Sanctity of Human Life
Sanctity of Human Life
In 1969 I was working as a junior surgeon in Sheffield Children’s Hospital. My consultant was a devout Roman Catholic who operated on all children with spina bifida even if they had extensive paralysis of their legs at birth and other congenital abnormalities. Many underwent several operations before dying at a few months of age, often from post-operative infection. A paediatrician in the same hospital who had no religious convictions believed that not all babies with spina bifida should have this intensive treatment. He recommended that babies with adverse criteria should have appropriate nursing care but no major surgery. I well remember meetings at which the two consultants had heated discussions on the pros and cons of their different opinions. By the early 1970s the policy of selective treatment was accepted in many centres. In Sheffield from 1971 to 1976, with the agreement of their parents 71 babies were given appropriate nursing care but no operations[i]. Of these 71, 49 died within the first month and only two survived beyond the age of one year, the longest survivor dying at the age of three and a half years. One of the children who survived more than a year had operative treatment for increasing pressure on the brain due to a collection of fluid around it.
Eight years after being in Sheffield I moved from paediatric surgery into paediatric emergency care. In 1979 I was appointed as the first consultant in the accident and emergency department of Alder Hey Children’s Hospital in Liverpool. I could no longer just listen in to other consultants discussing the ethical issues of treatment. All 35000 patients attending the department each year were my responsibility, but I was only in the department on average 50 hours each week. I had to agree guidelines with the doctors and nurses who would be treating infants, children and young persons in the 118 hours each week when I was not in the department. Two questions they asked were:
• If a child is brought in with no heart beat or the heart stops beating in the department should we attempt resuscitation?
• If we start giving artificial respiration and massaging the heart and there is no response how long should we go on?
The guidelines we agreed were:
• If the child had not had a heartbeat for five minutes resuscitation should not be attempted because by then the brain would be dead.
• If there was no response within 20 minutes attempts at resuscitation should cease
One day an infant age six months was brought in following a road crash. This baby girl had extensive head injuries but was still breathing. Very soon she stopped breathing. Oxygen was given but her heart stopped beating. Twenty minutes later there was still no heart beat so I advised that we should stop resuscitation. The parents were not present as one had been killed in the crash and the other was seriously injured. Some of the staff would not agree to stop the resuscitation so we continued treating the infant for a further 10 minutes with no effect. The staff then all agreed that the artificial prolongation of life should cease.
What if we had managed to start the heart and the babe had been transferred to the intensive care unit for artificial ventilation but after a week was still not breathing naturally and tests showed that the brain of the babe had apparently died? Should the ventilation be stopped then? Any decision must be the one which is in the best interests of the child.
In the last 50 years there have been unprecedented advances in emergency care, investigative techniques, drug therapy, surgery, anaesthesia and intensive care. These advances have been very significant in increasing the number of years which we who reside in England in the 21st century can expect to live. The difficult moral issue is this. Should those advanced techniques be used in every situation or are there times when evangelical zeal to extend life at all cost is not in the best interest of the patient?
As a Christian I believe that human life is sacred from conception to old age but I also believe that with the privilege of having the vocation of a health care professional comes the responsibility to consider that using advanced techniques to prolong life may not always be appropriate.
Preferably decisions on withholding or withdrawal of intensive treatment should be taken after due consideration. If a child is taken into an emergency department suffering from an illness in which death is imminent or an infant has multiple congenital abnormalities which are not amenable to treatment it is helpful if the case notes contain any decisions which had been made on the appropriate level of treatment to be given in an emergency.
All human life is sacred but life has a natural end. The point may come in the progression of the condition of a patient of any age when death is clearly drawing near. In these circumstances I agree with the General Medical Council guidance (2006)[ii], that doctors should not strive to prolong the dying process. For a child under the age of 16 years the issues must be discussed with those with parental responsibility as well as with the child if he or she is competent.
Speaking of parents brings me to another aspect of the sanctity of human life which I unfortunately dealt with frequently in Alder Hey. Not all parents and carers consider the lives of children to be sacred and many consider that children have no value. This lack of respect can lead to physical, emotional, psychological and physical abuse.
Ethical issues around the sanctity of life are complex. God created human beings in his own image. God is a God of love. As a Christian doctor I pray that I reflect that love in all the care I give to my patients, always respecting the sanctity of life by giving appropriate treatment but not prolonging the process of dying.
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[i] Lorber J, Salfield S A W Results of selective treatment of spina bifida cystica Archives of Disease in Childhood, 1981;56:822-830
[ii]
Joan Robson FRCS FCEM FRCPCH
Consultant in Paediatric Emergency Care
29.05.08
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