Nurses and euthanasia

Sometimes merely mentioning something can spark a controversy.

In the May/June 2008 edition of the US-based Pediatric Nursing Journal, on stands now, authors Anita J. Catlin and Renee Novakovich discuss infanticide for children with terminal disease in their column "The Groningen Protocol: What Is It, How Do the Dutch Use It, and Do We Use It Here?"

The protocol allows doctors in the Netherlands, in consultation with parents, to end the life of a child  with a terminal disease. Of the 1,000 babies annually who die in their first year in the Netherlands, 600 die under the protocol, according to the New England Journal of Medicine.

The article has attracted little mainstream attention, but has been a hot topic among medical ethics bloggers. And now, the Drudge Report has picked up on the issue, summarizing some of the arguments of others.

I have not been able to find a full online version of the column, but it seems the two authors do not come right out and argue in favour of infanticide,  instead refering to the issue as "complex" and a "difficult."

But that's enough to get critics talking. American blogger Wesley J. Smith argues that "what we don't condemn, what we claim to be mere `dilemmas,' we eventually are urged to allow."

"Infanticide," Smith says, "is moving into the mainstream of bioethics and the medical intelligentsia."

The article is written from an American perspective, but says that countries such as Canada and Britain, which have socialized medicine, are more likely to look favourably on infanticide as a way to keep costs down and ensure that medicare remains available to all.

It reminds me of conversations I had with McGill medical ethicist Margaret Somerville and Canadian Medical Association president Brian Day a couple of  weeks ago about rationing medical care. The conversations were about how to decide who gets expensive cancer drug treatments, in the wake of the Ontario government saying it would pay for Avastin. But the broader issue is the same: how do we decide who gets medical treatment, and who doesn't? The assumption being, of course, that we can't afford it for all, an issue Day has argued will become increasingly urgent as treatments become more costly and the population ages.

As a counter to the argument that socialized systems are more likely to look at infanticide, commenters to the Drudge Report have said that the private system of the United States already does this.

The longest excerpt of the article that I have been able to find is on Smith's blog:

Issues related to suffering infants, their families, and the nurses and doctors who care for them have been debated for many years. These issues have been examined medically(Carter & Levetown, 2004), ethically (Cassell, 2004), morally(Romesberg, 2003), and legally (Hurst, 2005). In the U.S., with the desire for beneficence (doing good), the lives of extremely premature infants are frequently supported at the estimated cost of nearly one million dollars per hospitalization. The principles of social justice (care for all children) and non-maleficence (allowing no harm) are seen as less important. However, in countries with socialized medicine, the principles of social justice and non-maleficence (avoiding doing `good,' which causes suffering) have been seen as more important. As long as the U.S. health care system supports the use of extensive technology for infants with life-limiting conditions and provides reimbursement for extremely long hospital stays, the dilemma over what some might consider miracles and others view as suffering will continue.

I will keep looking for more.