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Saad Riaz SS-100 Aqeela Zaman 16th Dec, 2013 Is neonatal Euthanasia Defensible?

Euthanasia refers to the act of putting any person to death in order to relieve him/her from the pain they suffer. This practice is considered to be controversial due to moral implications it has. Euthanasia is legal in few countries like Belgium, Netherlands and India under definite circumstances. Medical experts have made a distinction between active and passive euthanasia. Active euthanasia refers to a practice in which the patient is put to death deliberately. Passive euthanasia refers to the cases of euthanasia where no intervention to prolong the patients life is made. Even though we have made huge technological advances in the field of medical care, medical experts face the problem of prolonging the lives of neonates or newborn babies (infants who are less than four weeks) whose prognosis (course of medical recovery) appears to be too bleak. Occasionally the parents and the medical experts the question of whether they are doing the right thing in prolonging the patients lives. Medical experts and the parents must take into account the question of moral principles and possible criminal legal responsibility associated with the practice of euthanasia (Sklansky). Proponent of neonate euthanasia justify it by contending that neonates are not strictly persons in the biological sense; they also show their

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support for neonate euthanasia based on the principle of beneficence and the fact that doctors may predict a bleak prognosis for the neonate. This can be refuted by arguing for the impossibility of absolute prediction of medical cases and by raising the question of the final burden of decision and the problematic, slippery slope argument that makes it difficult to decide how many neonates can be let go and how many can be provided with medical care. From these arguments, this paper will show that neonate euthanasia is not justified. Parents substituted judgment (substituted judgment refers to the fact that the actual victim of euthanasia- the neonate- has no part in the decision) to take the lives of their defected neonates is ambiguous because their decision is based on predictions (after consultation with the doctor) about the quality of life the infant may live afterwards. This prediction about the quality of life is a common justification for carrying out neonatal euthanasia. This is very problematic as this prediction about the prognosis of the neonates life bears the risk of being faulty. Doctors can never be certain about no recovery or chances of survival. According to Carlo Belleini, a research fellow from Clinica Neonatologica, Ospedale Le Scotte, Siena, Italy, the power to predict neurological developments of neonates is only sixty two percent. Therefore, one can argue that there is no certainty about the prognosis of the neonate. Subsequently, one may argue that if the prediction is not right in almost forty percent cases then how can such an argument give anyone the right to initiate euthanasia on neonates? The second problem with the quality of life argument is that the quality itself is a very subjective term. The proponents of practice of euthanasia on neonates are judging the quality of life on what the individual may be able to do in life and there is no consideration of the intrinsic value of life itself. How can one infer from such an argument that it is morally justifiable to kill someone if they dont have a certain quality of life? It is impossible to know the intrinsic value

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life itself may have for neonate if it is able to survive. One must not treat the quality of life as something objective because we can never measure the quality of life. Consequently, one can say that quality of life differs for every individual. So, it is clear that the justification of euthanasia by quality of life argument is nothing more than a subjective appeal to human sensibilities and does not account for objective potential realities. Furthermore, predictions are never absolute and quality of life is a subjective term, thereby weakening the case for neonate euthanasia. When a child is born with defects, the decision has to be made whether euthanasia will be carried out or not. However, who is going to decide whether the child is to be treated or put to death? Parents are given the right to decide with the required consultation of the pediatricians. If the disagreement arises between the parents and the pediatricians then the ethics committee (Hospitals in the advanced countries have ethic committees) resolves the issue. Parents are always the main decision makers in this process, but we must consider the emotional pressure they face while deciding about the life of their child who is born with defects. We cannot ignore factors like financial constraints on the parents to keep the child alive by paying huge amounts of money. When parents are deciding about the course of action regarding the life and death of the neonate, they have to consider the limitations they face due to financial constraints by keeping the child alive. Sometimes, keeping the defective child alive may cost too much and it may result in harm to their financial situation in the long run. We can therefore argue that the decision made by the parents who face emotional pressure and financial pressure while deciding about the life of neonate carries far too much pressure for parents to behave rationally. After parents, doctors are considered to be authorities to give their opinion regarding the defected neonates course of medical treatment. Some critics argue that even though the doctors decision is considered to be sounder because they are not connected emotionally or financially to

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the neonate, insurance agencies may reward doctors for recommending non-treatment as this may be costly for the agencies, thereby biasing the decagons of doctors in favor of euthanasia. Thus, doctors also have their own limitations which influence their decision regarding the life of defected neonate. Last authority to decide on the course of action relating to neonate euthanasia is the ethics committee. In the cases of neonates with defects decisions have to be made as soon as possible so when the case is referred to such committees they sometimes fail to deliver in the required time as every case varies. Moreover, sometimes these committees can be dominated by single mindset or framework (committees own principles) which may be harmful for the life of neonates. Considering the problems of all these decision making authorities one can come to the conclusion that there are many chances of mistakes and biases of all parties involved in this process who have to decide for the life of a neonate. Proponents of euthanasia for neonates sometimes refer to complex philosophical arguments regarding the definition of being a person and its right to live which drives from being a person. They argue that infants right of life must not be derived from its biological existence rather it has to be driven from moral sense, as the neonates does not constitute to be person morally speaking so they dont have a right to life per se. Moreover, they define being a person as someone who can dream or think about his future. So, whatever is considered to be right for the children by performing euthanasia parents are not going against the right of life. But, one can say that the social aspect in this decision is missing. If social aspect is taken in account then it will enforce the social principles which are directed towards the weak. This is the category of human beings who do have certain rights but no duty. So, we can include infants in this category. Moreover, one can also say that these infants are born in a society and all societies believe in the principle of kindness towards weak. If we consider this argument in mind then we

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may realize that there is another aspect to this philosophical debate which tries to be careful while deciding about the life of the infants and treats them as someone who have some rights but no duties at all. In this debate the concept of autonomy is important. Traditionally individuals who are suffering are given the right to choose medical course of action or refuse it altogether. But, when we take cases of neonates we see that they dont have any ability to make such choices. Hence the traditional meaning of autonomy has almost no effect on treatment of neonates. Caregivers and parents of neonates have come up with the concept of beneficence; a moral virtue to act which tries to benefit another person. Beneficence aims to maximize someone elses best interests, so the parents can make the decisions to maximize their neonates short term and long term interests. However, as Sklansky argues that we cant look at this principle of beneficence in isolation because we have to take into consideration some other principles as well. Principle of justice is very important here as it maintains that everyone has equal rights. So, how can one not take into account some moral principles while deciding about their life? Moreover, best interests are not objective at all. We dont have any metric to measure whether putting neonate to death is best for the neonate. Sklansky talks about the problematic slippery slope argument and says that lets assume that euthanasia is acceptable in some rare cases and people are given the right to decide and it has been made legal. One problem may arise from accepting this morally complex debate, which is that the individuals may start to choose euthanasia for their infants based on their reflexive decisions. There is the possibility that if euthanasia is legalized it may help those who are suffering but at the same time it can also be misused by those who think they are suffering because of someone. This legalization may lead to this issue becoming desensitized and a

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common practice. One can say that this legalization may lead to the abuse of this law which is very problematic. To support Sklanskys argument lets take an example from the research conducted in Netherlands. Recently a research paper was published by English legal academic John Keown, which states: The Dutch reports contain abundant evidence that doctors kill more without their explicit request than with their explicit request, and that euthanasia is not restricted by the so-called strict medical guidelines provided by the Dutch courts. According to a report in Telegraph some hospitals in United Kingdom have tried to kill under the pretext of euthanasia. Elderly patients were 'helped to die to free up beds'. Such incidents are validated if euthanasia is allowed even for rare cases. This may lead to criminalization of this right to use euthanasia even when faced with severe cases where voluntary euthanasia is conducted. (Bowater) As far as the euthanasia for adults is considered one can argue that they have the ability to decide and they may be given the right to choose their considering the medical reports forefront. But as far as the euthanasia for neonatal infants is considered its justifications are faulty-consider the arguments of predicting the prognosis and quality of life, beneficence principle. Moral justifications for these arguments are not sufficient and they are faulty as well. Moreover, one can also argue that the legalizing such issues may be detrimental and create abuse of law as it is evident from the case of Netherlands. Every year, many cases of neonate euthanasia and other forms of euthanasia go unreported, which highlights the importance of legal actions relating to incidents which encourage the culprits to engage in such activity.

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Works Cited Bellieni, Carlo. Quality of Life is a Misnomer: The Case for Neonatal Euthanasia. Journal of Medicine and The Person 4.3 (2006): 103-105. Web. 15 Dec. 2013. Bowater, Donna. "Elderly Patients 'helped to Die to Free up Beds', Warns Doctor." The Telegraph. The Telegraph, 20 June 2012. Web. 15 Dec. 2013. Sklansky, Mark. Neonatal Euthanasia: Moral Considerations and Criminal Liability. Journal of Medical Ethics 27.1 (2001): 5-11. Jstor. Web. 15 Dec. 2013.

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