * Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

Please describe the competing interests

PLEASE NOTE:

A rapid response is a moderated but not peer reviewed online response to a published article in a BMJ journal; it will not receive a DOI and will not be indexed unless it is also republished as a Letter, Correspondence or as other content. Find out more about rapid responses.
We intend to post all responses which are approved by the Editor, within 14 days (BMJ Journals) or 24 hours (The BMJ), however timeframes cannot be guaranteed. Responses must comply with our requirements and should contribute substantially to the topic, but it is at our absolute discretion whether we publish a response, and we reserve the right to edit or remove responses before and after publication and also republish some or all in other BMJ publications, including third party local editions in other countries and languages
Our requirements are stated in our rapid response terms and conditions and must be read. These include ensuring that: i) you do not include any illustrative content including tables and graphs, ii) you do not include any information that includes specifics about any patients,iii) you do not include any original data, unless it has already been published in a peer reviewed journal and you have included a reference, iv) your response is lawful, not defamatory, original and accurate, v) you declare any competing interests, vi) you understand that your name and other personal details set out in our rapid response terms and conditions will be published with any responses we publish and vii) you understand that once a response is published, we may continue to publish your response and/or edit or remove it in the future.
By submitting this rapid response you are agreeing to our terms and conditions for rapid responses and understand that your personal data will be processed in accordance with those terms and our privacy notice.

I agree to and have read the terms and conditions for rapid responses and BMJ Privacy Notice *

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Other responses

Jump to comment:

The "holding back" of intensive care.
Indranil Bagchi
Published on: 9 January 2022

Published on: 9 January 2022
The "holding back" of intensive care.
- Indranil Bagchi, Specialist Registrar, Neonatal Unit
Dear Editor
I note with deep interest the article by Dr. Chiswick on the dilemma surrounding the issues of withdrawal of intensive care from a sick newborn infant. I would like to highlight one aspect of 'withdrawal' which I felt was missing in this thought provoking article.
Although the most common scenario entailing withdrawal of intensive care is either surrounding an 'end of life decision' or 'quality...
Show More

Dear Editor
I note with deep interest the article by Dr. Chiswick on the dilemma surrounding the issues of withdrawal of intensive care from a sick newborn infant. I would like to highlight one aspect of 'withdrawal' which I felt was missing in this thought provoking article.
Although the most common scenario entailing withdrawal of intensive care is either surrounding an 'end of life decision' or 'quality of life decision' (as Dr. Chiswick puts in the article) ,the article does not deal with the issue of a third, perhaps the most painful, scenario. This is of a baby who has unfortunately suffered severe organ (usually pulmonary or neurological) damage in the process of prior intensive care. It is often possible that these babies come off the ventilator after a prolonged suffering ,not only for the baby but also for the parents. They may stay 'well' for a period and then often deteriorate from a new insult, like new infection, even when they are in the baby unit. What do we do then when we know the futility of reintroducing intensive care? We often counsel the parents against intensive care on the grounds of a combination of the inevitability of dying and the even worse quality of life were our new efforts to succeed. The result is often the 'holding back' of intensive care.
Are we terminating life in that case ?
This I feel is the grey area between the clear cut 'end of life' and 'quality of life' situations. This is the instance when a parent will need the most support, information and sympathy from doctors and nurses as they have seen their baby fight, survive and then die in front of them. This is all the more difficult for them as sometimes they do not get enough time to think before giving the consent because the intercurrent illness comes on quickly.
The other issue is about introducing opiates in these babies after a decision has been made to withhold intensive care. After we have made a decision, along with parents, to withhold intensive care the babies often live for quite a few hours during which he or she almost inevitably goes through a hideous sensation of slow asphyxia, undoubtedly causing life long impressions for the parents. Many in this situation would not hesitate to give opiate analgesics. However, few would give 'unconventional doses' if it is needed - the grounds being that it would tantamount to euthanasia. Do we have the right to take this moral high ground once we have decided, albeit with someone else, not to treat a suffering human being?
If the parents can give consent for withdrawal or withholding of life prolonging measures, can they not give consent to curtail suffering once we have already decided not to treat the baby?
I strongly feel that this requires open and honest debate.
Indranil Bagchi
Show Less

Conflict of Interest:
None declared.
- Back to top

Main menu

Plain text

PLEASE NOTE:

Vertical Tabs

Other responses

Jump to comment:

Log in using your username and password

Main menu

Log in using your username and password

You are here

Plain text

PLEASE NOTE:

Vertical Tabs

Other responses

Jump to comment:

Read the full text or download the PDF:

Log in using your username and password