Bad News for Babies

Anthony McCarthy

After much comment in the press, the Nuffield Council has produced its long-awaited Report: “Critical care decisions in fetal and neonatal medicine: ethical issues”. Publication was preceded by a number of media stories, including one on the submission made to the Council by the Royal College of Obstetricians and Gynaecologists. The College asked the Council to consider allowing for “deliberate intervention to cause the death of an infant.” Aware that this amounts to an endorsement of active homicide, the RCOG Ethics Committee hastily added that it “does not have a view that we would like euthanasia to be discussed, but do feel that it has to be covered and debated...”1 Presumably the feelings of the Committee differ from its views!

In the context of recommendations for the deliberate active killing of newborn babies, many were relieved to hear that the Nuffield Report 2 “unreservedly rejects the active ending of neonatal life even when that life is ‘intolerable’”. (2.37). But as we keep learning, such feelings of relief can be premature.

In the first instance, the Report is quite clear that it “regards the moment of birth...as the significant point of transition not just for legal judgements about preserving life but also for moral ones”. (2.19). The rights of unborn children not to be given lethal injections (what the Report calls feticide) are in no way defended in the Report – quite the reverse. Despite claims that a moral discussion of abortion was outside the remit of the Report, it tellingly informs us that “Feticide is not always considered necessary if a fetus has an unequivocally fatal condition and will die during or soon after birth” (4.15) (my emphasis). Later the Report explicitly recommends that “Parliament should not accede to suggestions to grant legal status to the fetus.” (8.4).

Perhaps more worrying, however, is the section of the Report that deals with the killing of newborn babies. If we look again at the statement at 2.37 we find the word “intolerable” crying out for a definition. According to the Report there are treatments which should be withheld because they impose an “ ‘intolerable’ existence, even in the absence of evidence of great pain or distress.” (2.13).

The Report goes on to state that “clinical evidence” may “indicate that any future existence for the baby will be a life bereft of any of those features that give meaning and purpose to human life (for example, being aware of his or her surroundings or other people)”.(2.13).   So, there are people who have lives not worth living, according to “clinical evidence”. And these people have lives not worth living because they lack certain valuable functions.

The crucial point missed here is that these valuable functions belong to a living whole (the human organism/person), that must itself have a valuable overall function which unifies its other valuable functions. It is this overall function – that which makes a human being a human being – which  these other functions serve.

By making the value of a human being rest only on certain features, rather than on the human being’s existence itself, the Report allows that those who have a life not worth living - an “impossibly poor” life - should not be given treatment. Doctors, the Report says, have a duty so to act that such a life is not preserved.

However, if we were to accept the idea of “impossibly poor” lives, it becomes difficult to see what is wrong with “active” euthanasia – i.e. intentional killing of a human being by an active intervention (e.g. a lethal injection). After all, death is a “benefit” for such people, on this view.  And indeed, there is no important moral difference between deliberate killing by lethal injection and deliberate killing by withholding treatment (the Report’s authors are aware of this point (8.40) but make no argument against it), though it might be argued that active euthanasia will at least be quicker and more humane than deliberate killing by omission. Euthanasia enthusiasts are well aware that euthanasia by omission, once accepted, will lead the way to active euthanasia, and this Report, apparently unwittingly, helps their cause.

The Report does recognise that there can be treatments that are genuinely burdensome as treatments and which offer such a limited benefit to the patient that they should not be provided. By sliding from sensible talk about treatments that are overly burdensome to talk about intolerable human existence, the authors undermine the basic principle that there are no lives so lacking in value that they may be ended on those grounds. Such confusion undermines the good features of the Report and makes its condemnation of active euthanasia incoherent, while, tragically, making its effective endorsement of euthanasia by omission all too coherent.

At the slick launch of the Report, I asked one of the authors, moral philosopher David Archard, whether he endorsed euthanasia by omission, and asked him whether he believed that there were lives not worthy of life. He said yes twice. Not only that, but he seemed rather shocked that anyone might disagree. This is worrying, especially as Archard is on record as saying that we ought to “deny the baseless and bogus rights of parents to dictate what is, and what is not, taught to their children”. 3  As views such as these gain ascendancy, the culture of death quietly extends through our hospitals and schools.  In the words of T.S. Eliot, “This is the way the world ends/Not with a bang but a whimper.”

An earlier version of this article was published in The Universe on 26 November 2006.

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