4 thoughts on “Neonatal Euthanasia”

1. Hi Jana,

   Thank you for sharing your writing piece on neonatal euthanasia. I am going to follow the rubric guidelines for feedback and then I will post spelling and grammar errors in a separate comment.

   Context: your topic falls within the topics of ethics and what we have discussed in class. I think this is an interesting debate. Perhaps you can add a picture for the reader as a reference point, it may help to trigger thoughts about the piece or to draw the reader to your view. I suggest a picture of a neonate with a disability or a neonate with their family? I think you have addressed the most important points regarding the topic, however you can draw it out more. I suggest writing about the ‘patient’ or family and the burden of bringing up a child with disability from a financial point of you as well as from an emotional distress perspective. You could also argue this and describe how many different conditions and the same conditions present differently and that a child may turn out to have a high quality of life and place less of a burden on parents than anticipated. For example, cerebral palsy children present differently and one can only find out how they will present through developmental milestones (how can you tell this from birth?). I am sure there is literature on this that will support these claims.

   Argument: You proposed a good argument with good statements and claims. However I think the strength of your argument is lost in the structure of your piece. I found it hard to follow as your claims are scattered and repeated. I suggest each paragraph dealing with a claim or statement with the following paragraph countering this and so on. This will ensure it is logically consistent and may convince the reader of your argument.

   References: you used good references, these assist in the strengthening and justification of your claims. Although there are a few places that need to be adjusted. For example , you mention Justice O’Regan, when did he make this statement and where did it come from? This is also repeated with Van Van der Westhuizen (date?).

   Writing: there are a few spelling and grammar errors that I will address in a new comment.

   I remember reading your assignment last year and giving you feedback, there is a big improvement in your writing style and writing confidence. Well done!

   I enjoyed reading this, it triggered me to think about my thoughts on the topic and I found it insightful to read about the South African laws/trends on the topic.

   Thank you,
   Jemma

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2. SPELLING AND GRAMMAR CORRECTIONS
   Euthanasia can be defined as of ending the life of a terminally ill and suffering person in a painless, rapid and intentional manner for reasons of compassion and mercy (Vizcarrondo, 2014). In other words, one can argue that the term means “good death” and that the thought behind the process is to allow the patient to die in peace and with dignity. Furthermore, it allows the physician to care for the patient by alleviating pain and suffering. The topic of euthanasia in newborn babies with terminal illness and/or disability is not typically discussed. However, it’s acceptance and practice exists and varies between countries.

   While I was working in Tygerberg’s ICU, I witnessed a patient go for an emergency C-Section due to pre-eclampsia and foetal distress. This experience triggered personal thoughts on the topic of neonatal euthanasia. I wondered what had happened to the baby and mother as the pregnancy was only in the 2nd trimester. I researched the topic and realised how difficult it is to justify the morals and ethical principles.

   Since 2002, neonatal euthanasia has been legal in the Netherlands. This is due to the courts failing to exercise judgement on euthanasia since 1984. For this reason, it lead to the widespread use by the medical community which later on became accepted by the public (Vizcarrondo, 2014). Nevertheless, in 2002 the Groningen Protocol (GP) for neonatal euthanasia was created with the intent to regulate the implementation of actively ending the life of neonates. Therefore, ensuring that neonatal euthanasia would be controlled and could be justified. The GP for neonatal euthanasia consists of five criteria, namely:

   Diagnosis and prognosis need to be certain (no quality in life)
   The suffering is unbearable
   The doctor consulted with at least one other independent doctor or the treatment team
   Both parents must give informed consent, the doctor informed the parents of the diagnosis and prognosis, and together they agreed that there was no other alternative
   The procedure must be performed in accordance with the accepted medical standard

   On the other hand, the GP has received severe criticism. One author explains that the protocol lacks clinical and ethical accuracy meaning that the protocol does not specify the definitions of the following phrases: “quality of life” or “unbearable suffering” (van der Westhuizen, 2017). One may argue that if a neonate suffers unbearably, the burdens of life is larger than the benefits of life, which could justify the act. Although, the doctor or parents cannot objectively determine if the neonate is suffering or in severe pain.

   When looking at the South African law, it is clear that both active euthanasia and physician-assisted suicide is illegal and unlawful. On the other land, passive euthanasia is regarded as lawful. Passive euthanasia is viewed as when treatment is withheld or withdrawn which would prolong a patient’s life (van der Westhuizen, 2017).

   Section 7 of the National Health Act states that a health care professional may not provide medical treatment before acquiring informed consent of the patient, and in this case as neonates cannot express their thoughts, their parents or guardians can give consent to medical treatment on their behalf. Furthermore, the right to life is guaranteed in the Bill of Rights and can be regarded as the most fundamental right (Van Aswegen & Nienaber, n.d.). According to Justice O’Regan, a predecessor to the Bill of Rights, a foetus is not recognised as a living person under South African law and, therefore, is not afforded the right to life. Nonetheless, the same cannot be said in the case of a neonate who is born alive. The neonate is entitled to full protection in terms of the Bill of Rights in the Constitution, regardless of the degree of prematurity or impairment it was born with (Van Aswegen & Nienaber, n.d.). Despite that, many may argue that if no further medical interventions or treatments may benefit the neonate’s condition or prolong the suffering, then a dying neonate has the right to die with dignity.

   It is clear that neonatal euthanasia is controversial. Autonomy, or in other words the right to refuse treatment, is well accepted. If medical treatment is withdrawn and there is consensus, there may be no moral criticism (Clarke & Egan, 2009). Van der Westhuizen acknowledges that the South African Law commission drafted a document regarding euthanasia and the artificial preservation on life. However, the Minister of Health did not give any attention to it and the report was shelved. In the drafted report, the authors stated that the termination of a patient’s life should be legal under certain and specific circumstances, provided that these conditions are met. In addition, it made special reference that this should also be applicable when babies are born severely ill and disabled. This prognosis must be decided upon by more than one medical professional and indicate that they have no prospect of recovery and will inevitably die due to their conditions. Therefore, there should be no legal or moral obligation to provide treatment for neonates with a hopeless prognosis (van der Westhuizen, 2017).

   The question this proposes is, is there any moral or ethical grounds ever-justifying neonatal euthanasia? Many philosophers fully condemn any form of euthanasia, based on the sacred value of human life. In addition, they argue that even in the case of relieving the hopeless and unbearable suffering of a neonate, it can never fully be ensured. Therefore, this would suggest that stopping or withdrawing treatment which leads to neonatal euthanasia, is indeed morally unaccepted.

   On the other hand, other authors argued that although neonates are individual human beings, they are not yet persons, referring in the sense of individuals who are able to create their own future. Similarly, neonatal euthanasia could then in this case, not be harmful to them. Therefore, if one takes a closer look at this notion, it is the key to the moral debate as this determines the moral status of the neonates. If we consider that neonates to not yet be persons, then this could equally defend and be morally acceptable neonatal euthanasia (Eijden & Martinovici, 2013).

   Understanding competing moral principles such as autonomy, beneficence, non-maleficene and justice, can aid in a constructive approach and important moral question that the medical professional might face related to neonate euthanasia. Autonomy refers to the individuals right to refuse medical treatment and due to neonates being unable to make decisions for themselves, the term has little moral bearing on the treatment of the neonates. Actions that are beneficent in nature, aim to maximise someone’s best interests. However, one can argue whether the principle of beneficence encourages the prolonging of neonates unbearable and hopeless suffering (Sklansky, 2001).

   In terms of neonatal euthanasia, justice and what is morally acceptable, will dictate that all neonates should be treated equally. This principle ensures the protection of certain rights, even when doing so may conflict with the principle of beneficence. To conclude, neonatal euthanasia will always remain in a grey area in South Africa. Finally, the question could be asked whether it is in the best interests of a neonate who is suffering unbearably not to allow him or her to die, thereby ultimately ending their suffering

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3. Hi Jana, I really like that you chose such an important topic to write about, I will follow the rubric that we were given in order to provide you with feedback. I think that this will make my feedback more relevant.
   Content: I like that the content of your piece is relevant to what we have discussed in class, as well as to clinical practice. Have you thought about perhaps adding a picture or videos to the piece, I think that this might help to draw your readers attention from the beginning. In addition to this, I think that if you were to add some literature, with regards to the reasons behind Euthenasia, such as shame. You could also consider speaking about success rates of diagnosing children with a specific condition prior to birth. All in all I felt that your content was relevant
   Argument: I found that your claims and counter claims were relevant, however the structure of the piece can be improved by only speaking about a particular topic in a specific paragraph. You can then follow it up with the counter argument in the next. I like how you spoke about the Netherlands and then compared it to South-Africa, however I feel that one has to consider the different dynamics of South African society, such as poverty and substance abuse.
   References : You have used good references, such as journal articles. Therefore your argument is strengthened. There are a few references that need to be tweaked. Such as the O’reagen in text reference. Your bibliography references are correct however.
   Grammatical errors: refer to Jemma’s comment above, I feel that she has given you sufficient feedback with regards to this topic.
   Well done!

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4. Hi Jana, I really like that you chose such an important topic to write about, I will follow the rubric that we were given in order to provide you with feedback. I think that this will make my feedback more relevant.
   Content: I like that the content of your piece is relevant to what we have discussed in class, as well as to clinical practice. Have you thought about perhaps adding a picture or videos to the piece, I think that this might help to draw your readers attention from the beginning. In addition to this, I think that if you were to add some literature, with regards to the reasons behind Euthenasia, such as shame. You could also consider speaking about success rates of diagnosing children with a specific condition prior to birth. All in all I felt that your content was relevant
   Argument: I found that your claims and counter claims were relevant, however the structure of the piece can be improved by only speaking about a particular topic in a specific paragraph. You can then follow it up with the counter argument in the next. I like how you spoke about the Netherlands and then compared it to South-Africa, however I feel that one has to consider the different dynamics of South African society, such as poverty and substance abuse.
   References : You have used good references, such as journal articles. Therefore your argument is strengthened. There are a few references that need to be tweaked. Such as the O’reagen in text reference. Your bibliography references are correct however.
   Grammatical errors: Euthanasia can be defined as the ending of the life of a terminally ill and suffering person in a painless, rapid and intentional manner for reasons of compassion and mercy (Vizcarrondo, 2014). In other words, one can argue that the term means “good death” and that the thought behind the process is to allow the patient to die peacefully with dignity. Furthermore, it allows the physician to care for the patient by alleviating pain and suffering. Generally, euthanasia for newborn babies/neonatals with terminal illnesses and disabilities are not typically discussed. However, in reality its acceptance and practice vary between different countries. (Well done on this paragraph!) Perhaps add your picture or video prior to this.

   The topic of neonatal euthanasia crossed my mind while I was working in Tygerberg hospital’s ICU and had to see a patient who underwent an emergency C-Section due to Pre-eclampsia and fetal distress. I immediately wondered what had happened to her baby as she was still in the second trimester. I started researching this topic and found it hard to completely justify the morals and ethical principles surrounding the topic. (I can only imagine!)

   Since 2002, neonatal euthanasia has been legal in the Netherlands. This was due to the courts failing to exercise judgement on euthanasia since 1984. For this reason, it lead to the widespread use of uethenasia? by the medical community which later on became accepted by the public (Vizcarrondo, 2014). Nevertheless, in 2002 the Groningen Protocol (GP) for neonatal euthanasia was created with the intent to regulate the implementation of actively ending the life of neonates. Therefore, ensuring that neonatal euthanasia would be controlled and justified. The GP for neonatal euthanasia consists of five criteria, namely:

   Diagnosis and prognosis need to be certain (no quality in life)
   The suffering is unbearable
   The doctor consulted with at least one other independent doctor or the treatment team
   Both parents must give informed consent, in other words the doctor informed the parents of the diagnosis and prognosis, and together they agreed that there was no other alternative
   the procedure must be performed in accordance with the accepted medical standard

   On the other hand, the GP has received severe criticism. One author explains that the protocol lacks clinical and ethical accuracy such as that the protocol does not specify the definitions of the following phrases: “quality of life” or “unbearable suffering” (van der Westhuizen, 2017). One may argue that if a neonate suffers unbearably, the burdens of life is larger than the benefits of life, which could be a justification for neonatal euthanasia. Although, the doctor or parents cannot objectively determine if the neonate is suffering or in severe pain. (The last sentence is extremely powerful!)

   When analyzing South African law, it is clear that both active euthanasia and physician-assisted suicide is illegal and unlawful. On the other land, passive euthanasia is regarded as lawful. Passive euthanasia refers to when treatment is withheld or withdrawn which would prolong a patient’s life (van der Westhuizen, 2017).

   Section 7 of the National Health Act states that a health care professional may not provide medical treatment before acquiring informed consent of the patient, and in this case as neonates cannot express their thoughts, their parents or guardians can give consent to medical treatment on their behalf. Furthermore, the right to life is guaranteed in the Bill of rights and can be regarded as the most fundamental right (Van Aswegen & Nienaber, n.d.). According to Justice O’Regan, a predecessor to the Bill of Rights, acknowledges that a foetus is not recognised as a living person under South African law and, therefore, is not afforded the right to life. Nonetheless, the same cannot be said in the case of a neonate who is born alive. The neonate is entitled to full protection in terms of the Bill of Rights in the Constitution, regardless of the degree of prematurity or impairment it was born with (Van Aswegen & Nienaber, n.d.). Despite that, many may argue that if no further medical interventions or treatments may benefit the neonate’s condition or prolong the suffering, then a dying neonate has the right to die with dignity (citation?)

   It is clear that neonatal euthanasia is controversial. Autonomy, or in other words the right to refuse treatment, is well accepted. If there is decided to withdraw medical treatment and there is consensus, then may be no moral criticism (Clarke & Egan, 2009). Van der Westhuizen acknowledges that the South African Law commission drafted a document regarding euthanasia and the artificial preservation on life. However, the Minister of Health did not give any attention to it and the report was shelved (Do you know why?) In the drafted report, the authors stated that the termination of a patient’s life should be legal under certain and specific circumstances, provided that these conditions are met. In addition, it made special reference that this should also be applicable when babies are born severely ill and disabled, whom through prognosis from more than one medical professional, have no prospect of recovery and will inevitable die due to their conditions. Therefore, there should be no legal or moral obligation to provide treatment for neonates with a hopeless prognosis (van der Westhuizen, 2017). Define a hopeless prognosis? Perhaps that needs to be defined.

   Is there any moral or ethical grounds ever-justifying neonatal euthanasia? Many philosophers fully condemn ant form of euthanasia, based on the sacred value of human life. Also, they argue that even in the case of relieving the hopeless and unbearable suffering of a neonate could be accepted, it can never fully be ensured. (THIS IS TRUE) Therefore, this would suggest that stopping treatment and eventually neonatal euthanasia, is indeed morally unaccepted.

   On the other hand, other authors argued that although neonates are individual human beings, they are not yet persons, referring in the sense of individuals who are able to create their own future. Similarly, neonatal euthanasia could then in this case, not be harmful to them. Therefore, if one takes a closer look at this notion, it is the key to the moral debate as this determines the moral status of the neonates. If we consider that neonates to not yet be persons, then this could equally defend and be morally acceptable neonatal euthanasia (Eijden & Martinovici, 2013).

   Understanding competing moral principles such as autonomy, beneficence, non-maleficene and justice, can aid in a constructive approach and important moral question that the medical professional might face related to neonate euthanasia. Autonomy refers to the individuals right to refuse medical treatment and due to neonates being unable to make decisions for themselves, the term has little moral bearing on the treatment of the neonates. Actions that are beneficent in nature, aim to maximise someone’s best interests. However, one can argue whether the principle of beneficence encourages the prolonging of neonates unbearable and hopeless suffering (Sklansky, 2001).

   In terms of neonatal euthanasia, justice and what is morally acceptable, will dictate that all neonates should be treated equally. This principle ensures the protection of certain rights, even when doing so may conflict with the principle of beneficence. To conclude, neonatal euthanasia will always remain a grey area in South Africa. Finally, the question could be asked whether it is in the best interests of a neonate who is suffering unbearably not to allow him or her to die, thereby ultimately ending their suffering.
   Well done! I really enjoyed this piece, I felt that it was well written, with few grammatical errors, I think that your argument was valid and I enjoyed the fact that you did not try to end with a conclusion in which there is a clear solution, as the problem is bigger than that. If you require any further assistance, feel free to contact me. I hope that my comments were in no way offensive.
   Well done Jana! Kind regards

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