Many paediatricians believe that there are circumstances in which infants should be allowed to die without having their lives prolonged by intensive care or surgery. During a four-year period, in a regional neonatal intensive-care unit, 75 infants were so seriously ill that withdrawal of treatment was discussed. 26 infants had severe acquired neurological damage, 26 had been born after extremely short gestation (25 weeks or less), and 23 had severe congenital abnormalities. The decision to withdraw treatment from a particular infant had to be unanimous among all the medical and nursing staff caring for that child and was based on a virtual certainty, not just of handicap, but of total incapacity--eg, microcephaly, spastic quadriplegia, and blindness. Of the 75 infants, the decision of the medical team was to withdraw treatment from 51. The parents of 47 infants accepted the decision and all these infants died. The parents of 4 infants chose continued intensive care, and 2 infants survived with disabilities. In the other 24 cases, the medical decision was to continue treatment. Of these, 17 survived and 7 died. When a thorough medical assessment had led to unanimous agreement among staff and parents that treatment should be withdrawn, its continuation on purely legal grounds is not justifiable.
KIE: A consultant neonatologist in the regional neonatal intensive care unit at London's Hammersmith Hospital contends that, when medical assessment of a seriously ill infant produces a prognosis of total incapacity and the decision to withdraw treatment is unanimously agreed upon by the unit staff and parents, there is no need for legal or infant care review committee involvement. He supports his argument by analyzing a study of 75 infants at Hammersmith Hospital to whom this policy was applied. Withdrawal of treatment was recommended for 51 infants and implemented in 47, all of whom died. Two of the four infants who were intensively treated at the parents' request survived, but with disabilities. Of the 24 infants for whom the medical decision was to continue treatment, 17 survived, 9 with disabilities.