Neonatal Care: A Case Study

Neonatal care has greatly improved in recent years and it has become possible for very low birth weight or asphyxiated newborns to survive. Until a few years ago, many of these babies inevitably died early. Now we can prolong their life, but with handicaps in many cases. A recent debate centred on whether it is ethical to withhold or withdraw therapy, sometimes in an active way, allowing newborns, presumed unable to lead a normal life, to die. 1,2,3,4,5,6

Attitudes on this ethical question in neonatal intensive care units of four Western countries,7 France,8 The Netherlands,9 and other states10 have been published. Guidelines have been proposed for withholding or withdrawing therapy from high-risk newborns,11 actively hastening death,12,13

Once medicine could not avoid the idea of solidarity, which sprang from recognition of physicians’ and patients’ limits. There has been a shift from the ethics of solidarity in facing troubles to an ethic of escape and fear, escape from relationship and fear of losing the mask that everybody creates when faces someone’s pain, withholding therapy in a sick baby is an easy shortcut: maybe too easy to be effective. The feeling of anguish experienced by doctors withholding life support ("Anguish invades us and leaves its mark. We baptise him and then we kill him"; "On days of withholding care I don’t feel good: they are heavy, they are not like other days"8) arises from this point. But one cannot always escape from the unknown, i.e., what he cannot manage: "Modern western medicine is ‘scientific’, in the sense that it presumes to control and dominate things. But death is unavoidable."27 Thus withholding or withdrawing life supportive care on the basis of fear of a future handicap is also ominous for caregivers. It is a negation of the desire and wonder of existence, however imperfect; it means negation of the wonder and desire of our own existence, however flawed: "The caregiver’s dialectic is identical to the patient’s dialectic. To what extent is the caregiver able to accept a person who is suffering, especially where he is suffering?"28 The caregiver here falls prey to sentimentalism: "He who participates in another’s pain so deeply as to be crushed by it is capable of compassion but lacks force. He cannot care for the other, because he cannot give him comfort. . . . This temptation grows in the field of loneliness."29 We cannot forget that eugenic selection is often masked by