When to let babies die

When is a premature baby so premature that we should consider them non-viable? When we do not intubate them and provide intensive care. Instead, we inform the parents that nothing can be done and provide excellent palliative care to help them die peacefully. There has always been disagreement about where the viability line should be drawn. A few years ago, experts from Europe and the US gathered in Norway to talk about the different approaches taken in different Scandinavian countries. In Sweden, they recommended resuscitation of babies born at 22 weeks and above, in Norway 23 weeks, and in Denmark 24 weeks. Each country’s policies were deeply rooted in their respective national and medical cultures. Each accepted the variation across the border. Much of the difference turned on questions on whether too many survivors would have unacceptably severe disabilities.

This week, I’m returning to Trondheim for a conference on shared decision making (SDM) in neonatology. I will be fascinated to learn how things have evolved in the five years since we last discussed these complex issues in Norway. Over those years, the borderline of viability has been slowly and steadily shifting downward in many parts of the world. I’ll be curious to discover whether differences persist in Scandinavian countries and, if so, how people understand the philosophical values and cultural forces that undergird differences. I am an advocate for SDM. I am aware of the many difficulties inherent in this nuanced approach. Still, as Churchill said about democracy, it may be the least-worst approach to these complicated decisions.

After Trondheim, I’ll be visiting Groningen in The Netherlands. That quaint university town is famous in neonatal bioethics as the place where Verhagen and Sauer developed a controversial protocol for neonatal euthanasia. Again, some countries followed the Netherlands while others objected vehemently to policies that allowed doctors to administer lethal injections to babies. I will be curious to see whether fears of slippery slopes were prescient or whether, instead, the Groningen Protocol resulted in fewer cases of neonatal euthanasia.

It should be an interesting week. I’ll be blogging about it all. Stay tuned…