It would be possible to respond to Peter Barr’s paper “Relation of neonatologists’ end-of-life decisions to their personal fear of death” with anger, disbelief or indifference, and it could be misunderstood as suggesting that covert euthanasia is a rampant practice in neonatal units, at least in Australasia. Neither these responses nor such a misreading would do justice to a paper that explores the personal attitudes that mediate the decision-making processes of neonatal consultants when faced with babies in whom the possibility of forgoing continued life support has become an option to be seriously considered.

In a survey of Australian and New Zealand (ANZ) neonatologists, using validated instruments for measuring dimensions related to fear of death or dying, Barr confirmed that some ANZ neonatologists are comfortable with knowingly hastening death with sedation and analgesia. This has already been shown in Europe, and Barr’s paper suggests that the finding is generalisable across culturally similar nations. The most striking finding was an association between the acknowledgement of this practice and greater “fear of the dying process” and “fear of premature death”. We are left with the question as …